While peanut oral immunotherapy (POIT) represents a promising treatment for peanut allergies in children, safety concerns remain a common barrier to widespread adoption.
Researchers from the University of Adelaide's Robinson Research Institute in Australia aimed to systematically assess available evidence to determine the risk and frequency of adverse events occurring during POIT by examining 27 previous studies of oral immunotherapy involving 1500 children.
Lead researcher Dr. Luke Grzeskowiak said the study, which was published in the journal Scientific Reports, identified three key factors that could reduce the risk of an adverse reaction when being treated for peanut allergy.
Dr. Grzeskowiak said the study found a 10 percent increase in the number of children who could tolerate the oral immunotherapy when given antihistamines and probiotics (co-treatment).
A systematic search of MEDLINE, EMBASE, and Web of Science was conducted through April 2019. Controlled and non-controlled studies evaluating POIT were eligible. Twenty-seven studies, involving 1488 subjects, were included.
The researchers found that the overall risk of an adverse event requiring treatment was 38.3% and risk of treatment discontinuation due to adverse events was 6.6%.
Frequency of adverse events requiring treatment was lower among studies which included antihistamines and probiotics (9.2 per 10,000 doses) compared with studies which used POIT alone (19.4 per 10,000).
70% of children children who started a treatment that did not use a co-treatment were classified desensitized. This increased to 80% in studies using co-treatments such as probiotics or antihistamines.
The proportion reaching target maintenance dose was higher among studies which included co-treatment (95.0%) compared with studies without (72.7%).
The researchers also conclude that the higher the dose that is aimed for in the therapy and the faster the dose is given on the first day, the greater the chance of allergic reaction to the treatment.
The researchers conclude: "Given the current evidence that OIT is superior to placebo in achieving the immunological goal of desensitisation, future clinical trials should be focused on improving treatment protocols with the aim of improving safety, while maintaining high levels of efficacy.
"While expense and administration-related challenges associated with the use of omalizumab as a co-treatment may prohibit widespread adoption in clinical practice, we observed evidence that lower cost co-treatments such as use of oral antihistamines or probiotics were also associated with improved treatment-related outcomes."
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Source: Scientific Reports
Grzeskowiak. L. E., et al
"Adverse events associated with peanut oral immunotherapy in children – a systematic review and meta-analysis"