Comparing the risk of anaphylaxis requiring epinephrine in oral immunotherapy and subcutaneous immunotherapy: A review of recent Canadian real-world literature

Uliana Kovaltchouk; Samira Jeimy; Lianne Soller; Kara Robertson; Elissa M Abrams; Scott B Cameron; Harold Kim; Edmond S Chan

doi:10.1016/j.jacig.2023.100080

Comparing the risk of anaphylaxis requiring epinephrine in oral immunotherapy and subcutaneous immunotherapy: A review of recent Canadian real-world literature

J Allergy Clin Immunol Glob. 2023 Feb 8;2(2):100080. doi: 10.1016/j.jacig.2023.100080. eCollection 2023 May.

Authors

Uliana Kovaltchouk¹, Samira Jeimy¹, Lianne Soller², Kara Robertson¹, Elissa M Abrams³, Scott B Cameron², Harold Kim^{1

4}, Edmond S Chan²

Affiliations

¹ Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada.
² Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada.
³ Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Abstract

Background: The safety of pediatric food oral immunotherapy (Ped-OIT) has been depicted by some as less favorable than subcutaneous immunotherapy (SCIT) owing to the increased number of serious adverse events requiring epinephrine. A review of real-world data comparing Ped-OIT and SCIT safety is necessary to guide shared decision making.

Objectives: Our aim was to compare the safety and adverse event profiles of peanut Ped-OIT and SCIT using Canadian real-word literature.

Methods: We performed a retrospective review of recent Canadian real-world literature on peanut Ped-OIT and SCIT safety and adverse events.

Results: The incidences of systemic reactions requiring epinephrine were 11 in 270 patients (4.07%) and 12 in 41,020 doses (0.029%) in a multicenter study in British Columbia, Alberta, Manitoba, and Nova Scotia studying 270 preschool-age children treated with peanut OIT. Similarly, a multicenter study in South-Western Ontario examining 160 patients between the ages of 1 and 17 years who were treated with peanut OIT showed that the incidences of systemic reactions requiring epinephrine were 5 in 160 patients (3.1%) and 8 in 52,751 doses (0.015%). A single-center retrospective review of 380 patients receiving aeroallergen SCIT showed that the incidences of systemic reactions requiring epinephrine were 28 in 380 patients (7.4%) and 1 in 1047 injection visits (0.095%). These findings are comparable to those of a review of 860 patients in Ontario who received either aeroallergen or venom SCIT, in which the incidence of systemic reaction requiring epinephrine was 10 in 4242 injections (0.24%).

Conclusion: Despite differences in the OIT protocols used and age groups studied, recent real-world data suggest that the safety of preschool peanut OIT or peanut OIT using a slower buildup schedule is comparable to that of SCIT.

Keywords: Peanut oral immunotherapy; subcutaneous immunotherapy; systemic reactions.

Publication types

Review