A Practical, Stepwise Approach to Peanut Oral Immunotherapy in Clinical Practice: Benefits and Risks

Figures & data

Table 1 POIT Aims and Contraindications

POIT Aims
Protection from accidental trace exposures
Ability to reintroduce varying amounts* of peanut into the diet
Improvement in quality of life
POIT contraindications
Uncontrolled or severe asthma
Active eosinophilic esophagitis
Severe gastroesophageal reflux, dysphagia or any chronic undiagnosed GI condition
Inability to follow protocols or non-compliance with regular dosing
Pregnancy or breast feeding
Undergoing build-up for another form of immunotherapy at the same time (ie, allergy shots)
History of life-threatening anaphylaxis to peanut requiring ICU admission
Any chronic condition that affects safety during POIT or may become exacerbated due to POIT
Any concomitant medication that affects response to epinephrine (ie, β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers)
History of mast cell disorder
History of drug, alcohol or medication abuse

Note: *Amount depends on study protocol and maintenance dose.

Table 2 Benefits and Risks of POIT

Benefits	Risks
High efficacy	Frequent side effects
Side effects mostly mild or moderate	Anaphylaxis in 10–35%*
Desensitization occurs within a few months	Practical limitations and co-factor effect (exercise, illness, tiredness, sleep deprivations, NSAIDs)
Larger amounts tolerated over time	Taste aversion
Less side effects over time	Continued carriage of epinephrine
Protective effect against accidental trace exposures	Unknown protection against large accidental exposures, but likely less severe reactions after desensitization
Improvement in quality of life	Likely life-long therapy, not a cure

Note: *Different rates are reported in different studies.