Peanut allergy: risk factors, immune mechanisms, and best practices for oral immunotherapy success

• Published in: Expert review of clinical immunology Vol. 19; no. 7; pp. 785 - 795
• Main Authors: Tirumalasetty, Jyothi, Barshow, Suzanne, Kost, Laurie, Morales, Lu, Sharma, Reyna, Lazarte, Carlos, Nadeau, Kari C.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 03.07.2023
• Subjects: Desensitization; food allergy; immune mechanisms; natural history; oral immunotherapy; peanut allergy; remission; sustained unresponsiveness; peanut allergy; Desensitization; immune mechanisms; remission; sustained unresponsiveness; oral immunotherapy; food allergy; natural history
• ISSN: 1744-666X; 1744-8409
• DOI: 10.1080/1744666X.2023.2209318

Peanut oral immunotherapy (pOIT) is the only FDA-approved treatment for food allergy and its adoption amongst allergist immunologists and their patients is growing. pOIT is the subject of numerous clinical trials, however, the focus is often on treatment efficacy, safety, and tolerability, rather than identifying patients most likely to benefit from pOIT. Here, we review existing data on the clinical and immunological outcomes of pOIT that inform best practices for pOIT candidate selection. In this review, we describe the natural history of peanut allergy, summarize immunological and clinical outcomes of pOIT at different ages, discuss the optimization of pOIT in key age groups, and finally suggest an ideal age range at which to initiate pOIT for best outcomes. pOIT is currently underutilized by patients and allergist-immunologists. Developing guidelines for selecting appropriate patients and optimizing treatment may help to increase access to pOIT. Many aspects of pOIT need additional study to further our understanding of the optimal timing to start pOIT, with careful consideration to clinical, immunological, and quality of life outcomes.