Sustained unresponsiveness is maintained despite erratic peanut consumption after home-based induction: telephone follow up

We have previously shown (Garvey JACI-IP 2017) that some highly selected, “high-dose tolerant” peanut allergic children can achieve sustained unresponsiveness to peanut in a home-based induction program. It is not known whether this unsreponsiveness is permanent, when it could be defined as genuine tolerance. Telephone survey of ten children from the published paper who achieved desensitization (2/10) or sustained unsresponsiveness (8/10) and been advised to keep eating peanut 3 times a week indefinitely. Follow-up interval ranged from 1.4 to 3.5 years. Only three children (30%) are eating peanut three or more times a weeks, as advised. Two children (20%) have completely stopped consuming peanut by choice. Five children (50%) eat peanuts less than the advised 3 times/week (including one who just eats food with precautionary labelling about peanut). No subject reported interval reactions to peanut either eaten deliberately, as advised, or accidentaly. All parents report to feel safer since they have completed this programm. Just two of the children still carry their epinephrine pens as they have other food allergies (egg and tree nut respectively). Compliance with post program advice to continue consumption of peanut was very erratic, but no allergic reactions occurred in any subject, irrespective of either compliance or accidental exposure to peanut. This suggests that true tolerance has been achieved by home based exposure to peanut in a select group of “high-dose tolerant” peanut allergic children. More formal prospective studies are needed to confirm this finding.