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TOPLINE:

Most participants who received peanut oral immunotherapy (OIT) at 1-3 years of age continued peanut consumption years later and had persistent immune changes, with only some reporting allergic reactions.

METHODOLOGY:

• Researchers followed up 58 participants who had received peanut OIT and 20 who received placebo in a previous trial to assess the long-term outcomes of therapy initiated at 1-3 years of age.
• Participants completed surveys on current peanut intake and allergic reactions. Overall, 58 participants provided blood for peanut- and Ara h 2-specific antibody testing (Ara h 2 is a protein found in peanuts), and 49 underwent skin-prick testing.
• The primary outcome was the consumption of at least 300 mg of peanut protein per serving at follow-up. The main analysis focused on 40 participants who had received peanut OIT only and no other subsequent intervention.
• The median follow-up was 9 years after the original trial.

TAKEAWAY:

• At follow-up, 80% of the participants who had received OIT alone reported eating peanuts, and 94% of those consumed at least 300 mg per serving.
• All participants who had achieved remission at week 160 (n = 14) reported consuming peanuts at follow-up, with some reporting an intake of over 4000 mg per serving.
• Among those who received OIT alone, 35% reported experiencing allergic reactions since trial completion.
• Participants who received OIT alone had lower peanut- and Ara h 2-specific immunoglobulin E (IgE) levels (P < .001 for both) and higher peanut- and Ara h 2-specific IgG4 levels (P < .05 for both) than those who received placebo. 

IN PRACTICE:

“While we recognize that potential risk may never disappear, our findings highlight the relative safety of ongoing peanut consumption after early-life pnOIT [peanut OIT], as well as reassuring data regarding discontinuation due to dosing fatigue or aversion. The presumed ‘window of opportunity’ for long-standing immunomodulation and beneficial treatment outcomes among young peanut-allergic children outlined in the IMPACT [original] trial is further supported by findings almost a decade later,” the authors of the study wrote. 

SOURCE:

Jennifer A. Dantzer, MD, MHS, with the Johns Hopkins University School of Medicine, Baltimore, was the corresponding author of the study, which was published online on May 20 in the Journal of Allergy and Clinical Immunology.

LIMITATIONS:

Only half of the original participants took part in follow‑up, which may have biased the results. Researchers did not perform oral food challenges. Many participants used other treatments for food allergy, which may have affected the outcomes.

DISCLOSURES:

The study received funding from multiple institutional and philanthropic sources, including the National Institutes of Health/National Institute of Allergy and Infectious Diseases, Claudia and Steve Strange Family Fund, and Dorothy and Frank Robins Family. Several authors reported receiving consulting fees, honoraria, research funding, advisory board compensation, patent royalties, equity or stock options, travel support, and other income streams from various commercial entities, academic institutions, and nonprofit organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.