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Oral desensitisation to peanuts: too many adverse effects

Oral desensitisation to peanuts increases rather than reduces the risk of subsequent serious allergic reactions.

2019 saw the publication of the results of a review of clinical trials evaluating oral desensitisation by allergenic extracts versus absence of oral desensitisation in patients allergic to peanuts.

The twelve randomised clinical trials involved a total of 1 000 patients, half of them children under the age of 9, monitored for a median duration of one year. The evaluation criterion was significant food allergy events.

Oral desensitisation to peanuts was shown to increase the risk of allergic reactions, including severe anaphylactic shock (risk increased threefold), and doubled adrenaline use, as well as serious adverse effects, in a statistically significant way. This is regardless of the desensitisation protocol used or the period of desensitisation – initial or maintenance.

Various adverse effects related to allergic events were also more frequent. These included digestive disorders, skin or mucous membrane disorders, nasal and respiratory disorders. However, patients in the oral desensitisation groups had better test results for peanut tolerance with increasing standardised oral doses of peanuts under supervision in hospitals than those in the other groups.

In peanut-allergic patients, oral desensitisation increases rather than reduces the risk of serious allergic reactions, particularly anaphylaxis. Hospital tolerance tests are not sufficiently reliable. Avoidance of peanuts is the priority measure, for want of a better solution.

©Prescrire 1 February 2020

"Oral peanut desensitisation: excessive adverse effects" Prescrire Int 2020; 29 (212): 44. (Pdf, subscribers only).

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