Oral Immunotherapy for Peanut Allergies Improves Quality of Life Post-Treatment

Sophie Rosser, MSc

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A meta-analysis observed the benefit of oral immunotherapy on health-related quality of life post-food allergy treatment but not necessarily during active treatment.¹

Studies have demonstrated the effectiveness of oral immunotherapy for food allergies, desensitizing patients to their allergens to the point where they can sustain peanuts, eggs, or milk—whatever their allergy may be.² It has been reported that oral immunotherapy has worked in approximately 60 to 80% of participants who are allergic to the foods mentioned above.

The effectiveness of oral immunotherapy has not been closely examined for other food allergies. Common adverse events of oral immunotherapy involve the gastrointestinal tract, such as symptoms of abdominal pain, vomiting, and cramping. Patients on oral immunotherapy also often experience itching, rash, hives, swelling, wheezing, and anaphylaxis.

Thus, this begs the question, does oral immunotherapy, although helpful for weaning away food allergies, improve a patient’s quality of life? Uncertainty surrounded this question, with limited up-to-date meta-analyses on the health-related quality of life of patients undergoing oral immunotherapy for food allergies.¹

A systematic review and meta-analysis, presented at the 2025 American Academy of Allergy, Asthma, & Immunology (AAAAI) annual meeting in San Diego from February 28 – March 3, aimed at seeing whether oral immunotherapy boosts health-related quality of life. Led by Sophie Rosser, MSc, from the Murdoch Children’s Research Institute, investigators searched MEDLINE, Embase, CENTRAL, and Google Scholar on July 27, 2024, for randomized trials that compared oral immunotherapy with any comparator and measured health-related quality of life using a validated instrument. Studies had data on health-related quality of life during treatment, short-term post-treatment (≤ 12 months), or long-term post-treatment (> 12 months).

Investigators contacted the original study authors for this information for trials with unreported health-related quality of life scores. The team completed their data search in October 2024. This meta-analysis included 10 trials, with 9 on peanuts and 1 on milk.

Rosser and colleagues observed no group differences for active peanut oral immunotherapy among parent proxy-reported child (g = - 0.07; 95% confidence interval [CI], - 0.19 to 0.04) or teen self-reported (g = 0.00; 95% CI, -0.41 to 0.40) health-related quality of life. However, they did notice a weak benefit of oral immunotherapy for children who self-reported their health-related quality of life, with high heterogeneity (g = - 0.23; 95% CI, -0.73 to 0.27).

The team observed significant improvement in the parent proxy-reported child health-related quality of life for oral immunotherapy compared with the control group at 12 months post-treatment (g = -0.51; 95% CI, -0.84 to -0.19). A single trial reported even greater improvement at 4 years post-treatment (g = -0.87; 95% CI, -1.52 to -0.22).

Conversely, the milk study found no group differences in health-related quality of life in children during treatment (P > .05).

“[Health-related quality of life] benefits of [oral immunotherapy] are observed post-treatment, with limited evidence of benefit during active treatment,” investigators concluded. “Continued exploration of long-term [oral immunotherapy] effects and into a range of allergens is crucial for informing clinical practice.”

References

1. Rosser, S, Llyod, M, Tang, P, et al. A systematic review and meta-analysis of the effect of oral immunotherapy on food allergy-related quality of life. Late breaker presented at AAAAI 2025 in San Diego from February 28 – March 3.

2. The Current State of Oral Immunotherapy. American Academy of Allergy, Asthma & Immunology. January 10, 2025. https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/the-current-state-of-oral-immunotherapy. Accessed February 21, 2025.