Wesley Burks, MD, CEO of UNC Health and dean of the UNC School of Medicine, professor of pediatrics, Division of Pediatric Allergy/Immunology, Department of Pediatrics and Corinne A. Keet, MD, PhD, professor of pediatrics, Division of Pediatric Allergy/Immunology, Department of Pediatrics, write editorial in New England Journal of Medicine Evidence titled, “To Eat or Not to Eat: Oral Immunotherapy for High Threshold Peanut Allergy.”
Managing peanut allergy with oral immunotherapy can improve quality of life. However, existing research on OIT and other treatments for food allergy are largely limited to children who are very sensitive to peanut protein, i.e., they have a low threshold for reaction. To explain more about the benefits and risks of OIT among children with high-threshold peanut allergy, Wesley Burks, MD, CEO of UNC Health and dean of the UNC School of Medicine, professor of pediatrics, Division of Pediatric Allergy/Immunology, Department of Pediatrics, and Corinne A. Keet, MD, PhD, professor of pediatrics, Division of Pediatric Allergy/Immunology, Department of Pediatrics, wrote an editorial in New England Journal of Medicine Evidence titled, “To Eat or Not to Eat: Oral Immunotherapy for High Threshold Peanut Allergy.”
Here’s an excerpt:
Recently, treatment options for food allergy have rapidly expanded, with two products approved by the FDA: Palforzia, oral immunotherapy (OIT) for peanut allergy, and omalizumab, an IgE blocker. Clinical trials of OIT show high rates of success at increasing threshold for reaction to allergen exposure. However, the risk of allergic reactions, including systemic reactions and eosinophilic esophagitis is significant and most who are treated regain sensitivity if their treatment is stopped or paused. Summarizing the evidence, the Institute for Clinical and Economic Review concluded that the totality of the evidence did not conclusively show that OIT for peanut allergy was superior to avoidance. However, existing research on OIT and other treatments for food allergy are largely limited to children who are very sensitive to peanut protein, i.e., they have a low threshold for reaction. How to treat the 20 to 30% of children with peanut allergy who have too high of a threshold to meet entry criteria for clinical trials but nonetheless retain peanut allergy is not known.
The full editorial available here.