Journal of Allergy and Clinical Immunology: Global (May 2023)

Risk factors associated with safety of preschool peanut oral immunotherapy

  • Duva Karunakaran, BSc,
  • Edmond S. Chan, MD,
  • Qian Zhang,
  • Jeffrey N. Bone,
  • Stuart Carr, MD,
  • Sandeep Kapur, MD,
  • Gregory A. Rex, MD,
  • Mary McHenry, MD,
  • Scott B. Cameron, MD, PhD,
  • Victoria E. Cook, MD,
  • Sara Leo, MD,
  • Tiffany Wong, MD,
  • Thomas V. Gerstner, MD,
  • Joanne Yeung, MD,
  • Elissa M. Abrams, MD,
  • Raymond Mak, MD,
  • Stephanie C. Erdle, MD,
  • Lianne Soller, PhD

Journal volume & issue
Vol. 2, no. 2
p. 100094

Abstract

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Background: An understanding of how patient characteristics such as age, baseline peanut-specific IgE, and atopic comorbidities may influence potential safety outcomes during peanut oral immunotherapy (P-OIT) could aid in shared decision making between clinicians and patient families. Objective: This study explored the relationship between baseline patient characteristics and reactions during P-OIT using a large sample size to better understand potential risk factors influencing P-OIT safety. Methods: Data were obtained from the Food Allergy Immunotherapy (FAIT) registry, which collects real-world OIT data from community and academic allergy clinics across Canada. Multivariable logistic regression modeling was performed to examine the relationship between baseline patient characteristics and reactions during P-OIT. Multiple imputation was applied to reduce potential bias caused by missingness and to maximize the use of available information to preserve statistical power. Results: Between April 2017 and June 2021, a total of 653 eligible patients initiated P-OIT. Multivariable regression analysis showed pre-OIT grade 2+ initial reaction (odds ratio [OR] = 1.33, 95% confidence interval [CI] 1.10, 1.61), allergic rhinitis (OR = 1.60, 95% CI 1.08, 2.38), older age (OR = 1.01, 95% CI 1.00, 1.02), and higher baseline peanut-specific IgE (OR = 1.02, 95% CI 1.02, 1.03) were associated with grade 2+ reaction during P-OIT after adjusting for potential risk factors. Conclusion: Our study identified several clinically important risk factors for grade 2+ reactions during P-OIT: pre-OIT grade 2+ initial reaction, allergic rhinitis, older age, and higher baseline peanut-specific IgE. These results highlight the need for individualized risk stratification for OIT.

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