PMID- 33005286 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201003 IS - 1939-4551 (Print) IS - 1939-4551 (Electronic) IS - 1939-4551 (Linking) VI - 13 IP - 8 DP - 2020 Aug TI - Oral immunotherapy for peanut allergy: The pro argument. PG - 100455 LID - 10.1016/j.waojou.2020.100455 [doi] LID - 100455 AB - Food allergy (FA) is a growing public health problem with personal, social, nutritional, and economic consequences. In the United States, it is estimated that 8% of children and 10.8% of adults have food allergies. Allergies to peanuts are particularly worrisome as unlike allergies to other allergenic foods, such as milk and egg, which are commonly outgrown by 5 or 10 years of age, 80% of peanut allergies persist into adulthood. The first drug for peanut allergy, Palforzia, was approved by the US Food and Drug Administration (FDA) in January 2020. For other food allergies, the current standard of care for the management of FA is suboptimal and is limited to dietary elimination of the offending allergen, vigilance against accidental ingestion, and treatment of allergic reactions with antihistamines and epinephrine. However, dietary avoidance can be challenging, and it is estimated that approximately 40% of patients with food allergies report at least one food allergy-related emergency department in their lifetime. Reactions, even from minimal exposures, can be life-threatening. Oral immunotherapy (OIT) has been the best researched therapeutic approach for treating FA over the last decade, with clinical trials investigating its efficacy, safety, and ability to improve participants' quality of life (QoL). A number of studies and meta-analyses have shown that OIT treatment is effective in raising the threshold of reactivity to peanuts and other foods in addition to producing a measurable serum immune response to such therapy. Although OIT-related adverse events (AEs) are common during treatment, serious reactions are rare. In fact, while the majority of patients experience AEs related to dosing, most continue daily dosing in hopes of achieving protection against the culprit food. Moreover, the majority of participants report improvement of QoL after OIT and are positive about undergoing OIT. These results show patients' commitment to OIT and their optimism regarding the benefits of treatment. As a first step in therapeutic options to protect from reactions to unintentional ingestion of allergenic foods, and importantly, to address the many psychosocial aspects of living with FA, OIT shows promise. Future research will focus on identifying optimal OIT regimens that maintain protection after therapy and allow for regular food consumption without allergic symptoms. Education and informed shared decision making between patients and providers are essential in optimizing current therapy regimens. CI - (c) 2020 The Authors. FAU - Chinthrajah, R Sharon AU - Chinthrajah RS AD - Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA. AD - Division of Pulmonary, Allergy, and Clinical Care, Stanford University, Stanford, CA, USA. AD - Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, CA, USA. FAU - Cao, Shu AU - Cao S AD - Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA. AD - Division of Pulmonary, Allergy, and Clinical Care, Stanford University, Stanford, CA, USA. FAU - Dunham, Theresa AU - Dunham T AD - Department of Internal Medicine, Stanford University, Stanford, CA, USA. FAU - Sampath, Vanitha AU - Sampath V AD - Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA. AD - Division of Pulmonary, Allergy, and Clinical Care, Stanford University, Stanford, CA, USA. FAU - Chandra, Sharad AU - Chandra S AD - Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA. FAU - Chen, Meng AU - Chen M AD - Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA. AD - Division of Pulmonary, Allergy, and Clinical Care, Stanford University, Stanford, CA, USA. FAU - Sindher, Sayantani AU - Sindher S AD - Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA. AD - Division of Pulmonary, Allergy, and Clinical Care, Stanford University, Stanford, CA, USA. AD - Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, CA, USA. FAU - Nadeau, Kari AU - Nadeau K AD - Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA. AD - Division of Pulmonary, Allergy, and Clinical Care, Stanford University, Stanford, CA, USA. AD - Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, CA, USA. LA - eng PT - Journal Article PT - Review DEP - 20200918 PL - United States TA - World Allergy Organ J JT - The World Allergy Organization journal JID - 101481283 PMC - PMC7519204 OTO - NOTNLM OT - AEs, adverse events OT - AF, Adult form OT - BOT, Burden of treatment OT - CF, Child form OT - Efficacy OT - FA, Food allergy OT - FAIM, Food allergy independent measure OT - FAQOL, Food allergy quality of life OT - OIT, Oral immunotherapy OT - Oral immunotherapy OT - PB, Parental burden form OT - PF, Parental form OT - Peanut allergy OT - PedsQL, Pediatric quality of life inventory OT - QoL, Quality of life OT - Quality of life OT - SAE, Serious adverse events OT - Safety OT - TF, Teenage form COIS- Dr. Nadeau reports grants from National Institute of Allergy and Infectious Diseases (NIAID), Food Allergy Research & Education (FARE), End Allergies Together (EAT), Allergenis, and Ukko Pharma; Grant awardee at NIAID, National Institute of Environmental Health Sciences (NIEHS), National Heart, Lung, and Blood Institute (NHLBI), and the Environmental Protection Agency (EPA); involved in Clinical trials with Regeneron, Genentech, AImmune Therapeutics, DBV Technologies, AnaptysBio, Adare Pharmaceuticals, and Stallergenes-Greer; Research Sponsorship by Novartis, Sanofi, Astellas, Nestle; Data and Safety Monitoring Board member at Novartis and NHLBI; Cofounded Before Brands, Alladapt, ForTra, and Iggenix; Chief Intellectual Office at FARE, Director of the World Health Organization (WAO) Center of Excellence at Stanford, Personal fees from Regeneron, Astrazeneca, ImmuneWorks, and Cour Pharmaceuticals; Consultant and Advisory Board Member at Ukko, Before Brands, Alladapt, IgGenix, Probio, Vedanta, Centecor, Seed, Novartis, NHBLI, EPA, National Scientific Committee of ITN and NIH Programs, US patents (patent numbers 62/647,389; 62/119,014; 12/610,940, 12/686,121, 10/064,936, 62/767,444; application numbers S10-392); Dr. Chinthrajah receives grant support from CoFAR NIAID, Aimmune, DBV Technologies, Astellas, AnaptysBio, Novartis, and Regeneron, and is a scientific advisory board member for Alladapt Immunotherapeutics; Dr. Sayantani Sindher receives grant support from Aimmune, DBV Technologies, and Regeneron; all other authors declare no conflict of interest. EDAT- 2020/10/03 06:00 MHDA- 2020/10/03 06:01 PMCR- 2020/09/18 CRDT- 2020/10/02 05:44 PHST- 2020/04/27 00:00 [received] PHST- 2020/07/20 00:00 [revised] PHST- 2020/07/30 00:00 [accepted] PHST- 2020/10/02 05:44 [entrez] PHST- 2020/10/03 06:00 [pubmed] PHST- 2020/10/03 06:01 [medline] PHST- 2020/09/18 00:00 [pmc-release] AID - S1939-4551(20)30358-6 [pii] AID - 100455 [pii] AID - 10.1016/j.waojou.2020.100455 [doi] PST - epublish SO - World Allergy Organ J. 2020 Sep 18;13(8):100455. doi: 10.1016/j.waojou.2020.100455. eCollection 2020 Aug.