Oral immunotherapy for peanut allergy: a systematic review and meta-analysis
Why this work is in the frame
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Bibliographic record
Abstract
Oral immunotherapy (OIT) is an emerging experimental treatment for peanut allergy, but its benefits and harms are unclear. We systematically reviewed the efficacy and safety of OIT versus allergen avoidance/placebo (no OIT) for peanut allergy. In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, CENTRAL, LILACS, 中国知网/CNKI, ICTRP, EMA, and FDA databases from inception to December 6, 2018 for randomised trials comparing OIT versus no OIT for peanut allergy. We screened studies, extracted data and assessed risk of bias independently in duplicate. Main outcomes included anaphylaxis, allergic/adverse reactions, epinephrine use and quality of life (QoL), meta-analysed by random effects. We assessed certainty (quality) of evidence by the GRADE approach. PROSPERO CRD42019117930 12 trials (n=1041; median age across trials 8.7 years [IQR 5.9-11.2]) showed that OIT versus no OIT increased anaphylaxis risk (risk ratio [RR] 3.26 [95%CI:1.86-5.73], I2=0%, risk difference [RD]=+16.0%, high-certainty), frequency (incidence rate ratio [IRR] 2.94 [95%CI:1.73-5.01], I2=0%, RD=+13.8%, high-certainty), and epinephrine use (RR 2.21 [95%CI:1.27-3.83], I2=0%, RD=+4.5%, high-certainty) similarly during build-up and maintenance (pinteraction=0.92). OIT increased serious adverse events (RR 1.92 [95%CI:1.00-3.66], I2=0%, RD=+5.7%, moderate-certainty), and non-anaphylactic reactions (e.g. vomiting, RR 1.79 [95%CI:1.35-2.38], I2=0%, RD=+14.7%, high-certainty). Passing a supervised challenge, a surrogate for preventing out-of-clinic reactions, was more likely with OIT (RR 12.42 [95%CI:6.82-22.61], I2=0%, RD=+36.5%, high-certainty). QoL was not different between groups (RR 1.14 [95%CI:0.66-1.99], I2=0%, RD=+0.03%, low-certainty). Findings were robust to IRR, trial sequential, subgroup, and sensitivity analyses. In patients with peanut allergy, there is high-certainty evidence that current peanut OIT regimens considerably increase allergic and anaphylactic reactions over avoidance/placebo, despite effectively inducing desensitisation. These data support the need for safer peanut allergy treatment approaches and rigorous randomized trials that evaluate patient-important outcomes.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.003 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it