Dosing Reactions and Missed Doses Affect Peanut Oral Immunotherapy Outcomes.

Abstract

Peanut oral immunotherapy (pOIT) is a recognized treatment for patients with peanut allergy, though not all patients who undergo this therapy achieve desensitization or remission.To determine whether missed doses or dosing-reactions predict clinical outcomes with pOIT.Data from the IMPACT trial, a randomized, double-blind, placebo-controlled trial of pOIT in children aged 1 to 4 years with peanut allergy, was analyzed to determine whether treatment-emergent variables influence desensitization (ability to consume 5000mg of peanut protein without reaction during a blinded oral food challenge after 134 weeks of pOIT) and remission (six months after discontinuation of pOIT). Logistic regression models, controlling for age and Ara h2-specific IgE, were performed to assess the relationship between dosing reactions, missed doses, and outcomes.Consecutive missed doses during build-up significantly correlated with reduced likelihood of desensitization (p = 0.03, OR 0.69 (0.49, 0.96)), whereas consecutive missed doses during maintenance did not (p = 0.10, OR 0.79 (0.59, 1.05)). Furthermore, the total individual missed doses did not significantly correlate with desensitization or remission in either phase of pOIT. Conversely, dosing-reactions during maintenance did significantly correlate with reduced likelihood of desensitization (p = 0.01, OR 0.71 (0.54, 0.93)) while dosing-reactions during build-up did not significantly correlate with desensitization (p = 0.57, OR 0.95 (0.79, 1.14)) . Fewer than 10% of missed doses were attributed to dosing reactions.Missed doses during therapy and dosing-reactions during maintenance associated with poorer pOIT outcomes. Clinicians should support adherence during build-up and consider dose adjustments for patients having dosing-reactions during maintenance therapy.

View details for DOI 10.1016/j.jaip.2025.11.008

View details for PubMedID 41270832