• 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, and Arnon Elizur.
• Department of Pediatrics, Medical City Children's Hospital, Dallas, Tex. Electronic address: drrichwasserman@gmail.com.
• J Allergy Clin Immunol Pract. 2014 Jan 1; 2 (1): 91-6.

BackgroundPeanut 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.ObjectiveThe 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.MethodsRetrospective chart review of peanut oral immunotherapy performed in 5 clinical allergy practices.ResultsA 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%.ConclusionPeanut 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.Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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