Oral immunotherapy for peanut allergy: Multipractice experience with epinephrine-treated reactions

Richard L. Wasserman*, Jeffrey M. Factor, James W. Baker, Lyndon E. Mansfield, Yitzhak Katz, Angela R. Hague, Marianne M. Paul, Robert W. Sugerman, Jason O. Lee, Mitchell R. Lester, Louis M. Mendelson, Liat Nacshon, Michael B. Levy, Michael R. Goldberg, Arnon Elizur

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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%. Conclusion: 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.

Original languageEnglish
Pages (from-to)91-96.e2
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number1
StatePublished - Jan 2014


  • Food allergy
  • Food allergy treatment
  • Oral immunotherapy
  • Peanut


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