Immunotherapy Effectiveness in Treating Peanut Hypersensitivity: A Systemic Review

Abstract

Peanut hypersensitivity is one of the top causes of food-related allergic responses and death in high-income countries. As a result, the goal of this study was to see if various forms of immunotherapies can help reduce the severity of peanut hypersensitivity reactions. From 2019 to 2021, a systematic search of PubMed, Web of Science, Wiley online library, and Science Direct was done. Peanut immunotherapy (PIT) clinical trials were considered. There were 19 trials with a total of 1565 participants. Twelve were on oral immunotherapy (OIT), two on sublingual immunotherapy (SLIT), two on subcutaneous immunotherapy (SCIT), two on epicutaneous immunotherapy (EPIT), and one was a comparison of SLIT and OIT. Desensitization was achieved by 74.3% of those who received OIT, 11% of those who received SLIT, 61% of those who received SCIT, and 49% of those who received EPIT. The majority of adverse events (AE) were mild to moderate. Those requiring epinephrine, on the other hand, were moderate to severe and were more common in the therapy groups. This systematic review showed that the current PIT regimens can accomplish desensitization regardless of the route of administration, with an acceptable safety profile.

Keywords: anaphylaxis; desensitization; immunotherapy; non-randomized clinical trial; peanut hypersensitivity; randomized clinical trial.

Figure 1. Flowchart of the systematic literature research and selection process

Figure 2. Risk of bias graph

The review authors' judgments about each risk of bias item are presented as percentages across all included studies. The highest risk bias was among allocation concealment (65%) while selective reporting got no risk bias; the unclear risk bias was detected in incomplete outcome data, blinding of outcome assessment, and allocation concealment.

Figure 3. Risk of bias summary

The review authors' judgments about each risk of bias item for each included study are depicted. In selective reporting, all studies applied it except Vickery 2014 [29]. We couldn’t determine it in Jones 2009 [24] and Nozawa 2014 [22]. Blinding of participants was applied in all of them except Clark 2009 [23], Vickery 2014 [29], and Jones 2009 [24].

Figure 4. Percentages of the compared groups: placebo, untreated, avoidance, other types of immunotherapy, and historical avoidance

Placebo was the most used group (23%), Untreated came second (13.8%) while Avoidance (6.4%), Other Types of Immunotherapy (0.9%), and Historical Avoidance were exactly the same.

Figure 5. Graph shows the different durations of the therapy

The longest duration was 68 months (five years and six months approximately) and the shortest was one month only.

Figure 6. The maximum tolerated dose

The mean tolerated dose was 2035.37 mg; most individuals took 100-200 mg. The least dose was 2000 mg and the highest dose was 150,000 mg.

Figure 7. Graph showing the types of therapy

OIT was the most used immunotherapy (885), SCIT was the least used (four), EPIT is the second most common (217), and SLIT was in the middle (60). SCIT = Subcutaneous Immunotherapy. OIT = Oral Immunotherapy. SLIT = Sublingual Immunotherapy. EPIT = Epicutaneous Immunotherapy.