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Bjelac J, Shaker M, Greenhawt M, Kodish E. Viewing Pediatric Food Oral Immunotherapy Through an Ethical Lens-A Narrative Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1914-1925. [PMID: 36965706 DOI: 10.1016/j.jaip.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/31/2023] [Accepted: 03/11/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Food allergy remains a common problem and a lifelong condition for many children. In recent years, food allergy management has increasingly involved conversations about food oral immunotherapy (OIT). Although ethical considerations of autonomy, beneficence, nonmaleficence, and justice implicitly inform these conversations, applying these principles can be complex, particularly in young children. Families of young children assume a role of surrogate decision-maker and must balance immediate risks with the hope of longer-term benefits. OBJECTIVE To explore implementation of OIT in children through an ethical lens. METHODS To evaluate OIT through an ethical lens, we conducted a literature search to explore currently published frameworks in this area. RESULTS Evaluation of the harm principle, the basic interest principle, and the best interest principle of parental decision-making can be informative. Shared decision-making continues to be central to the process of engaging with patient-family units to individualize the best care, at the right time, and minimize decisional discord. Although OIT is well-positioned to promote health and well-being, challenges to equity, sustainability, and organizational support must be considered to improve access for appropriate patients. CONCLUSIONS Whereas approaches to food OIT may be tailored to the individual context of each patient-family unit, ethical principles must guide decisions to initiate and continue therapy. Traditional ethical principles of autonomy, beneficence, nonmaleficence, and justice remain cornerstones when considering the ethical context of OIT.
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Affiliation(s)
- Jaclyn Bjelac
- Food Allergy Center of Excellence, Center for Pediatric Allergy and Immunology, Cleveland Clinic, Cleveland, Ohio.
| | - Marcus Shaker
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Matthew Greenhawt
- Section of Allergy/Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Eric Kodish
- Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
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Kovaltchouk U, Jeimy S, Soller L, Robertson K, Abrams EM, Cameron SB, Kim H, Chan ES. Comparing the risk of anaphylaxis requiring epinephrine in oral immunotherapy and subcutaneous immunotherapy: A review of recent Canadian real-world literature. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100080. [PMID: 37780796 PMCID: PMC10509862 DOI: 10.1016/j.jacig.2023.100080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/27/2022] [Accepted: 12/06/2022] [Indexed: 10/03/2023]
Abstract
Background The safety of pediatric food oral immunotherapy (Ped-OIT) has been depicted by some as less favorable than subcutaneous immunotherapy (SCIT) owing to the increased number of serious adverse events requiring epinephrine. A review of real-world data comparing Ped-OIT and SCIT safety is necessary to guide shared decision making. Objectives Our aim was to compare the safety and adverse event profiles of peanut Ped-OIT and SCIT using Canadian real-word literature. Methods We performed a retrospective review of recent Canadian real-world literature on peanut Ped-OIT and SCIT safety and adverse events. Results The incidences of systemic reactions requiring epinephrine were 11 in 270 patients (4.07%) and 12 in 41,020 doses (0.029%) in a multicenter study in British Columbia, Alberta, Manitoba, and Nova Scotia studying 270 preschool-age children treated with peanut OIT. Similarly, a multicenter study in South-Western Ontario examining 160 patients between the ages of 1 and 17 years who were treated with peanut OIT showed that the incidences of systemic reactions requiring epinephrine were 5 in 160 patients (3.1%) and 8 in 52,751 doses (0.015%). A single-center retrospective review of 380 patients receiving aeroallergen SCIT showed that the incidences of systemic reactions requiring epinephrine were 28 in 380 patients (7.4%) and 1 in 1047 injection visits (0.095%). These findings are comparable to those of a review of 860 patients in Ontario who received either aeroallergen or venom SCIT, in which the incidence of systemic reaction requiring epinephrine was 10 in 4242 injections (0.24%). Conclusion Despite differences in the OIT protocols used and age groups studied, recent real-world data suggest that the safety of preschool peanut OIT or peanut OIT using a slower buildup schedule is comparable to that of SCIT.
