Risk factors associated with safety of preschool peanut oral immunotherapy

Duva Karunakaran; Edmond S Chan; Qian Zhang; Jeffrey N Bone; Stuart Carr; Sandeep Kapur; Gregory A Rex; Mary McHenry; Scott B Cameron; Victoria E Cook; Sara Leo; Tiffany Wong; Thomas V Gerstner; Joanne Yeung; Elissa M Abrams; Raymond Mak; Stephanie C Erdle; Lianne Soller

doi:10.1016/j.jacig.2023.100094

Risk factors associated with safety of preschool peanut oral immunotherapy

J Allergy Clin Immunol Glob. 2023 Mar 21;2(2):100094. doi: 10.1016/j.jacig.2023.100094. eCollection 2023 May.

Authors

Duva Karunakaran^{1

2}, Edmond S Chan^{1

3}, Qian Zhang¹, Jeffrey N Bone¹, Stuart Carr⁴, Sandeep Kapur^{5

6}, Gregory A Rex^{5

6}, Mary McHenry^{5

6}, Scott B Cameron^{3

7}, Victoria E Cook^{3

7}, Sara Leo^{3

8}, Tiffany Wong^{1

3}, Thomas V Gerstner^{9

10}, Joanne Yeung^{3

10

11}, Elissa M Abrams^{3

9

10}, Raymond Mak^{1

3}, Stephanie C Erdle^{1

3}, Lianne Soller^{1

3}

Affiliations

¹ British Columbia Children's Hospital, Vancouver, British Columbia.
² Department of Medicine, Queen's University, Kingston, Ontario.
³ Department of Pediatrics, Division of Allergy, University of British Columbia, Vancouver, British Columbia.
⁴ Snö Asthma & Allergy Clinic, Abu Dhabi, United Arab Emirates.
⁵ Department of Pediatrics, Division of Allergy, Dalhousie University/IWK Health Centre, Halifax.
⁶ Halifax Allergy & Asthma Associates, Halifax, Nova Scotia.
⁷ Community Allergy Clinic, Victoria, British Columbia.
⁸ West Coast Allergy and Immunology Clinic, Vancouver, British Columbia.
⁹ Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba.
¹⁰ Meadowood Medical Center, Winnipeg, Manitoba.
¹¹ Vancouver Kids Allergy, Vancouver, British Columbia.

Abstract

Background: An understanding of how patient characteristics such as age, baseline peanut-specific IgE, and atopic comorbidities may influence potential safety outcomes during peanut oral immunotherapy (P-OIT) could aid in shared decision making between clinicians and patient families.

Objective: This study explored the relationship between baseline patient characteristics and reactions during P-OIT using a large sample size to better understand potential risk factors influencing P-OIT safety.

Methods: Data were obtained from the Food Allergy Immunotherapy (FAIT) registry, which collects real-world OIT data from community and academic allergy clinics across Canada. Multivariable logistic regression modeling was performed to examine the relationship between baseline patient characteristics and reactions during P-OIT. Multiple imputation was applied to reduce potential bias caused by missingness and to maximize the use of available information to preserve statistical power.

Results: Between April 2017 and June 2021, a total of 653 eligible patients initiated P-OIT. Multivariable regression analysis showed pre-OIT grade 2+ initial reaction (odds ratio [OR] = 1.33, 95% confidence interval [CI] 1.10, 1.61), allergic rhinitis (OR = 1.60, 95% CI 1.08, 2.38), older age (OR = 1.01, 95% CI 1.00, 1.02), and higher baseline peanut-specific IgE (OR = 1.02, 95% CI 1.02, 1.03) were associated with grade 2+ reaction during P-OIT after adjusting for potential risk factors.

Conclusion: Our study identified several clinically important risk factors for grade 2+ reactions during P-OIT: pre-OIT grade 2+ initial reaction, allergic rhinitis, older age, and higher baseline peanut-specific IgE. These results highlight the need for individualized risk stratification for OIT.

Keywords: Oral immunotherapy; peanut allergy; personalized medicine; shared decision making.