The Case for Prompt Salvage Infant Peanut Oral Immunotherapy Following Failed Primary Prevention.

J Allergy Clin Immunol Pract

British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.

Published: October 2022

AI Article Synopsis

  • * Infants with severe eczema, who are at the highest risk for peanut allergies, often do not benefit from this approach due to hesitancy about introducing peanuts and challenges in maintaining regular ingestion.
  • * Peanut oral immunotherapy (OIT) is emerging as a safe and effective treatment for infants who develop peanut allergies, and it is proposed that it should be offered as a proactive solution following failed early introduction.

Article Abstract

Recent guideline recommendations have shifted from recommending prolonged avoidance of allergenic foods in the first 3 years of life to a primary prevention approach involving the deliberate early introduction to infants at risk of developing food allergy. Despite this, some infants, especially those with severe eczema who are at highest risk for developing peanut allergy, fail to receive the preventative benefits of early peanut introduction due to hesitancy and other factors. Difficulty adhering to regular ingestion after introduction further reduces the effectiveness of primary prevention. As emerging real-world evidence has demonstrated that performing peanut oral immunotherapy (OIT) among infants is effective and safe, peanut OIT could be a treatment option for infants with peanut allergy. This review discusses the benefits, risks, and barriers to offering peanut OIT to infants who fail primary prevention strategies. We propose the novel concept that infants with peanut allergy be offered peanut OIT as soon as possible after failed peanut introduction through a shared decision-making process with the family, where there is a preference for active management rather than avoidance.

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Source
http://dx.doi.org/10.1016/j.jaip.2022.05.040DOI Listing

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