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Affiliation(s)
- Uliana Kovaltchouk
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
| | - Lianne Soller
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Robertson
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
| | - Elissa M. Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott B. Cameron
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Edmond S. Chan
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
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Patel N, Shreffler WG, Custovic A, Santos AF. Will Oral Food Challenges Still Be Part of Allergy Care in 10 Years' Time? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:988-996. [PMID: 36822320 PMCID: PMC10698627 DOI: 10.1016/j.jaip.2023.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/05/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
Oral food challenges (OFCs) are currently the definitive diagnostic procedure in food allergy. Their design has evolved over the decades to maximize safety, optimize convenience, and address several specific clinical questions. However, they are a resource-intensive investigation that carry a risk for severe allergic reaction in which fatal outcomes, although rare, have been reported. In this review, we explore the many roles that OFC fulfil in the clinical and research settings. We also discuss progress that has been made in developing alternative diagnostic tools and how far these have reached in offering a viable replacement to OFC in clinical practice. Finally, we discuss the ongoing importance of research OFC to improve the future diagnostic capabilities of novel diagnostic tools.
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Affiliation(s)
- Nandinee Patel
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Wayne G Shreffler
- Food Allergy Center and Center for Immunology and Inflammatory Disease, Massachusetts General Hospital/Harvard Medical School, Boston, Mass
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom.
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Lloyd M, Patel N, Munblit D, Tang MLK. Endpoints and Outcomes After Immunotherapy for Food Allergy: What Is Meaningful for Patients? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:998-1007. [PMID: 36736959 DOI: 10.1016/j.jaip.2023.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 02/04/2023]
Abstract
Multiple novel interventions for food allergy are currently at various stages of development with the goal of reducing or eliminating allergic reactions. However, the relative success of these therapeutics in achieving meaningful, long-term improvements to patients' lives is difficult to determine as there is currently very limited understanding of the degree of alignment between clinical trial efficacy endpoints and patient-centered outcomes. Furthermore, outcome measures used in clinical trials of food allergy immunotherapies vary widely, are often misinterpreted, and not necessarily consistent with what patients expect to achieve through treatment. This review aims to assist clinicians in critically interpreting outcomes reported in clinical trials and accurately communicating risks and outcomes to patients when practicing shared decision-making.
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Affiliation(s)
- Melanie Lloyd
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Nandinee Patel
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Daniel Munblit
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia.
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Turner PJ, Tang MLK, Wood RA. Food Allergy and Eosinophilic Gastrointestinal Diseases-The Next 10 Years. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:72-78. [PMID: 36371062 DOI: 10.1016/j.jaip.2022.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022]
Abstract
The first report of food allergy desensitization was in 1908, at least a few years before the first published description of a diagnostic test for food allergy. It has taken almost 100 years for food allergy to move from passive management of avoidance to a more proactive approach including prevention and treatment. In parallel, this has been matched by recognition of eosinophil gastrointestinal diseases, which were first described in the 1980s (although eosinophilic esophagitis was itself described in 1978). As we celebrate 10 years of The Journal of Allergy and Clinical Immunology: In Practice, we take the opportunity to look into the future and speculate how our practice may develop over the next decade.
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Affiliation(s)
- Paul J Turner
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| | - Robert A Wood
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
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Wasserman RL. Long term oral immunotherapy management and assessment of success. JOURNAL OF FOOD ALLERGY 2022; 4:102-105. [PMID: 39021850 PMCID: PMC11250640 DOI: 10.2500/jfa.2022.4.220015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
There is limited data addressing the optimal dose, dosing frequency, and duration of OIT maintenance. Using higher maintenance doses, more frequent dosing, and a long dosing duration makes it more likely that sustained unresponsiveness will be achieved but also increases the burden of care on the OIT patient and family. The OIT maintenance regimen should be individualized based on the treatment goals of the patient and family.
