Changing Patient Mindsets about Non-Life-Threatening Symptoms During Oral Immunotherapy: A Randomized Clinical Trial

J Allergy Clin Immunol Pract. 2019 May-Jun;7(5):1550-1559. doi: 10.1016/j.jaip.2019.01.022. Epub 2019 Jan 23.


Background: Oral immunotherapy (OIT) can lead to desensitization to food allergens, but patients can experience treatment-related symptoms of allergic reactions that cause anxiety and treatment dropout. Interventions to improve OIT for patients are needed.

Objective: To determine whether fostering the mindset that non-life-threatening symptoms during OIT can signal desensitization improves treatment experience and outcomes.

Methods: In a randomized, blinded, controlled phase II study, 50 children/adolescents (28% girls, aged 7-17 years, M = 10.82, standard deviation = 3.01) completed 6-month OIT for peanut allergies. Patients and their parent(s) had monthly clinic visits at the Sean N. Parker Center for Allergy and Asthma Research between January 5, 2017, and August 3, 2017. All families received identical symptom management training. In a 1:1 approach, 24 patients and their families were informed that non-life-threatening symptoms during OIT were unfortunate side effects of treatment, and 26 patients and their families were informed that non-life-threatening symptoms could signal desensitization. Families participated in activities to reinforce these symptom mindsets.

Results: Compared with families informed that symptoms are side effects, families informed that symptoms can signal desensitization were less anxious (B = -0.46, 95% confidence interval [CI]: -0.76 to -0.16; P = .003), less likely to contact staff about symptoms (5/24 [9.4%] vs 27/154 [17.5%] instances; P = .036), experienced fewer non-life-threatening symptoms as doses increased (BInteraction = -0.54, 95% CI: -0.83 to -0.27; P < .001), less likely to skip/reduce doses (1/26 [4%] vs 5/24 [21%] patients; P = .065), and showed a greater increase in patient peanut-specific blood IgG4 levels (BInteraction = 0.76, 95% CI: 0.36 to 1.17; P < .001).

Conclusions: Fostering the mindset that symptoms can signal desensitization improves OIT experience and outcomes. Changing how providers inform patients about non-life-threatening symptoms is a promising avenue for improving treatment.

Keywords: Allergic symptoms; Allergy; Food allergy; Mindsets; Oral immunotherapy; Patient experience; Peanut allergy; Pediatric allergy.

Publication types

  • Clinical Trial, Phase II
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adolescent
  • Allergens / therapeutic use*
  • Anxiety / psychology
  • Attitude to Health*
  • Child
  • Desensitization, Immunologic / adverse effects
  • Desensitization, Immunologic / psychology*
  • Family
  • Female
  • Humans
  • Immunoglobulin E / immunology
  • Immunoglobulin G / immunology
  • Male
  • Patient Dropouts
  • Peanut Hypersensitivity / immunology
  • Peanut Hypersensitivity / therapy*
  • Thinking*
  • Treatment Adherence and Compliance*


  • Allergens
  • Immunoglobulin G
  • Immunoglobulin E