Peanut allergy
A product for oral immunotherapy (OIT) to peanut has been recently licensed by FDA and EMA and will soon become widely available109,110. Other products and routes of administration have been explored111.
Peanut allergic reactions can be triggered by storage proteins, such as Ara h 1,2,3,6112, which have been associated to life-threatening symptoms, as well as by cross-reactive allergens, such as Ara h 5113, a profilin associated to grass pollen allergy, Ara h 8, belonging to PR10 family and associated to birch pollinosis and Ara h 9, a nsLTP, associated to the LTP syndrome discussed earlier(Table 1). Symptoms elicited by Ara h 5 and Ara h 8 are usually mild and limited to the oral cavity, the oropharynx, known as oral allergy syndrome. Ara h 2 sIgE levels are associated to both severity and threshold of allergic reactions during oral provocation challenges, thus being a good biomarker for severity.114,115. In fact, Ara h 2 is the dominant 2S globulin allergen116. As storage proteins can trigger systemic food allergic reactions and anaphylaxis, peanut allergy with confirmed sensitization to seed storage proteins like Ara h 1,2,6 can constitute an indication for POIT to peanut.
A summary of the decision process to select POIT is shown in Figure 8.