Efficacy and safety of sublingual immunotherapy for peanut allergy: A systematic review and meta-analysis

Background: Current management strategies for peanut allergy involve shared decision-making and several treatment modalities, including immunotherapy. Sublingual immunotherapy (SLIT) is emerging as a potential safer option for peanut immunotherapy. Objective: We sought to systematically evaluate the efficacy and safety of SLIT for peanut allergy management in comparison with placebo. Methods: We searched four data bases for randomized controlled trials (RCT). Outcomes of interest were tolerated dose during double-blind placebo controlled food challenge (DBPCFC), immunoglobulin E (IgE) and IgG4 levels, skin-prick test (SPT) and adverse events (AE). Results: We identified three RCTs, comprising 108 patients with peanut allergy. There was a statistically significant increase in IgG4 levels (standardized mean difference [SMD] 0.56 kU/L [95% confidence interval [CI], 0.17-0.96 kU/L) and oropharyngeal AE (risk ratio [RR] 19.90 [95% CI, 4.00-99.07]) in the SLIT group. No significant difference in DBPCFC after treatment (mean difference [MD] 1612.90 mg [95% CI, −949.93 to 4175.74 mg]) and IgE levels (SMD −0.54 [95% CI, −1.46 to 0.37]) was observed. Respiratory, skin, and gastrointestinal AE incidences in the SLIT group were comparable with the placebo group (RR 2.11 [95% CI, 0.18-25.18], RR 1.57 [95% CI, 0.06-39.13], RR 3.51 [95% CI, 0.30-40.87], respectively). In children, SLIT showed improvement in DBPCFC results (MD 2529.57 mg [95% CI, 347.39-4711.75]) and SPT (MD −8.60 mm [95% CI, −11.13 to −6.07 mm). Conclusion: Our meta-analysis demonstrated peanut SLIT safety and demonstrated a desensitization potential in children.