A review of sublingual immunotherapy for treatment of peanut allergy.

Background: Peanut allergy remains a common problem that persists into adulthood for most patients, with risks of accidental ingestion and poor quality of life. Oral immunotherapy (OIT) and anti-immunoglobulin E (IgE) therapy are effective options for peanut allergy; however, each therapy has limitations, which makes them not ideal for all patients. Objective: The objective was to summarize recent studies that support sublingual immunotherapy (SLIT) for peanut allergy as an alternative option to OIT and anti-IgE therapy, and to discuss practical considerations for its use in clinical practice. Methods: Published reports of SLIT for the treatment of peanut allergy from the past 15 years were identified. Efficacy as measured by food challenges was compared across studies as well as dosing reactions during SLIT therapy. Results: Published studies of peanut SLIT demonstrate significant increases in reaction threshold after therapy. When considering desensitization, higher thresholds were reported with younger age at initiating therapy. Furthermore, the potential for a 3-month remission was seen for toddlers after treatment. Adverse effects with SLIT were similar across the ages, with transient oropharyngeal pruritus being most commonly reported. Severe symptoms that require treatment with epinephrine have generally not been reported. Despite the reassuring safety, withdrawal from therapy was common in older participants. Key questions remain with regard to the minimum duration of sublingual administration, optimal maintenance dose, and best measures of treatment efficacy. Conclusion: Peanut SLIT has been extensively studied, which demonstrated desensitization at levels that approach OIT while also having a simple administration and reassuring safety that may make it a good option for peanut allergy alongside OIT and anti-IgE therapy.