Peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patients
Background: Peanut oral immunotherapy (pOIT) protocols typically remain below the threshold for reaction during the initial dose escalation (IDE) day. However, some patients may have higher thresholds for reaction or may not have an ongoing peanut allergy. Objective: We sought to characterize the re...
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Elsevier
2025-05-01
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| Series: | Journal of Allergy and Clinical Immunology: Global |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772829325000438 |
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| author | Candice N. Gard, MD Georgiana M. Sanders, MD, MS Ian F. Slack, MD Charles F. Schuler, IV, MD George E. Freigeh, MD, MA Kelly M. O’Shea, MD |
| author_facet | Candice N. Gard, MD Georgiana M. Sanders, MD, MS Ian F. Slack, MD Charles F. Schuler, IV, MD George E. Freigeh, MD, MA Kelly M. O’Shea, MD |
| author_sort | Candice N. Gard, MD |
| collection | DOAJ |
| description | Background: Peanut oral immunotherapy (pOIT) protocols typically remain below the threshold for reaction during the initial dose escalation (IDE) day. However, some patients may have higher thresholds for reaction or may not have an ongoing peanut allergy. Objective: We sought to characterize the response to an accelerated initial dose escalation (A-IDE) for qualifying low-risk peanut-allergic patients younger than 4 years in which IDE progressed to a full peanut oral food challenge as tolerated. Methods: Records of 76 pOIT patients younger than 4 years were reviewed. Those with history of peanut reaction with peanut allergy testing of less than 95% positive predictive value for failed oral food challenge were offered an A-IDE. A-IDE proceeded stepwise until patients refused dosing, any reaction occurred, or they tolerated the challenge (cumulative dose: 4000 mg peanut protein). If the A-IDE was not tolerated, patients completed pOIT. Results: From April 2022 to February 2024, 16 patients participated in an A-IDE. Eleven (68.8%) tolerated the 4000 mg cumulative dose, demonstrating resolution of their peanut allergy. The remaining had mild symptoms not requiring epinephrine. Mean pOIT starting dose following A-IDE was 450 mg (vs 25 mg in standard pOIT). Maintenance dosing was reached with a mean of 5.2 visits (vs 9.7 in standard pOIT). Conclusions: Nearly 70% of low-risk patients younger than 4 years with previous diagnosis of peanut allergy tolerated a full peanut serving when initiating pOIT. This indicates the importance of diagnostic peanut challenge to selected patients before initiating OIT. |
| format | Article |
| id | doaj-art-1781e94609c1444ebb308b1566489ad2 |
| institution | OA Journals |
| issn | 2772-8293 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Allergy and Clinical Immunology: Global |
| spelling | doaj-art-1781e94609c1444ebb308b1566489ad22025-08-20T01:49:05ZengElsevierJournal of Allergy and Clinical Immunology: Global2772-82932025-05-014210044210.1016/j.jacig.2025.100442Peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patientsCandice N. Gard, MD0Georgiana M. Sanders, MD, MS1Ian F. Slack, MD2Charles F. Schuler, IV, MD3George E. Freigeh, MD, MA4Kelly M. O’Shea, MD5Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, MichDivision of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Research Center, University of Michigan, Ann Arbor, MichDivision of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Research Center, University of Michigan, Ann Arbor, MichDivision of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Research Center, University of Michigan, Ann Arbor, MichDivision of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Research Center, University of Michigan, Ann Arbor, MichDivision of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Mary H. Weiser Food Allergy Research Center, University of Michigan, Ann Arbor, Mich; Corresponding author: Kelly M. O’Shea, MD, Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Lobby H, Ste H2100, Ann Arbor, MI 48106.Background: Peanut oral immunotherapy (pOIT) protocols typically remain below the threshold for reaction during the initial dose escalation (IDE) day. However, some patients may have higher thresholds for reaction or may not have an ongoing peanut allergy. Objective: We sought to characterize the response to an accelerated initial dose escalation (A-IDE) for qualifying low-risk peanut-allergic patients younger than 4 years in which IDE progressed to a full peanut oral food challenge as tolerated. Methods: Records of 76 pOIT patients younger than 4 years were reviewed. Those with history of peanut reaction with peanut allergy testing of less than 95% positive predictive value for failed oral food challenge were offered an A-IDE. A-IDE proceeded stepwise until patients refused dosing, any reaction occurred, or they tolerated the challenge (cumulative dose: 4000 mg peanut protein). If the A-IDE was not tolerated, patients completed pOIT. Results: From April 2022 to February 2024, 16 patients participated in an A-IDE. Eleven (68.8%) tolerated the 4000 mg cumulative dose, demonstrating resolution of their peanut allergy. The remaining had mild symptoms not requiring epinephrine. Mean pOIT starting dose following A-IDE was 450 mg (vs 25 mg in standard pOIT). Maintenance dosing was reached with a mean of 5.2 visits (vs 9.7 in standard pOIT). Conclusions: Nearly 70% of low-risk patients younger than 4 years with previous diagnosis of peanut allergy tolerated a full peanut serving when initiating pOIT. This indicates the importance of diagnostic peanut challenge to selected patients before initiating OIT.http://www.sciencedirect.com/science/article/pii/S2772829325000438Food allergyoral immunotherapypeanutoral food challenge |
| spellingShingle | Candice N. Gard, MD Georgiana M. Sanders, MD, MS Ian F. Slack, MD Charles F. Schuler, IV, MD George E. Freigeh, MD, MA Kelly M. O’Shea, MD Peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patients Journal of Allergy and Clinical Immunology: Global Food allergy oral immunotherapy peanut oral food challenge |
| title | Peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patients |
| title_full | Peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patients |
| title_fullStr | Peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patients |
| title_full_unstemmed | Peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patients |
| title_short | Peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patients |
| title_sort | peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patients |
| topic | Food allergy oral immunotherapy peanut oral food challenge |
| url | http://www.sciencedirect.com/science/article/pii/S2772829325000438 |
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