Pediatric Resident Inova Children's Hospital Trumbull, Connecticut, United States
Background: Peanut allergies have become more prevalent in the United States in the past decade. It was previously thought that avoiding the potential allergen could prevent children from developing an allergic reaction. However, more recent studies have demonstrated that introducing peanuts early in an infant’s life can reduce the risk of developing a peanut allergy later in childhood. Nevertheless, despite early introduction, some children still have an IgE-mediated reaction to peanuts. This can prompt practitioners and families to avoid the allergen, increasing sensitivity and reactivity to peanuts.
Early oral immunotherapy(OIT) can improve the quality of life for many of these patients who react to the early introduction of peanuts. Oral immunotherapy involves introducing the allergen in small quantities and gradually increasing it to promote tolerance. This can limit the risk of an anaphylactic or life-threatening event due to accidental exposure. Objective: We developed a simple protocol for infants presenting to our clinic with peanut allergy, using peanut powder and measuring spoons. The purpose of this study is to review the safety and efficacy of infant OIT. Design/Methods: We performed a chart review of 33 infants with IgE-mediated peanut allergy who underwent our infant protocol for peanut OIT. We examined the starting doses, ending doses, and reactions. Results: At the start of OIT, patients ranged in age from 6 to 22 months. The majority of patients (19) started at 1/64 teaspoon (15mg) of peanut powder. Others started at varying doses between 7 mg and 250 mg. The starting dose was determined by a provider after obtaining the history of the initial reaction to peanut and reviewing the results of skin testing. In-office skin testing results showed wheals ranging from 0-17 mm for these patients. Parents were advised to schedule up-dosing every two weeks until they reached the goal of 2000 mg (2 teaspoons). Thirty patients reached this goal. Three patients reached 1000mg (1 teaspoon). Two were lost to follow-up.
Sixteen patients had cutaneous reactions at various doses that resolved without intervention. Subsequent doses were tolerated well. One patient required cetirizine for hives at 2000 mg. No patients required epinephrine.
Conclusion(s): Most of the infants that were started on peanut OIT reached the goal of 2 teaspoons of peanut powder (2000 mg). Our protocol was easy for parents to follow and appears to be a safe way to desensitize infants with IgE-mediated peanut allergy.
