Current Insights

A Systemic Review of Therapeutic Options for Peanut Allergy

Eimear O'Rourke; Hilary Tang; Andrew Chin; Andrew Long; Sayantani Sindher; R. Sharon Chinthrajah

Disclosures

Curr Opin Allergy Clin Immunol. 2022;22(3):188-193. 

In This Article

Management and Quality of Life

The current standard of care and effective management of PA is avoidance of the allergen and use of an Adrenaline Auto-injector (AAI) in the event of an allergic reaction. Ingestion of the allergen can result in mild to severe allergic reactions impacting the skin, respiratory, cardiovascular and gastrointestinal systems and can lead to anaphylaxis, a life-threatening allergic reaction.[35] Living with FA places significant burden on individuals and their families, which can negatively impact the individuals physical and psychological well-being and health-related QoL (HRQoL).[69]

Caregiver anxiety is also associated with the child's severity of PA and reaction history.[70] The 2021 Peanut Allergy Burden Study investigated the real-world impact of caregivers and patients with PA on patient productivity and healthcare resource utilization, finding that 30–44% of PA patients utilized urgent care at least 3 times and 21–29% had at least one overnight hospital stay due to PA over their lifetime.[71] PA was also a burden on housework and schoolwork productivity in adolescents due to their PA. Adults reported losing on average 2.8 h of housework, 8.8 h of employment, and 5.3 h of schoolwork per week due to their PA. PA did not prevent patients from attending school or work, but rather impacted their ability to be fully present and complete the tasks set out. Treatments that can lower or prevent the risk of allergic reaction would subsequently decrease the healthcare resource utilization for patients due to incidental exposure and would decrease productivity lost due to PA for patients.

With OFC and OIT as leading treatment options for PA, researchers sought to understand its effects and possible improvements on HRQoL for PA patients and families. According to a meta-analysis on studies assessing changes in HRQol after OFC and OIT in participants from 2010 to 2020, OFC and OIT as interventions are both significantly associated with an improvement in HRQoL in patients with FA.[72] OIT reduces the psychosocial burden of FA for patients, families, and caregivers. OFC and OIT are also associated with fewer limitations in dietary choices and social interactions, with patients reported fewer concerns regarding the severity of potential allergic reaction and accidental exposures.[71,73] Therefore, peanut OIT has substantially improved the QoL of PA patients.

Findings from children aged 4–11 years with PA who completed 12 months of EPIT therapy during the phase 3 of the Peanut EPIT Efficacy and Safety Study (PEPTIDES) and the first 12 months of the follow-on open label extension study (PEOPLE) suggest that EPIT treatment had a positive impact on FA QoL on the lives of individuals with PA along with significant reductions in children's and parents' expectation of the possibility of death occurring due to accidental ingestion of a peanut.[74] EPIT desensitization was found to have positive effects for both children and their parents due to less social and dietary restrictions and decreased fear of daily challenges caused by PA. The potential benefits for immunotherapies such as OIT and EPIT to continue to improve the psychosocial burden, management, and QoL of patients and their families suggest positive impacts of the introduction of immunotherapy for these families. As treatments beyond food avoidance continue to be explored, benefits of immunotherapy on the lives of FA patients and caregivers have been demonstrated and continue to be studied.[65]

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