Peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patients

Peanut challenges prior to oral immunotherapy demonstrate high tolerance rates in selected patients

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Background: Peanut oral immunotherapy (pOIT) protocols typically remain below the threshold for reaction during the initial dose escalation 3 Piece Power Reclining Sectional with Chaise (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 FME/F-Type/N-Type patients before initiating OIT.