Editor's note: Originally published on January 25, 2019, this article has recently been updated.
We are on the cusp of a revolution in the management of food allergy, with a promising treatment now on the horizon.
The results of an industry-sponsored peanut oral immunotherapy (OIT) trial recently published in the New England Journal of Medicine[1] have generated a lot of excitement. Impressively, it showed that in patients aged 4-17 years, 67.2% treated with the peanut-derived oral immunotherapy drug AR101 could tolerate 600 mg of peanut protein (about two whole peanuts) versus only 4% of controls. Nearly all patients who finished therapy could eat about 1.5 peanuts at the end, as long as they kept taking AR101. Almost 5% withdrew because of gastrointestinal (GI) side effects. Severe reactions occurred in about 5% of treated patients as well.
Comparatively, a recently published study[2]of OIT in the private practice setting using peanut flour and other commercial peanut foods reported a higher rate of patient dropout (about 20%) and frequency of GI symptoms (37%). These authors reported that only 6.5% of patients achieved sustained unresponsiveness (defined as not reacting to peanut even a few months after stopping the study drug). Of patients with peanut-specific IgE levels >100, all were still reactive to peanut challenge.
