title: Oral immunotherapy for peanut allergy: multipractice experience with epinephrine-treated reactions.
abstract: BACKGROUND
  Peanut allergy creates the risk of life-threatening anaphylaxis that can disrupt psychosocial development and family life. The avoidance management strategy often fails to prevent anaphylaxis and may contribute to social dysfunction. Peanut oral immunotherapy may address these problems, but there are safety concerns regarding implementation in clinical practice.
  
  
  OBJECTIVE
  The purpose of this report is to communicate observations about the frequency of epinephrine-treated reactions during peanut oral immunotherapy in 5 different allergy/immunology practices.
  
  
  METHODS
  Retrospective chart review of peanut oral immunotherapy performed in 5 clinical allergy practices.
  
  
  RESULTS
  A total of 352 treated patients received 240,351 doses of peanut, peanut butter, or peanut flour, and experienced 95 reactions that were treated with epinephrine. Only 3 patients received 2 doses of epinephrine, and no patient required more intensive treatment. A total of 298 patients achieved the target maintenance dose for a success rate of 85%.
  
  
  CONCLUSIONS
  Peanut oral immunotherapy carries a risk of systemic reactions. In the context of oral immunotherapy, those reactions were recognized and treated promptly. Peanut oral immunotherapy may be a suitable therapy for patients managed by qualified allergists/immunologists.
authors.affiliation: Department of Pediatrics, Medical City Children's Hospital, Dallas, Tex. Electronic address: drrichwasserman@gmail.com.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Wasserman
authors.affiliation: New England Food Allergy Treatment Center, Connecticut Children's Medical Center, West Hartford, Conn.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Factor
authors.affiliation: Department of Allergy and Immunology, Emanuel Hospital, Portland, Ore.
authors.forename: James W
authors.initials: JW
authors.lastname: Baker
authors.affiliation: Paul Foster School of Medicine, El Paso, Tex.
authors.forename: Lyndon E
authors.initials: LE
authors.lastname: Mansfield
authors.affiliation: Zerifin Israel and Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yitzhak
authors.initials: Y
authors.lastname: Katz
authors.affiliation: DallasAllergyImmunology, Dallas, Tex.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Hague
authors.affiliation: Department of Allergy and Immunology, Emanuel Hospital, Portland, Ore.
authors.forename: Marianne M
authors.initials: MM
authors.lastname: Paul
authors.affiliation: Department of Pediatrics, Medical City Children's Hospital, Dallas, Tex.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Sugerman
authors.affiliation: New England Food Allergy Treatment Center, Connecticut Children's Medical Center, West Hartford, Conn.
authors.forename: Jason O
authors.initials: JO
authors.lastname: Lee
authors.affiliation: New England Food Allergy Treatment Center, Connecticut Children's Medical Center, West Hartford, Conn.
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Lester
authors.affiliation: New England Food Allergy Treatment Center, Connecticut Children's Medical Center, West Hartford, Conn.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Mendelson
authors.affiliation: Allergy & Immunology Institute, Asaf Harofe Medical Center, Zerifin, Israel.
authors.forename: Liat
authors.initials: L
authors.lastname: Nacshon
authors.affiliation: Allergy & Immunology Institute, Asaf Harofe Medical Center, Zerifin, Israel.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Levy
authors.affiliation: Allergy & Immunology Institute, Asaf Harofe Medical Center, Zerifin, Israel.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Goldberg
authors.affiliation: Zerifin Israel and Department of Pediatrics, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Elizur
mesh_terms: D000284:Administration, Oral; D000322:Adrenergic Agonists / Q000627:therapeutic use*; D000485:Allergens / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D000707:Anaphylaxis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010367:Arachis / Q000009:adverse effects* / Q000276:immunology; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D004837:Epinephrine / Q000627:therapeutic use*; D006801:Humans; D007557:Israel; D021183:Peanut Hypersensitivity / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D010940:Plant Proteins / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000322:Adrenergic Agonists; D000485:Allergens; D010940:Plant Proteins; D004837:Epinephrine
keywords: AMS; Avoidance management strategy; ETR; Epinephrine-treated reaction; Food allergy; Food allergy treatment; IRB; Institutional review board; OIT; Oral immunotherapy; POIT; PP; Peanut; Peanut oral immunotherapy; Peanut protein; SCIT; SPT; Skin prick test; Subcutaneous immunotherapy