Probiotic peanut oral immunotherapy is associated with long‐term persistence of 8‐week sustained unresponsiveness and long‐lasting quality‐of‐life improvement

Peanut allergy persists for life in the majority of patients. Current management relies on allergen avoidance; however, about 50% of patients have accidental exposures within 1 year. 1 Peanut oral im munotherapy (OIT) is effective at inducing desensitization and can induce sustained unresponsiveness (SU) in a subset of treated pa tients; however, data on long- term effectiveness and health- related quality- of- life (HRQL) impact are lacking. OIT- induced SU may be short- lived, with up to 67% of treatment responders losing their SU within 12 months. 2 Furthermore, a meta- analysis found that peanut OIT was associated with frequent adverse events (AE) and no signif icant improvement in HRQL. 3 We previously reported results from a proof- of- concept random ized trial (PPOIT- 001), which showed that 18- month treatment with combined probiotic and peanut oral immunotherapy (PPOIT) in duced 2- to 6- week SU in 74.2% of children aged 1– 10 years. 4 A long-term follow- up of PPOIT- 001 patients showed that PPOIT- induced SU persisted to 4- year post- treatment in 70% of initial treatment responders. 5 Weaknesses of the parent PPOIT- 001 study included participant selection based upon the clinical history of reaction and positive peanut skin prick test (SPT) or specific- IgE (sIgE) rather than double- blind placebo- controlled food challenge (DBPCFC), and the assessment of SU at 2- to 6- week post- treatment rather than after