Oral immunotherapy in peanut allergy linked to anaphylaxis: Lancet

The researchers examined 12 trials in which over 1000 patients with peanut allergy were randomized to receive either oral immunotherapy or no oral immunotherapy (e.g., peanut avoidance, placebo).

It was found that during a median follow-up of 1 year, patients on oral immunotherapy were at higher risk for peanut-induced anaphylaxis compared to controls (relative risk, 3.1). The authors estimate that 151 more episodes of anaphylaxis per 1000 patients occurred because of oral immunotherapy. Other serious adverse events and epinephrine use were also more common in the treatment group. Oral immunotherapy was not associated with significantly better quality of life.

The authors concluded that in patients with peanut allergy, high-certainty evidence shows that available peanut oral immunotherapy regimens considerably increase allergic and anaphylactic reactions over avoidance or placebo, despite effectively inducing desensitisation. Safer peanut allergy treatment approaches and rigorous randomised controlled trials that evaluate patient-important outcomes are needed.

It was found that immunotherapy-related side-effects at home for allergic reactions to accidental exposures may decrease in some patients when they are out of the house namely in social situations. But it is not clear that which patients would benefit most and what the relative balance of reactions in and out of patients' homes would be.

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Lancet article