Long-Term Follow up after Peanut Immunotherapy
Saturday, March 5, 2016: 1:15 PM
Room 503 (Convention Center)
Kim E. Mudd, RN MSN CCRP, , , ,
Rationale: Little is known about long-term outcomes following peanut immunotherapy.

Methods: Peanut allergic children (7-13years) participated in a randomized peanut immunotherapy trial.  Subjects who completed ≥12 months of maintenance underwent a desensitization food challenge (d-OFC), and those passing the d-OFC stopped treatment for 4 weeks with re-challenge to determine sustained unresponsiveness (SU-OFC). Follow-up occurred at 9-month intervals over 27-28 months to assess peanut ingestion (PI) and adverse reactions.

Results: 14/21 subjects completed maintenance. 4/14 failed the d-OFC but continued with individually prescribed PI. Of these 4, one returned to avoidance due to aversion/intermittent oral symptoms; three continued PI: one 300-500mg/day with intermittent oral symptoms and a reaction requiring epinephrine, one 300-900mg/day with intermittent oral symptoms, and another 3900mg/day with intermittent coughing.  6/10 subjects failed the SU-OFC but continued PI. Two returned to avoidance, one with severe anxiety and one after a reaction requiring epinephrine.  Four continued PI: one 1400mg/day with intermittent wheezing/pruritus and a reaction with wheezing/hives/abdominal pain, one 3000mg/day with intermittent oral symptoms, one 3000mg/day with a reaction with hives/shortness of breath, and one 9000mg/day with intermittent pruritus/throat/chest tightness. All 4 who passed the SU-OFC continued PI: one 1500-3000mg/week with intermittent oral symptoms, one 1800-2100mg/day with intermittent oral symptoms and a reaction requiring epinephrine for syncope/vomiting/chest-tightness/hives, and two (2000mg/week and 4800mg/week) with no symptoms.

Conclusions: Of the original 21 subjects, eleven were still ingesting peanut after 27 months.  However, two of the eleven experienced reactions requiring epinephrine and nine reported at least intermittent symptoms, underscoring the need for additional long term follow-up studies.