title: Oral immunotherapy for the treatment of peanut allergy:  systematic review of six case series studies.
abstract: BACKGROUND
  Allergy to peanuts is associated with considerable morbidity and, in a minority of cases, mortality. Natural resolution to  peanut allergy occurs in only a few cases, hence the need to find effective interventions. Peanut oral immunotherapy (OIT) is a potentially  important new therapeutic development.
  
  
  OBJECTIVE
  To assess the benefits and harms of OIT for peanut allergy.
  
  
  METHODS
  Fourteen databases were searched for published reports and unpublished/in-progress studies. We included studies employing  randomised controlled trial (RCT), quasi-RCT, controlled clinical trial, controlled before-and-after, interrupted time series, and case series  designs.
  
  
  RESULTS
  Six studies enrolling a total of 85 participants satisfied our inclusion criteria. All studies employed a case series design and were  thus judged to be at high risk of bias. Overall, this body of evidence provided suggestive evidence that it is possible for many participants  to increase their threshold dose for peanut exposure whilst receiving treatment. Adverse reactions were common and, whilst most of these  were relatively minor, some were potentially life-threatening.
  
  
  CONCLUSIONS
  OIT appears to be a potentially promising new therapy for the short- to medium-term management of carefully selected and  monitored patients with peanut allergy. The effectiveness and cost-effectiveness of OIT - particularly over the longer term - need to be  clearly established using more robust designs before its clinical use can be contemplated. Given the risk of triggering serious adverse  reactions, OIT should not be administered outside clinical trial settings.
authors.affiliation: Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK. aziz.sheikh@ed.ac.uk
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.forename: Ulugbek
authors.initials: U
authors.lastname: Nurmatov
authors.forename: Iris
authors.initials: I
authors.lastname: Venderbosch
authors.forename: Erik
authors.initials: E
authors.lastname: Bischoff
mesh_terms: D000284:Administration, Oral; D003888:Desensitization, Immunologic / Q000379:methods*; D006801:Humans; D021183:Peanut Hypersensitivity / Q000628:therapy*