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Management of Anaphylaxis During Peanut Oral Immunotherapy

  • Anaphylaxis and Drug Allergy (M Castells, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Background

Peanut oral immunotherapy (POIT) has emerged as an active management option for peanut allergy, with an FDA-approved product now available for therapy. Allergic reactions, including anaphylaxis, can occur during therapy and their management is key in optimizing this treatment and patient outcomes.

Purpose of Review

In this manuscript, we will review the rates of allergic reactions and anaphylaxis in seminal peanut oral immunotherapy research studies. We will examine factors that can alter the risk of anaphylaxis and describe various strategies, including adjunct therapies, that have the potential to mitigate anaphylaxis risk based on published evidence.

Recent Findings

Rates of anaphylaxis and epinephrine administration vary in different research studies, but there is consensus that most POIT-related allergic reactions are mild or moderate and not severe. Certain external factors (for example, tiredness, exercise, viral illness) as well as uncontrolled allergic co-morbidities (asthma, allergic rhinitis) have been shown to increase the risk of anaphylaxis during OIT. The search of biomarkers who may predict who is at risk for severe allergic reactions is ongoing. Adjunct therapies have shown promise, but further studies are required to optimize their use alongside POIT.

Summary

Our understanding of anaphylaxis during POIT has increased in recent years, resulting in better management strategies. However, future plans will need to involve all stakeholders, including physicians, patients and families, researchers, public health authorities, and the food, hospitality, and catering industries.

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Authors and Affiliations

  1. Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children’s Hospital, Houston, TX, USA

    Vibha Szafron & Aikaterini Anagnostou

  2. Section of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, TX, USA

    Vibha Szafron & Aikaterini Anagnostou

  3. Feigin Center, 1102 Bates Avenue Suite 330, MS: BCM320, Houston, TX, 77030, USA

    Aikaterini Anagnostou

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  1. Vibha Szafron
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Correspondence to Aikaterini Anagnostou.

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Aikaterini Anagnostou declares PI for Aimmune Therapeutics peanut oral immunotherapy trials and receives Institutional funding, has served as Advisory Board member for DBV Technologies, all outside of the submitted work. Vibha Szafron declares no conflict of interest.

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Szafron, V., Anagnostou, A. Management of Anaphylaxis During Peanut Oral Immunotherapy. Curr Allergy Asthma Rep 23, 21–27 (2023). https://doi.org/10.1007/s11882-022-01054-x

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