Life after Peanut Immunotherapy
Monday, March 6, 2017
Exhibit Hall B2 (Georgia World Congress Center, Building B)
Megan Ott Lewis, MSN, RN, CPNP, Terri F. Brown-Whitehorn, MD FAAAAI, Deirdre D. Burke, CRC III, Antonella Cianferoni, MD PhD FAAAAI, Jennifer Heimall, MD, Ashwini Reddy, MD, Courtney Rooney, BSN, RN, Jessica Wiedmann, RN, Jonathan M. Spergel, MD PhD FAAAAI
Rationale:  Much of the focus of current research is on study outcomes, but what happens once patients complete study protocols?  This quality improvement project sought to gain insight into life after three types of peanut immunotherapy- oral (OIT), oral+ omalizumab (O+OIT) and epicutaneous (EPIT).

Methods: This project surveyed 33 participants who participated in 3 different clinical trials for peanut. Questionnaires were distributed about study participation, desensitization method and impact on daily life.  

Results: All participants responded and were happy they participated.  29 subjects introduced peanut into their diet.  However, 16 reported dosing interfered with daily life.

Quantity of peanut consumption varied.  89% of O+OIT consumed at least 300 mg compared to 56% with OIT and 53% with EPIT.  11% of O+OIT patients are completely avoiding compared to EPIT (20%) and OIT (22%).  Dosing frequency varied from once per month to daily.

Only six participants liked the taste and were from the EPIT cohort.  One patient in each OIT and O+OIT groups was interested in eating more compared to nine (82%) EPIT.

Since completion, four experienced allergic reactions requiring epinephrine due to dosing (O+OIT: 3; EPIT: 1).   Two participants in both the OIT and O+OIT currently complain of increased gastrointestinal symptoms. 

Conclusions:   Overall participants had success, yet incorporating continued ingestion proves challenging and optimum dosing still needs to be determined. The O+OIT group reached the highest doses, but had the greatest frequency of reactions.  The EPIT group appears to like peanut suggesting a possible different mechanism of immunotherapy.