Gard Candice N, Sanders Georgiana M, Slack Ian F, Schuler Charles F, Freigeh George E, O'Shea Kelly M
Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich.
Mary H. Weiser Food Allergy Research Center, University of Michigan, Ann Arbor, Mich.
J Allergy Clin Immunol Glob. 2025 Feb 18;4(2):100442. doi: 10.1016/j.jacig.2025.100442. eCollection 2025 May.
Peanut oral immunotherapy (pOIT) protocols typically remain below the threshold for reaction during the initial dose escalation (IDE) day. However, some patients may have higher thresholds for reaction or may not have an ongoing peanut allergy.
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.
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.
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).
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 patients before initiating OIT.
花生口服免疫疗法（pOIT）方案在初始剂量递增（IDE）日期间通常保持在反应阈值以下。然而，一些患者可能对反应有较高阈值，或者可能不存在持续性花生过敏。
我们试图描述4岁以下符合条件的低风险花生过敏患者对加速初始剂量递增（A-IDE）的反应特征，其中IDE根据耐受情况进展为完整的花生口服食物激发试验。
回顾了76例4岁以下pOIT患者的记录。对于那些有花生反应史且花生过敏检测对口服食物激发试验失败的阳性预测值低于95%的患者，提供A-IDE。A-IDE逐步进行，直到患者拒绝给药、发生任何反应或耐受激发试验（累积剂量：4000毫克花生蛋白）。如果A-IDE不耐受，患者完成pOIT。
从2022年4月到2024年2月，16例患者参与了A-IDE。11例（68.8%）耐受了4000毫克的累积剂量，表明其花生过敏得到缓解。其余患者有轻微症状，无需使用肾上腺素。A-IDE后pOIT的平均起始剂量为450毫克（标准pOIT为25毫克）。平均5.2次就诊后达到维持剂量（标准pOIT为9.7次）。
近70%先前诊断为花生过敏的4岁以下低风险患者在开始pOIT时耐受了完整的一份花生。这表明在开始OIT之前对选定患者进行诊断性花生激发试验的重要性。
