TOPLINE

In a real-world cohort of children undergoing oral immunotherapy (OIT) for food allergies, 15% of treatment courses were discontinued, with rates varying across allergens. Taste aversion and adverse events contributed almost equally to discontinuation, each accounting for approximately 40% of discontinued treatment courses.

METHODOLOGY

• Researchers conducted a prospective cohort study in Switzerland between July 2022 and March 2026 to examine the reasons why children discontinue OIT across a range of food allergens.
• They included 307 children who initiated 406 OIT courses for an immunoglobulin (Ig)E-mediated food allergy spanning 14 separate food allergens such as peanuts, tree nuts, and milk.
• Treatment was counted as discontinued only when a child stopped taking it permanently, whether for medical or personal reasons; brief pauses shorter than 3 months were not considered as discontinuations.
• The reason for discontinuation was classified as either an adverse event (categorized as an immediate reaction or a delayed reaction) or a nonadverse event (encompassing taste aversion, logistic obstacles, and anxiety or distress).

TAKEAWAY

• Overall, 58 children discontinued OIT across 61 treatment courses. Discontinuation rates differed across allergens, with milk having the highest rate (25%) and cashew and sesame having the lowest rates (9% and 7%, respectively).
• Among discontinued treatment courses, adverse events (41%; n = 25) and taste aversion (39%; n = 24) emerged as the leading causes, followed by logistic obstacles (11%; n = 7) and anxiety or distress (8%; n = 5).
• Discontinuation occurred sooner for adverse events (median, 2.1 months) than for taste aversion (median, 5 months), which was more common after patients reached the maintenance phase.
• Specific IgE levels at baseline were significantly higher among children who discontinued due to adverse events than among those who cited logistic obstacles, taste aversion, or anxiety (P = .02).

IN PRACTICE

"Improving real-world OIT outcomes will require patient-centered protocols that systematically address sensory, psychological, and logistical barriers alongside immunological risk from treatment initiation through the maintenance phase and beyond," the authors wrote.

SOURCE

Maria Breiding with the University of Zurich, Zurich, Switzerland, was the corresponding author of the study, which was published online on September 16 in Pediatric Allergy and Immunology.

LIMITATIONS

The study was conducted at a single center, possibly limiting the applicability of the findings to other settings. Groups for less common allergens were small. Each patient's reason for stopping treatment was classified under a single primary category even though the decision to discontinue often involves more than one factor.

DISCLOSURES

The study received no specific funding, and the authors reported having no conflicts of interest.

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