Allergy, Asthma, and Clinical Immunology
Objective: This review focuses on the burden and quality of life (QOL) of peanut allergy, and how these factors may impact the decision to pursue peanut oral immunotherapy (OIT). Various cofactors influencing outcomes and success of OIT are also reviewed, as well as goals and barriers associated with peanut OIT, to allow for shared decision-making and potentially improve patient outcomes.
Data Sources: A PubMed literature search was performed using search terms “peanut allergy”, “oral immunotherapy”, “quality of life”, and “food allergy”. Forty pertinent articles were retrieved and used for this review.
Results: There is an overall improvement in QOL, especially in food anxiety and social and dietary limitation domains, after treatment with peanut OIT. History of severe reactions and anxiety over accidental exposures are major motivators for parents of young children to pursue OIT. Many caregivers of patients with peanut allergy pursue OIT to achieve a “buffer zone” and additional protection against severe reactions triggered by accidental exposures. Worse baseline QOL and increased food allergy anxiety are associated with the largest improvements in QOL after OIT. Older age, higher peanut-specific IgE, higher Ara h 2 IgE, and larger skin prick test wheal to peanut were associated with increased adverse events during OIT. Barriers to treatment included time commitment, daily dosing, and taste aversion.
Conclusions: Overall, QOL domains related to food anxiety and social and dietary limitations show improvement after peanut OIT. Numerous patient characteristics and augmenting factors associated with development of adverse events or withdrawal from OIT have been reported. More research needs to be done looking more closely at the influence of these variables on OIT outcomes. Incorporating patient and caregiver values and perceived burden of the peanut allergy, along with various patient-related co-factors, can help aid the provider in discussions with parents and patients considering OIT. Ultimately, continued peanut avoidance may be the best option for many patients and the choice to pursue OIT is a shared decision between patient, family, and provider.
Michaud AL. Quality of Life and Improving Outcomes in Peanut Oral Immunotherapy. Lynchburg Journal of Medical Science. 2021; 4(1).
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