656 - The Impact of Lower Respiratory Comorbidities on Oral Immunotherapy Reactions in Food Allergic Patients

Publication Number: 656.6741

Simon Peck, Weill Cornell Medicine, New York, NY, United States; Eirene Fithian, Weill Cornell Medicine, New York, NY, United States; Allison Anderson, Latitude Food Allergy Care, Seattle, WA, United States; Samuel Shrank, Latitude Food Allergy Care, Boulder, CO, United States; Zahida Rani Maskatia, Latitude Food Allergy Care, Redwood City, CA, United States; Charlene Thomas, Weill Cornell Medicine, New York, NY, United States; Priya Katari, Weill Cornell Medicine, New York, NY, United States; Perdita Permaul, NY-Presbyterian/Weill Cornell Medicine, New York, NY, United States

Background: Oral immunotherapy (OIT) has broadened treatment options for patients with food allergies, yet data remains limited for patient-specific counseling on OIT-related allergic reactions. Prior research indicates that asthma and viral-induced wheezing may influence the risk of OIT reactions.

Objective: This study aims to assess how lower respiratory comorbidities impact OIT reactions, and to what extent these effects vary by specific food allergen in clinical practice.

Design/Methods: A retrospective cohort study was conducted using clinical data collected from 1003 patients (ages 0-47yo) undergoing OIT at Latitude Food Allergy Care from 2018-2024. OIT-related reactions were categorized by symptom type and severity and stratified by 29 allergens. Descriptive statistics calculated reaction frequencies and 95% confidence intervals with the Wilson method to assess the association between lower respiratory comorbidities and OIT reactions to specific food allergens.

Results: Of patients with asthma, viral-induced wheezing (VIW), exercise-induced bronchoconstriction (EIB), and reactive airway disease (RAD), 70% reported OIT-related reactions (95% CI: 65%, 75%) compared to 60% of patients without these conditions (95% CI: 56%, 64%, p=0.002). Patients with comorbid EIB, RAD, or mild to moderate asthma did not show significant differences in the frequency of OIT reactions. However, patients with VIW had more OIT reactions, with an overall frequency of 73.8% (95% CI: 66%, 81%), of which 71.6% were mild ( 95% CI: 63%, 79%), 34.8% moderate (95% CI: 27%, 43%), and 19.2% severe (95% CI: 13%, 27%), compared to patients without lower respiratory comorbidities (mild 58.1%; 95% CI: 54%, 62%; moderate 19.9%; 95% CI: 17%, 23%; severe 10.6%; 95% CI: 8.4%, 13%). Additionally, patients with lower respiratory comorbidities were more likely to experience reactions with peanut, tree nut, or sesame OIT (p=0.005, p=0.008, and p=0.008, respectively). A higher number of severe OIT reactions were seen with peanut, pistachio, and hazelnut (p < 0.001, p=0.043, p=0.031, respectively) while sesame was associated with mild reactions (p=0.006).

Conclusion(s): These findings indicate that patients with mild to moderate asthma and other lower respiratory comorbidities, particularly those with VIW, have a higher risk of OIT reactions with peanut, tree nut, and sesame administration. This association underscores the need for individualized risk assessment and cautious OIT administration for certain allergens in patients with lower respiratory comorbidities.