Oral immunotherapy for food allergy safe for asthmatic children on medication

A recent study published in the Clinical and Translational Allergy found that oral immunotherapy (OIT) is a safe and effective treatment for children with persistent egg or peanut allergy and co-existing asthma. The study highlights the importance of assessing Bronchial hyperresponsiveness (BHR) in children with food allergy and asthma and the safety of OIT in these patients.

The team led by Janne Burman aimed to evaluate bronchial hyperresponsiveness in children with persistent egg or peanut allergy receiving OIT and to investigate whether OIT affects asthma control. The study included 89 children with persistent egg or peanut allergy and 80 control children without food allergy. Methacholine challenge testing was performed to evaluate BHR.

Of the 89 food-allergic children, 50 received OIT for egg allergy and 39 received OIT for peanut allergy. Sensitization to aeroallergens was evaluated by skin prick testing. Forty of the 89 children with regular controller treatment for asthma underwent methacholine challenge testing and 34 had measurement of exhaled nitric oxide (FeNO) at baseline and after 6-12 months of OIT.

The results showed that BHR was significantly more frequent in children with persistent egg or peanut allergy compared to children without food allergy. Methacholine challenge testing revealed significant BHR in 58% of children with egg allergy, 38% of children with peanut allergy, and 7.5% of control children.

However, OIT did not increase BHR, and it was safe for children on regular asthma medication. The mean cumulative dose of methacholine causing a 20% fall in FEV1 differed significantly between the egg and peanut-allergic versus the control children, indicating increased sensitivity to methacholine in children with food allergy.

Source:

Burman, J., Palosuo, K., Pelkonen, A., Malmberg, P., Remes, S., Kukkonen, K., & Mäkelä, M. J. (2022). Bronchial hyperresponsiveness and asthma during oral immunotherapy for egg or peanut allergy in children. In Clinical and Translational Allergy (Vol. 12, Issue 10). Wiley. https://doi.org/10.1002/clt2.12203