A Practical, Stepwise Approach to Peanut Oral Immunotherapy in Clinical Practice: Benefits and Risks

Abstract

Food allergies are common, affecting 6–8% of the children in the United States. There is a significant burden on the quality of life of allergic children and their caregivers, due to multiple dietary, social and psychological restrictions. Peanut allergy affects approximately 2–5% of the school-age children. Despite the recommended dietary avoidance, reactions tend to occur due to unintentional exposures and the fear of accidental ingestions potentially resulting in anaphylaxis and death, which creates a lot of anxiety in peanut-allergic individuals. Peanut oral immunotherapy (POIT) has emerged as a form of active treatment and has shown high efficacy in research trials with the majority of participants achieving desensitization and protection from trace exposures. An improved quality of life has also been noted following successful POIT. The risks of POIT should be balanced against the benefits resulting from successful treatment for each individual. Rates of allergic reactions and anaphylaxis are reported to be higher in individuals pursuing therapy, but most subjects will experience mild or moderate reactions during treatment. The landscape of peanut allergy management is changing and the future offers more options for patients than were previously available. Shared decision-making, which is the process of how to choose between different available options, becomes an ongoing discussion between the clinician and the patient, which will ensure achievement of the best possible outcome for the peanut-allergic child. This is a multistep process that evaluates the benefits and risks of therapy or no therapy, as well as patient and family preferences and we review it in detail in this manuscript with the aim to provide clinicians with a practical approach.

Multifaceted role of the registered nurse on an oral immunotherapy clinical team

“…Oral immunotherapy (OIT) is an elective noncurative therapy aimed at mitigating allergic reaction risk from trace exposures in patients with persistent diagnosed immunoglobulin E (IgE) mediated food allergy (FA) by increasing clinical tolerance through desensitization to the allergen dose threshold. 1 – 4 The standard treatment for immunoglobulin E–mediated FA is strict allergen avoidance and epinephrine administration to treat anaphylaxis. 5 However, the diagnosis is associated with lower quality of life (QoL) because hypervigilance to avoid ubiquitous food allergens and the threat of anaphylaxis negatively impacts patients and families socially, financially, emotionally, and physically.…”

“… 6 , 7 OIT is an option for those patients selecting it after medical evaluation, OIT protocol education, therapy goal clarification, risk/benefit discussion, cost explanations, and other shared decision-making topics in consultation with allergists and allergy/immunology (A/I) team members to determine candidate suitability. 1 , 8 …”