Fatigue and Physical Activity Shape Peanut OIT Reaction Risk
Real-world data suggest common daily factors may influence allergic reactions during peanut oral immunotherapy.
Most patients undergoing peanut oral immunotherapy tolerate treatment without immediate allergic reactions, but everyday factors such as physical exertion, fatigue, and poor sleep may increase the chance that a reaction occurs and that epinephrine is needed.
Study Details
Peanut oral immunotherapy, aka OIT, is increasingly used to help people with peanut allergy reduce their risk of severe reactions after accidental exposure. While clinical trials provide controlled safety data, less is known about how real-life conditions affect reaction risk during treatment.
Researchers in France examined how often allergic reactions occurred during peanut OIT in routine clinical practice and whether external factors, known as cofactors, played a role. These cofactors included recent physical activity, fatigue or sleep deprivation, and emotional stress.
Methodology
This retrospective study analyzed medical records from 295 patients with peanut allergy treated at 12 centers across France between November 2019 and July 2021.
Participants had a mean age of 10.8 years, and about two-thirds were boys. Investigators focused on immediate allergic reactions occurring within six hours of peanut ingestion during the previous year of OIT. They also reviewed the circumstances surrounding each reaction, including whether patients had exercised recently, were fatigued, or were under stress.
Key Findings
84.4% of patients did not experience any immediate allergic reaction during peanut OIT
15.6% had at least one immediate reaction
Reaction severity ranged from mild to severe, with about 11% classified as grade 4
Around half of reactions occurred alongside external cofactors
Recent physical activity was the most common cofactor, followed by fatigue or sleep deprivation and stress
Epinephrine use was significantly higher when cofactors were present compared with when they were absent
Implications for Practice
For patients and families, these findings highlight that tolerance during peanut OIT is not just about the dose. How the body is functioning at the time of dosing matters. Skipping rest, intense exercise, or dosing during periods of illness or stress may increase the chance of a reaction.
For clinicians, the study reinforces the importance of ongoing education throughout OIT. Patients should be taught to recognize and avoid high-risk situations, understand when to delay dosing, and be prepared to manage anaphylaxis. Tailoring protocols for individuals who are more sensitive to cofactors may further improve safety in real-world settings.