Effect of oral immunotherapy to peanut on food-specific quality of life.

BACKGROUND: Peanut allergy is an increasingly common problem for which the only available treatment is avoidance. Oral immunotherapy has shown promise for increasing tolerance of peanut in allergic children. Food allergy has an effect on the quality of life of children and adolescents. OBJECTIVE: To measure the effect of oral immunotherapy to peanut on food-specific quality of life in children and adolescents. METHODS: One hundred patients (5-18 years of age) were enrolled in an open trial of peanut oral immunotherapy. Parents of children 5 to 12 years old, children 8 to 12 years old, and teenagers completed validated, age-specific, food-related quality-of-life surveys before and after peanut oral immunotherapy. RESULTS: Ninety patients (76 children 5-12 years old and 14 adolescents 13-18 years old) achieved the maintenance daily dose of 450 mg of peanut protein. A significant improvement in quality of life was found in all survey domains (allergen avoidance, dietary restriction, risk of accidental exposure, emotional impact, food-related anxiety, and social and dietary limitations) with the exception of the emotional impact domain on the adolescents' survey. Quality of life significantly improved (P < .02) on all 30 questions when parents assessed their children 5 to 12 years old. When children (8-12 years old) and teens assessed themselves, quality of life improved (P < .05) on 22 of 24 questions and 12 of 18 questions, respectively. CONCLUSION: Peanut oral immunotherapy significantly improves food-specific quality of life.

Oral immunotherapy for peanut allergy: multipractice experience with epinephrine-treated reactions.

BACKGROUND: Peanut allergy creates the risk of life-threatening anaphylaxis that can disrupt psychosocial development and family life. The avoidance management strategy often fails to prevent anaphylaxis and may contribute to social dysfunction. Peanut oral immunotherapy may address these problems, but there are safety concerns regarding implementation in clinical practice. OBJECTIVE: The purpose of this report is to communicate observations about the frequency of epinephrine-treated reactions during peanut oral immunotherapy in 5 different allergy/immunology practices. METHODS: Retrospective chart review of peanut oral immunotherapy performed in 5 clinical allergy practices. RESULTS: A total of 352 treated patients received 240,351 doses of peanut, peanut butter, or peanut flour, and experienced 95 reactions that were treated with epinephrine. Only 3 patients received 2 doses of epinephrine, and no patient required more intensive treatment. A total of 298 patients achieved the target maintenance dose for a success rate of 85%. CONCLUSION: Peanut oral immunotherapy carries a risk of systemic reactions. In the context of oral immunotherapy, those reactions were recognized and treated promptly. Peanut oral immunotherapy may be a suitable therapy for patients managed by qualified allergists/immunologists.