North Raleigh Today

Wesley Burks, MD, CEO of UNC Health and dean of the UNC School of Medicine, along with Corinne A. Keet, MD, PhD, professor of pediatrics at the same institution, have published an editorial in the New England Journal of Medicine Evidence. The piece is titled “To Eat or Not to Eat: Oral Immunotherapy for High Threshold Peanut Allergy.”

The editorial addresses the management of peanut allergies through oral immunotherapy (OIT), a treatment known to improve quality of life. However, current research predominantly focuses on children highly sensitive to peanut protein—those with a low threshold for allergic reactions.

In their publication, Burks and Keet highlight recent advancements in food allergy treatments. They note that two products have been approved by the FDA: Palforzia, which is OIT for peanut allergy, and omalizumab, an IgE blocker. Clinical trials indicate that OIT can significantly increase the threshold for allergic reactions. Nevertheless, they also point out the associated risks such as systemic allergic reactions and eosinophilic esophagitis. Furthermore, most patients tend to regain sensitivity if their treatment is discontinued.

They cite findings from the Institute for Clinical and Economic Review which suggest that evidence does not conclusively show OIT's superiority over avoidance strategies. Moreover, there is limited research on treating children who do not meet clinical trial criteria due to having a higher threshold but still retain a peanut allergy.

The authors emphasize the need for further exploration into effective treatments for this subset of children with high-threshold peanut allergies.