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KMID : 1143120230130030097
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Asia Pacific Allergy
2023 Volume.13 No. 3 p.97 ~ p.104
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Optimal period for achieving sustained unresponsiveness in peanut oral immunotherapy
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Kosei Yamashita
Toshinori Nakamura
Takanori Imai
Aiko Honda
Yuki Okada
Mayu Maeda
Taro Kamiya
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Abstract
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Background : Oral immunotherapy (OIT) can help children with persistent food allergies achieve sustained unresponsiveness (SU). However, the optimal therapeutic period for obtaining SU remains unclear.
Objective : We aimed to retrospectively investigate the association between the OIT treatment period and achievement of SU.
Methods : We enrolled patients who received OIT for peanut allergy between January 1, 2018 and December 31, 2022. OIT comprised the build-up phase, maintenance phase, complete avoidance, and an oral food challenge (OFC) for confirming SU. The peanut dose in the OFC was gradually increased to 3,000?mg (peanut protein: 795?mg), which was subsequently maintained for ≥5 months. SU was defined as a negative response to 795?mg of peanut protein after ≥2 weeks of complete avoidance. We evaluated the therapeutic OIT period for achieving SU using Kaplan?Meier analysis.
Results : Forty-eight patients underwent peanut OIT. The starting age at OIT initiation was 8 (interquartile range [IQR], 7?10) years. Forty-one (85%) patients had a history of anaphylaxis. The median specific immunoglobulin E concentration to peanut and Ara h 2 at OIT initiation was 85.3 (IQR, 33.7?100) and 57.6 (IQR, 21.9?100) UA/mL, respectively. The median observational period was 2.1 (IQR, 1.6?3.0) person-years (PY). Thirty-four (71%) patients achieved SU, with the rate of SU achievement gradually increasing with the therapeutic period. The median period until SU achievement was 2.1 (95% confidence interval, 1.6?2.5) PY. The rate of SU achievement slowed down after 2.7 PY.
Conclusion : OIT for at least 2.7 PY can increase the rate of SU achievement. The protocol No. 3107.
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KEYWORD
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Food allergy, oral food challenge, oral immunotherapy, peanut, sustained unresponsiveness
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