Landry Victoria, Lewis Rachel, Lewis William, MacDonald Lyndsey, Carson Beth, Chandra Kavish, Fraser Jacqueline, Flewelling Andrew J, Atkinson Paul, Vaillancourt Chris
Dalhousie University, Halifax, NS, Canada.
, 106 Neil St., Rothesay, NB, E2H 1J6, Canada.
Allergy Asthma Clin Immunol. 2024 Oct 24;20(1):57. doi: 10.1186/s13223-024-00916-5.
Peanut allergy is a common food allergy with potentially life-threatening implications. Early oral immunotherapy for peanut allergy (P-EOIT) has been shown to be effective and safe in research and specialty clinic settings. Provision of P-EOIT in primary care would make it available to more patients. We sought to assess the safety of P-EOIT in a primary care setting by documenting the rates of peanut-related allergic reactions leading to emergency department (ED) visits and use of epinephrine. We also examined adherence by assessing the percentage of patients reaching maintenance phase and continuing ingestion after one year of P-EOIT.
This retrospective study included all patients aged less than 36 months who started P-EOIT at a primary care allergy clinic in New Brunswick, Canada, from 2016 to 2020. The population included patients who (1) had a history of an allergic reaction to peanuts with a positive skin prick test or positive peanut specific IgE level (ps-IgE) or (2) no history of ingestion and a baseline ps-IgE ≥5 kU/L. Patients had biweekly clinic visits with graded increases in peanut protein up to a maintenance dose of 300 mg of peanut protein daily. A blinded retrospective review of paper charts and electronic medical records was conducted along with phone interviews regarding ED visits and epinephrine use.
All 69 consented patients reached maintenance dose over a median of 29 weeks, and 66 patients (95.7%) were still regularly consuming peanut protein after 1 year of maintenance. One patient had a peanut ingestion-related ED visit requiring epinephrine during the escalation phase of peanut protein dosing (1.4%). During the first year of maintenance phase, no patients had peanut ingestion-related ED visits nor required epinephrine.
Early oral immunotherapy for peanut allergy in a primary care setting appears to be safe and our findings suggest that it does not lead to an increased burden of emergency department visits. Our population had high adherence rates, with the majority achieving maintenance dose and staying on this dose for one year.
花生过敏是一种常见的食物过敏，可能会危及生命。在研究和专科诊所环境中，花生过敏的早期口服免疫疗法（P-EOIT）已被证明是有效且安全的。在初级保健中提供P-EOIT将使更多患者能够使用。我们试图通过记录导致急诊就诊和使用肾上腺素的花生相关过敏反应发生率，来评估P-EOIT在初级保健环境中的安全性。我们还通过评估达到维持阶段并在P-EOIT一年后继续摄入的患者百分比来检查依从性。
这项回顾性研究纳入了2016年至2020年在加拿大新不伦瑞克省一家初级保健过敏诊所开始接受P-EOIT的所有年龄小于36个月的患者。该人群包括以下患者：（1）有花生过敏反应史，皮肤点刺试验阳性或花生特异性IgE水平（ps-IgE）阳性；或（2）无摄入史且基线ps-IgE≥5 kU/L。患者每两周就诊一次，花生蛋白剂量逐渐增加，直至达到每日300毫克花生蛋白的维持剂量。对纸质病历和电子病历进行了盲法回顾性审查，并就急诊就诊和肾上腺素使用情况进行了电话访谈。
所有69名同意参与的患者在中位29周内达到了维持剂量，66名患者（95.7%）在维持一年后仍在定期食用花生蛋白。一名患者在花生蛋白剂量递增阶段因摄入花生而急诊就诊并需要使用肾上腺素（1.4%）。在维持阶段的第一年，没有患者因摄入花生而急诊就诊或需要使用肾上腺素。
在初级保健环境中，花生过敏的早期口服免疫疗法似乎是安全的，我们的研究结果表明，它不会导致急诊就诊负担增加。我们的研究人群依从率很高，大多数人达到了维持剂量并维持该剂量一年。
