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

J Allergy Clin Immunol Pract. 2014 Jan-Feb;2(1):91-6. doi: 10.1016/j.jaip.2013.10.001.


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.

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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adrenergic Agonists / therapeutic use*
  • Allergens / administration & dosage*
  • Allergens / adverse effects
  • Allergens / immunology
  • Anaphylaxis / diagnosis
  • Anaphylaxis / drug therapy*
  • Anaphylaxis / etiology
  • Arachis / adverse effects*
  • Arachis / immunology
  • Desensitization, Immunologic / adverse effects
  • Desensitization, Immunologic / methods*
  • Epinephrine / therapeutic use*
  • Humans
  • Israel
  • Peanut Hypersensitivity / diagnosis
  • Peanut Hypersensitivity / immunology
  • Peanut Hypersensitivity / therapy*
  • Plant Proteins / administration & dosage*
  • Plant Proteins / adverse effects
  • Plant Proteins / immunology
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • United States


  • Adrenergic Agonists
  • Allergens
  • Plant Proteins
  • Epinephrine