Background: In some countries of the world, peanut allergy represents an important source of anaphylactic reactions. Traditionally treated with the avoidance of responsible allergens, this condition can also be targeted by oral peanut immunotherapy.
Methods: In this study, we review the beneficial and side effects of currently available forms of peanut oral immunotherapy (POIT). We report the discussions resulting from the publication of a meta-analysis that brought to light the downsides of oral immunotherapy for peanuts.
Results: In some clinical situations, the risk-benefit ratio can favor peanut oral immunotherapy over avoidance. In many other situations, this is not the case. The decision must be based on the values and preferences of clinicians and patients. Those not ready to accept serious adverse effects from POIT are likely to continue the elimination diet; those motivated to achieving desensitization, and prepared to accept serious adverse effects, may choose to undergo POIT.
Conclusions: Without being prejudiced against peanut oral immunotherapy, we indicate the possible evolution of treatment for this condition is in a rapidly evolving broader scenario. Among the future options, sublingual immunotherapy, parenteral immunotherapy with modified allergens, transcutaneous immunotherapy, and the use of biologics will become important options.
Keywords: EAACI, European academy of allergy asthma and immunology; Efficacy; ICER, Institute for clinical and economic review; OFC, Oral food challenge; OIT, Oral ImmunoTherapy; OUtMATCH, Omalizumab as monotherapy and as adjunct therapy to multi-allergen OIT in Food allergic participants; Oral immunotherapy; PACE, Peanut allergen immunotherapy, clarifying the evidence meta-analysis; POISED, Peanut oral immunotherapy Study:Safety, efficacy and discovery; POIT, Peanut oral ImmunoTherapy; Peanut allergy; QoL, Quality of life; Quality of life; SCIT, Subcutaneous immunotherapy; SLIT, Sublingual immunotherapy; SPT, Skin prick test; Safety.
© 2020 The Authors.