Afinogenova Yuliya, Rubin Tamar N, Patel Sagar D, Powell Rachel L, Gilo Janina M, Denno Morgan N, Soffer Gary, Lee Jason O, Mendelson Louis M, Factor Jeffrey M
Yale Medicine: Department of Rheumatology, Allergy and Immunology, New Haven, Conn.
Florida Center for Allergy and Asthma Care, Palm Beach Gardens, Fla.
J Allergy Clin Immunol Pract. 2020 Sep;8(8):2727-2735. doi: 10.1016/j.jaip.2020.03.016. Epub 2020 Apr 2.
Peanut oral immunotherapy is an effective treatment for desensitizing peanut-allergic patients, but the frequency of adverse reactions has limited its widespread use.
To review the frequency of adverse reactions that patients on peanut oral immunotherapy experience during build-up and maintenance phases and explore factors that may contribute to adverse events.
A retrospective chart review of children and adults with peanut allergy undergoing peanut oral immunotherapy at the New England Food Allergy Treatment Center in West Hartford, Conn was performed. Data on patient demographics, allergic profile, peanut allergy testing, and details of reactions in build-up and maintenance phases were collected. A systemic reaction was defined as one of the following: (1) severe reaction involving 1 system, such as generalized hives and/or angioedema; (2) 2 or more of the following symptoms: cutaneous or oral, respiratory, or gastrointestinal symptoms; (3) drop in blood pressure; or (4) need for epinephrine.
Data were available on 783 patients aged 3.5 to 48.3 years. During buildup, 78 patients (10%) experienced at least 1 systemic reaction, 660 (84%) at least 1 gastrointestinal adverse event, 369 (47%) at least 1 cutaneous adverse event, and 157 (20%) at least 1 respiratory adverse event. Thirty-four patients (4%) required epinephrine during buildup. Six hundred ninety-seven patients (89%) completed buildup and progressed to maintenance. During maintenance, 131 patients (19%) experienced at least 1 systemic reaction, 190 (27%) at least 1 gastrointestinal adverse event, 104 (15%) at least 1 cutaneous adverse event, and 50 (7%) at least 1 respiratory adverse event. Seventy-four patients (11%) required epinephrine during maintenance. None of the adverse events required hospitalizations, and there were no mortalities. Nine patients (1%) were diagnosed with eosinophilic esophagitis during buildup or maintenance. Increasing pretreatment peanut specific IgE levels were associated with increased odds of a systemic reaction during buildup. Increasing age, pretreatment peanut specific IgE level, and a systemic reaction in buildup were associated with increased odds of a systemic reaction during maintenance.
Peanut oral immunotherapy may be an effective and safe treatment for carefully selected peanut-allergic patients under the guidance of experienced providers. Specific patient characteristics and immunologic factors may help predict adverse events.
花生口服免疫疗法是使花生过敏患者脱敏的一种有效治疗方法，但不良反应的发生率限制了其广泛应用。
回顾花生口服免疫疗法患者在剂量递增期和维持期出现不良反应的频率，并探讨可能导致不良事件的因素。
对康涅狄格州西哈特福德市新英格兰食物过敏治疗中心接受花生口服免疫疗法的花生过敏儿童和成人进行回顾性病历审查。收集患者人口统计学、过敏特征、花生过敏检测以及剂量递增期和维持期反应细节的数据。全身反应定义为以下情况之一：（1）涉及1个系统的严重反应，如全身性荨麻疹和/或血管性水肿；（2）以下2种或更多症状：皮肤或口腔、呼吸或胃肠道症状；（3）血压下降；或（4）需要使用肾上腺素。
有783名年龄在3.5至48.3岁患者的数据。在剂量递增期，78名患者（10%）经历至少1次全身反应，660名（84%）经历至少1次胃肠道不良事件，369名（47%）经历至少1次皮肤不良事件，157名（20%）经历至少1次呼吸不良事件。34名患者（4%）在剂量递增期需要使用肾上腺素。697名患者（89%）完成剂量递增并进入维持期。在维持期，131名患者（19%）经历至少1次全身反应，190名（27%）经历至少1次胃肠道不良事件，104名（15%）经历至少1次皮肤不良事件，50名（7%）经历至少1次呼吸不良事件。74名患者（11%）在维持期需要使用肾上腺素。所有不良事件均无需住院治疗，也无死亡病例。9名患者（1%）在剂量递增期或维持期被诊断为嗜酸性食管炎。剂量递增期预处理花生特异性IgE水平升高与全身反应几率增加相关。年龄增加、预处理花生特异性IgE水平升高以及剂量递增期出现全身反应与维持期全身反应几率增加相关。
在经验丰富的医疗人员指导下，花生口服免疫疗法对于精心挑选的花生过敏患者可能是一种有效且安全的治疗方法。特定的患者特征和免疫因素可能有助于预测不良事件。
