The Peanut OIT Controversy

By: Jessica Hui

There's an article that was recently published in The Lancet titled, "Peanut allergy oral immunotherapy increases allergic reactions, compared with avoidance or placebo". We want to give some highlights about it, as these articles are sometimes very dense and difficult to sift through. 

Understanding a "systematic review"

In the medical field, there are many types of research and articles that are published in various medical journals. This one is a "systematic review", which looks at all the major studies performed that pertain to the topic at hand. The authors of this systematic review looked at twelve studies looking at peanut oral immunotherapy (OIT) treatment, with over 1000 patients in total. These patients were followed for a year after peanut OIT treatment. In OIT, the patient is given gradually increasing doses of the allergen over time, with the ultimate goal of reducing reactions. The authors found that in following the patients one year after peanut OIT treatment, there actually is a big increase in allergic reactions, including anaphylaxis, compared with patients who avoided peanut completely or received placebo therapy. 

What the review said about Peanut OIT

When we look at the OIT studies, the study is deemed successful when a patient can pass a food challenge that is supervised in a medical facility. When this occurs, the goal of "desensitization" is achieved. However, this article shows us that even though patients may pass the food challenge, it doesn't equate to achieving fewer allergic reactions in the real world - in fact, the opposite happens with more allergic reactions. 

In the end, this review article doesn't condemn OIT, but it does show that food allergy research should focus on real-world outcomes with everyday exposures. We need to study measures that align with our patients' preferences. This is also a great reminder for healthcare providers, as we need to have more extensive discussions with our patients and convey these facts, then allow the patients and families to make an informed decision on the next steps. Food allergy is such a complicated topic, with so much more that needs to be discovered and researched.