Food allergen oral immunotherapy (OIT) showed a positive effect on health-related quality of life (HRQL) approximately 1 year after the treatment was completed, based on data from a systematic review of 10 studies including more than 1000 individuals.

Food allergy management based mainly on allergy avoidance contributes to poor HRQL, and patients have professed improved HRQL as their preferred outcome from OIT, Sophie A. Rosser, a PhD student at Murdoch Children’s Research Institute, Parkville, Australia, and colleagues wrote.

However, long-term data on HRQL for individuals who undergo OIT are limited and conflicting, the researchers noted.

In the review, published in Allergy, the researchers identified 10 clinical trials of food allergy OIT, nine involved peanut and one involved baked milk. The study population included 1330 individuals ranging in age from 1 to 18 years.

The primary outcome was whether OIT improved HRQL during or after treatment for individuals with immunoglobulin E-mediated food allergies compared with control individuals with food allergies who did not receive OIT. All the included studies measured HRQL at the beginning and end of treatment, and most HRQL measurements were conducted at the time of allergic status assessment via oral food challenge.

At 12 months post-treatment, the meta-analysis showed a moderately strong benefit in patients who underwent OIT compared with control individuals, with a between-group differences g value of -0.51.

By contrast, patient and parent reports showed no significant change in HRQL during the periods of active OIT treatment, with between-group differences for parent-reported child HRQL, self-reported child HRQL, and self-reported teenager HRQL g values of -0.07, -0.23, and -0.00, respectively.

The study findings were limited by several factors including that the selection of studies mainly related to children and teenagers with peanut allergy, which may not generalize to adults, by the differences in patient-reported outcome measures across studies, and a lack of long-term outcome data beyond 1 year, the researchers noted. However, the results suggest that much of the positive impact of OIT on HRQL happens after treatment, they concluded.

Remission Plays Key Role in HRQL Success

The inconsistency seen in previous studies of HRQL after OIT stems in part from tests of different OIT treatment regimens with different outcomes, desensitization, which is temporary and requires continuing therapy, vs remission, which provides lasting protection with no treatment, said corresponding author Mimi L. K. Tang, PhD, in an interview.

Although OIT didn’t provide more well-being benefits than control/placebo during the time patients were taking daily therapy, it led to substantial quality of life benefits in the longer term after patients were able to stop treatment, said Tang, director of the Allergy Translation Centre and head of allergy immunology at Murdoch Children’s Research Institute.

In the included studies of children and teens, “we identified achievement of remission as a likely key driver of this longer-term benefit; there is an important relationship between the clinical outcome a patient achieves from OIT and their quality of life,” Tang said.

Sustained Safety for Patients

The message to clinicians is that durable, high-level protection for patients with food allergies is possible, and it continues after treatment stops, Tang told Medscape Medical News. “This information should be communicated to patients when discussing OIT in clinical practice to assist clinicians and families in their decision-making about whether to start OIT,” she said.

The lack of difference in HRQL benefits during the treatment time between OIT and placebo patients was somewhat surprising, said Tang. However, this finding emphasizes the importance of comparison with a control or placebo group when evaluating effects on quality of life, she said. In the current review, for example, “attentive clinical care can be beneficial to patients and families in the absence of treatment,” she noted.

Encourage Patients to Stay the Course

OIT has been available for a while, and many people have either gone through it or are considering it for treatment for their food allergies, said Ruchi S. Gupta, MD, who was not involved in the study. “Earlier reviews of OIT effects were limited and sometimes conflicting, but new randomized trials allow for a more definitive analysis of how OIT affects quality of life during and after treatment,” said Gupta, professor of pediatrics and medicine at Northwestern University, Chicago, and director of the Center for Food Allergy and Asthma Research.

“OIT can be challenging as patients need to regularly eat food that they have explicitly avoided, and reactions do happen along the way; therefore, the lack of improvement in HRQL during treatment was understandable,” she said.

Overall, the current study findingssupport counseling families that OIT’s quality of life benefits are delayed, Gupta told Medscape Medical News. The results give patients a realistic view of what to expect with OIT and demonstrate that most will see positive improvement if they stick with the therapy, she added. This approach allows more room for individual analysis given the multiple treatments for food allergy, she said.

Looking ahead, studies with longer follow-up across diverse foods, adult populations, and improved HRQL measurement tools are important to better counsel patients and to plan treatment based on patient-centered conversations, Gupta noted.

This study was supported in part by the National Allergy Centre of Excellence (Australia). Tang reported being the scientific founder of Prota Therapeutics, an Australian clinical stage biotech company that is commercializing the high-dose peanut OIT tested in the studies. Tang also disclosed receiving consultant fees from Pfizer and CSL Seqirus, as well as shares/options in Prota Therapeutics, and serving on the board of directors for AllergyPal and Prota Therapeutics. Gupta disclosed ownership, investment interest in, or serving on the board of directors for Yobee Care, Inc. She also disclosed consulting relationships with many pharmaceutical companies and organizations.