Allergen specific IgE is a stronger predictor of remission following
Peanut Oral Immunotherapy than age in children aged 1-10 years
Abstract
Remission is the desired outcome following OIT as it allows individuals
to discontinue treatment and eat the allergen freely. Early initiation
of OIT in infants and toddlers has been embraced as an approach to
increase the likelihood of remission. However, there is no high-quality
evidence supporting younger age as an independent factor driving
remission; available studies are limited by small samples of younger
subjects and lack of adjustment for confounding covariates, particularly
peanut-specific IgE (sIgE) levels which is closely correlated with age.
This study examined relationships between peanut sIgE and age at
baseline and remission, in children aged 1-10 who completed 18 months of
OIT in the PPOIT-003 RCT (n=162). Remission was defined as absence of
clinical reactivity to peanut after 8 weeks of allergen
avoidance/treatment discontinuation. Age and sIgE were examined as
continuous variables in univariate and multivariate regression models.
Baseline peanut sIgE levels were significantly associated with
remission, independent of age (OR 0.1 [0.05-0.22], p<0.001).
Higher peanut sIgE was consistently predictive of lower likelihood of
remission, independent of age. In contrast, there was no independent
association between age and remission after adjusting for baseline sIgE
(OR 0.94 [0.79-1.12], p=0.5). Findings do not support age as an
independent predictor of remission following OIT. Additional studies
examining safety and efficacy of OIT in infants and younger children are
urgently needed, ahead of widespread adoption of early intervention.