Peanut Oral Immunotherapy Updosing via In-Office, Video, and Telephone Encounters: Safety and Caregiver Satisfaction.

BACKGROUND: Peanut oral immunotherapy (POIT) in infants and toddlers is highly efficacious and can facilitate ad lib peanut consumption. However, traditional protocols require all updosing to occur in the office setting, creating logistical barriers for both families and allergy/immunology practices. OBJECTIVE: To evaluate caregiver satisfaction and safety of POIT with home updosing, facilitated through telephone and video encounters. METHODS: Children aged 6-47 months with peanut allergy underwent POIT with updosing through telephone, video, and in-office encounters. Reaction rates were prospectively recorded, and caregivers completed a satisfaction survey at protocol completion. RESULTS: Fifty-three children completed the POIT protocol (median age, 13 months [IQR, 11-18]). Fourteen children (26.4%) experienced 24 treatment-related reactions; 54.2% resolved spontaneously, 41.7% improved with antihistamines, and one reaction (4.2%) required epinephrine during an in-office updosing encounter. Three reactions occurred during updosing, for a rate of 0.4% risk of reaction per dose, with 0.1% risk of requiring epinephrine. Although the odds of reaction were higher during updosing (OR = 2.34, 95% CI = 0.69-7.96), the difference in reaction rate did not reach statistical significance when comparing updosing to home maintenance dosing (p=0.16). Most caregivers (71.7%) preferred a combination of all three encounter types for updosing, citing convenience and reduced travel time as advantages. CONCLUSION: Updosing encounters for infant and toddler POIT are safe to complete via video and telephone encounters. Families prefer a combination of encounter types for updosing, including in-office, video and telephone encounters, commonly citing added convenience and lack of travel time as advantages of this hybrid approach.