Oral immunotherapy for peanut allergy: a systematic review and meta-analysis

Background and objectives: Food allergy, particularly peanut allergy, is a significant and growing health concern, especially in high-income countries. Affecting 2% of children and 1% of adults, peanut allergy is a chronic condition that severely impacts quality of life. The standard treatment remains allergen avoidance, though oral immunotherapy (OIT) has emerged as a potential strategy for desensitization. This systematic review and meta-analysis aims to evaluate the efficacy and safety of peanut oral immunotherapy (POIT) based on randomized controlled trials (RCTs). Methods: A systematic review and meta-analyses were conducted following PRISMA guidelines. Eligible studies included double-blind RCTs evaluating POIT versus placebo or avoidance. Databases such as PubMed, Google Scholar, Cochrane-Controlled Register of Trials, and ClinicalTrials.gov were searched. Risk of bias was assessed using the Cochrane Risk of Bias tool (ROB2), and statistical analysis was performed using the RevMan software. Results: A total of 20 studies with 2161 participants (median age: 8.6 years) were included. POIT demonstrated a significant increase in desensitization rates (RR = 7.25, 95% CI: 2.66–19.79, P = 0.0001). However, POIT was also associated with increased risks of anaphylaxis (RR = 2.27, 95% CI: 1.48–3.47, P = 0.0002) and epinephrine use (RR = 2.05, 95% CI: 1.35–3.12, P = 0.0008). Adverse effects such as gastrointestinal symptoms, respiratory events, and skin abnormalities were more frequent in the POIT group, leading to a higher treatment discontinuation rate (RR = 2.50, 95% CI: 1.20–5.21, P = 0.01). Conclusion: POIT is effective in inducing desensitization in peanut-allergic individuals but carries significant risks, including an increased likelihood of anaphylaxis and adverse events. These findings reinforce previous meta-analyses and highlight the need for individualized risk-benefit assessments in clinical practice. Further research is required to optimize treatment protocols and improve patient safety.