Long-Term Safety Behaviors and Receipt of Specialized Allergy Care Following Oral or Sublingual Immunotherapy

Abstract

Carolina at Chapel H. RATIONALE: Oral and sublingual immunotherapy (OIT/SLIT) for peanut allergy may reduce severe reactions with accidental exposure. However, it is not known how the degree of desensitization after OIT/SLIT impacts safety behaviors and patterns in clinical care over time. METHODS: A subset of subjects who received peanut OIT/SLIT were followed in a longitudinal observational study for up to eight years. Cumulative tolerated dose (CTD) during the final oral food challenge on immunotherapy was recorded. At the last follow-up visit, subjects completed questionnaires to assess improvement in quality of life (QOL), safety behaviors (routinely carrying Epipens, eating out, and engaging in unsupervised activities), and ongoing care by an allergist. Subjects with missing questionnaire data were excluded (n511). Responses were examined for differences by CTD using a dichotomized variable (5000 mg versus <5000 mg). RESULTS: Data were analyzed for 58 subjects (mean age 9.862.8 years, 43.1% female). 79% (n546) reported definite improvement in QOL. 86.2% (n550) carried an Epipen, 94.8% (n555) reported eating out, and 84.5% (n549) reported engaging in unsupervised activities. Compared to subjects with lower CTD, subjects with higher CTD were less likely to carry an Epipen (80.6% versus 95.5%; Fisher's p50.14) and to see an allergist (33.3% versus 59.1%; Fisher's p50.6). CONCLUSIONS: The majority of subjects undergoing OIT/SLIT reported increased risk taking behaviors relating to accidental allergen exposure. However, CTD appears to modify specific safety behaviors including carrying an epipen as well as receipt of long-term use of specialized allergy care, suggesting ongoing patient education is needed to reinforce safety behaviors regardless of CTD.