Skip to main content

Free Content Current management and use of oral immunotherapy in the United States for patients with peanut allergy


Peanut allergy is a major health burden in the United States. Treatment is limited to avoidance and acute reaction management. No drug or medical product is approved for use as a peanut oral immunotherapy (POIT) agent.


To examine peanut allergy diagnosis and treatment, peanut challenge protocols, nonpublished POIT approaches, POIT practice requirements and logistical considerations, and barriers to providing POIT.


Qualitative in-depth telephonic interviews were conducted with 34 allergists and nurse food allergy specialists across the United States between April and June 2016. Interviewed clinicians managed > 100 patients with peanut allergy per year; 50% of the interviewed allergists offered POIT in clinical studies or used self-developed approaches.


The physicians consistently reported conducting food challenges in 5‐10% of patients to confirm a peanut allergy diagnosis. The allergists who offered POIT described using a variety of approaches. Areas of divergence included patient selection (ages, 4‐7 years), peanut material (crushed peanuts, peanut flour, peanut protein, peanut butter, peanut extract), starting and ending doses, and updosing intervals (1 to 2 weeks). Generally, POIT administration and observation occupied an examination room for up to 2 hours; some practices reported accommodating 2 to 5 patients who received POIT simultaneously. Among physicians who did not offer POIT, barriers included medicolegal risks and the lack of a U.S. Food and Drug Administration (FDA) approved therapy.


Although POIT is currently not supported in treatment guidelines, some allergists have developed experimental POIT approaches to support patient needs. In the absence of a product that has approval by the FDA, European Medicines Agency (EMA) or other national competent authority, substantial variability in POIT approaches exists. Although logistical factors are not major obstacles to adoption, POIT dose preparation can be perceived as burdensome, and observation requires a dedicated staff. All the physicians interviewed suggested a need for effective, FDA-approved, disease-modifying treatments.

Keywords: Peanut allergy; food allergy; food challenge; immunotherapy; oral immunotherapy; peanut challenge; peanut oral immunotherapy

Document Type: Research Article

Affiliations: 1: From the Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Georgia; 2: ASTHMA Inc Clinical Research Center, Morrisville, North Carolina; 3: Northwest Asthma & Allergy Center, Seattle, Washington; 4: Aimmune Therapeutics, Brisbane, California; 5: Navigant Consulting, Inc., New York; 6: Navigant Consulting, Inc., London; 7: University of Tennessee/ LeBonheur Children's Hospital, Memphis, Tennessee

Publication date: July 1, 2019

This article was made available online on May 23, 2019 as a Fast Track article with title: "Current management and use of oral immunotherapy in the United States for patients with peanut allergy".

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
  • Editorial Board
  • Information for Authors
  • Submit a Paper
  • Information for Advertisers
  • Reprint Requests
  • Commercial level: Permission to use content
  • Ingenta Connect is not responsible for the content or availability of external websites
  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content