Immunotherapy approaches for peanut allergy

Introduction: Peanut allergy has continued to increase in prevalence and despite efforts to prevent the allergy with early peanut introduction, treatments for those already with the allergy have been lacking. While the physical effects of peanut allergy have been well known, what has more recently begun to be discussed are the broad psychosocial and financial implications that are also related to the allergy. Oral (OIT), epicutaneous (EPIT), and sublingual (SLIT) immunotherapy have been developed as potential treatments for peanut allergy.Areas covered: Pivotal clinical trials in OIT, EPIT, and SLIT from the past 10 years are reviewed in this manuscript. Peanut OIT has been shown to induce strong desensitization; however, side effects and safety of the treatment have remained a concern. Peanut EPIT has demonstrated a reassuring safety profile but with a more modest protective effect. Peanut SLIT has remained behind in development but recent studies have suggested a balance of desensitization, safety, and convenience.Expert opinion: There are no perfect treatments for peanut allergy and OIT, EPIT, and SLIT each has its unique pros and cons. Shared decision-making between patients and providers will be essential to achieve optimal care for patients with peanut allergy.