Primary outcome - 67% of participants could tolerate a single dose of 600 mg (total 1043 mg) peanut vs 4% in placebo after ~12 months of peanut oral immunotherapy (300 mg daily maintenance)
AR101 peanut immunotherapy has a goal daily dose of 300 mg.
There is a gradual build up starting with very small doses and then the maintenance dose must be taken daily. nejm.org/doi/suppl/10.1…
Main difference: AR101, now known as Palforzia, comes in a capsule and is manufactured in a dedicated facility.
1. It is not a cure
2. It is a desensitization readysetfood.com/blogs/communit…
3. It requires daily dosing for years
4. Allergic reactions can occur
-Can achieve a level of increased tolerance
-Have less severe reactions with accidental ingestion of small amounts
-Cannot eat that food ad lib
EVERYONE must continue to have epinephrine available at all times, even on daily dosing.
Shared decision making is essential.
Some families love it & changes their lives.
Some prefer ongoing avoidance.
NOT one size fits all.
We still don't fully understand optimal dosing, duration, frequency - this will likely vary by patient but we currently don't know how to adjust accordingly.
1. Improved quality of life (anxiety is a MAJOR part of living with peanut allergy)
2. Decreased risk for severe life-threatening reaction from accidental exposure
3. Liberalization of diet - likely cannot eat ad lib, but could include new foods
1. Anaphylaxis more likely compared with avoidance thelancet.com/journals/lance…
2. Chronic symptoms: abdominal pain, mild reactions
3. Nonadherence to the schedule (child/teen buy in for years is a major challenge)
- Asthma MUST be under good control
- History of severe life-threatening reaction may increase risk for reactions during treatment
- Anyone who was diagnosed by testing alone should have oral challenge to confirm allergy
Try to learn from those who love it, those who stopped due to problems, & those who decided not to pursue.
This is an individualized decision - no right or wrong