Safety and Feasibility of Peanut, Tree Nut, and Sesame Oral Immunotherapy in Infants and Toddlers in a Real-World Setting.

Background: Oral immunotherapy (OIT) for food allergy has been largely studied in older children within the context of clinical trials, and its availability has historically been limited for younger patients with food allergy. Data have shown that the most impact may actually be seen with the use of OIT in younger infants and toddlers.

Objective: To evaluate the safety and feasibility of OIT in subjects 24 months and younger in a real-world setting using commercially available food products.

Methods: This was a retrospective study of subjects 24 months and younger initiated on OIT for peanut, tree nut, or sesame allergy within the Scripps Clinic allergy department. Medical records were reviewed for data regarding initial oral food challenges, OIT, and adverse outcomes.

Results: Fifty-two subjects 24 months and younger were initiated on OIT. Most subjects (84.6%) were on single-food OIT, and some (15.4%) were on multifood OIT. No increased adverse outcomes were observed on multifood OIT. Of the 59 initial oral food challenges, objective reactions occurred during 42 challenges, most being low-grade reactions. During initial oral food challenges, 86.1% of peanut-allergic children tolerated 1/8 of 1 Bamba stick with no reaction. Most subjects (73.1%) updosed at home, and most (51.9%) had no reactions while updosing. Some had low-grade cutaneous reactions, none requiring epinephrine or emergency evaluation.

Conclusions: OIT in infants is safe and feasible to perform in a real-world setting using commercially available food products with at-home updosing, thus increasing the availability of OIT for patients.