IMPACT-PLuS follow-up data show 35% of children treated with peanut OIT had a reaction years later, with 5 requiring epinephrine, Jennifer Dantzer, MD, says.
A long-term follow up of IMPACT-PLuS found 35% (14/40) of children treated with
The reaction data follow earlier IMPACT-PLuS findings showing 80% of this cohort remained peanut tolerant at follow-up, raising practical questions about how clinicians should weigh ongoing reaction risk against sustained tolerance. Investigators also examined whether biomarkers measured a decade after early-life pnOIT could help identify children on a path toward durable remission rather than desensitization alone.
"Even though it was great with the ongoing success, and they were eating it, it's important to note it's not without risk," said Jennifer A. Dantzer, MD, MHS, from the department of pediatrics at Johns Hopkins University School of Medicine. "Most of the symptoms and reactions were mild, but there were still 5 people who needed epinephrine. The main thing [is] being prepared, knowing the risk exists, and talking with families about it when deciding if this is the right treatment."
Most reactions among the 14 affected participants were reported as rare, occurring in < 10% of peanut exposures, with oral pruritus, hives, and wheezing the most common symptoms.¹ Eleven of the 14 participants who reacted used medication to treat the reaction, including 8 who took oral antihistamines and 5 who required epinephrine, some more than once.
Three participants were diagnosed with eosinophilic esophagitis (EoE) after IMPACT, though the dataset does not establish peanut ingestion as a driver, Dantzer said. One case emerged during the trial and appeared short-term; of the other 2, diagnosed roughly 5 years later, one participant was not eating peanut at diagnosis, and the other continued eating peanut with disease controlled on treatment. Dantzer said long-term OIT studies should continue tracking EoE risk given the small sample.
A decade after treatment ended, children originally randomized to pnOIT still had significantly lower peanut and Ara h 2-specific IgE and higher IgG4 than those randomized to placebo. Remission-group participants trended toward the lowest IgE and smallest skin prick test wheals.¹ Many participants continued eating peanut regularly, which Dantzer said complicates isolating a stand-alone treatment effect, since ongoing exposure may itself help sustain these immunologic patterns.
No validated biomarker or lab test can currently distinguish durable remission from natural outgrowth or tolerance sustained by continued ingestion, Dantzer said. Age at pnOIT initiation and baseline peanut IgE, both predictive of remission in the original IMPACT trial, remain useful factors for counseling families on a child's likelihood of short- and long-term success, alongside their chances of natural outgrowth, when considering early-life OIT.
Watch part 1 of our interview with Dantzer here:
Dantzer has no reported disclosures.
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