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Affiliation(s)
- Richard L Wasserman
- From Pediatric Allergy and Immunology, Medical City Children's Hospital, Dallas, Texas
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Nagendran S, Patel N, Turner PJ. Oral immunotherapy for food allergy in children: is it worth it? Expert Rev Clin Immunol 2022; 18:363-376. [PMID: 35285356 DOI: 10.1080/1744666x.2022.2053675] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Oral immunotherapy (OIT) is effective at inducing desensitization in food-allergic individuals, and is a valid therapeutic option for those allergic to peanut, cow's milk and egg. However, there is a high rate of dose-related adverse events, and at least one fatality to OIT has been reported. AREAS COVERED We provide an update on the broader framework of issues which will impact on the availability and uptake of OIT. EXPERT OPINION The need for standardized products remains controversial. A licensed product exists for peanut-OIT, but OIT can also be safely achieved using peanut-containing foods at much lower cost. For other allergens, OIT can only be done with non-pharma products - something which has been done safely for over 2 decades. There is a need to develop personalized protocols for OIT, particularly for the 20% of patients unable to tolerate standard OIT. Cost-effectiveness is dependent on improved quality of life, but evidence for this is currently lacking, and is a key evidence gap. OIT is likely to be cost-effective, particularly if noncommercial products are used. There may be a trade-off: in patients with lower reaction thresholds, a commercial product may be needed for initial updosing, until a level of desensitization is achieved when they can be switched to natural food products.
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Affiliation(s)
| | - Nandinee Patel
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, UK
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Kotsapas C, Nicolaou N, Haider S, Kerry G, Turner PJ, Murray CS, Simpson A, Custovic A. Early-life predictors and risk factors of peanut allergy, and its association with asthma in later-life: Population-based birth cohort study. Clin Exp Allergy 2022; 52:646-657. [PMID: 35108754 PMCID: PMC9303430 DOI: 10.1111/cea.14103] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Understanding risk factors for peanut allergy (PA) is essential to develop effective preventive measures. OBJECTIVE To ascertain associates and predictors of PA, and the relationship between PA and asthma severity. METHODS In a population-based birth cohort, we investigated the association between objectively confirmed PA with early-life environmental exposures, filaggrin (FLG)-loss-of-function mutations and other atopic disease. We then examined the association of PA with longitudinal trajectories of sensitisation, wheeze and allergic comorbidities, which were previously derived using machine learning. Finally, we ascertained the relationship between PA and asthma severity. RESULTS PA was confirmed in 30/959 participants with evaluable data. In the multivariate analysis, eczema in infancy (OR=4.4, 95% CI 1.5-13.2, p=0.007), egg sensitisation at age 3 years (OR=9.7, 95% CI 3.3-29.9, p<0.001) and early-life cat ownership (OR=3.0, 95% CI 1.1-8.4, p=0.04) were independent associates of PA. In the stratified analysis among 700 participants with genetic information, in children with early-life eczema there was no difference in FLG mutations between children with and without PA (3/18 [16.7%] vs. 42/220 [19.1%], p=1.00). In contrast, among children without eczema, those with PA were almost 8-times more likely to have FLG mutations (2/6 [33.3%] vs. 27/456 [5.9%], p=0.049). We observed associations between PA and multiple allergic sensitisation profiles derived using machine learning, with ~60-fold increase in risk amongst individuals assigned to multiple early sensitisation. PA was significantly associated with persistent wheeze (but not other wheeze phenotypes), and with trajectories of atopic disease characterised by co-morbid persistent eczema and wheeze (but not with transient phenotypes). Children with PA were more likely to have asthma, but among asthmatics we found no evidence of an association between PA and asthma severity. CONCLUSIONS Peanut allergy is associated with multiple IgE-sensitisation and early-onset persistent eczema and wheeze. FLG loss-of-function mutations were associated with peanut allergy in children without eczema.
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Affiliation(s)
| | - Nicolaos Nicolaou
- University of Nicosia Medical School, Cyprus.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sadia Haider
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Gina Kerry
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Paul J Turner
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Clare S Murray
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Science Centre and NIHR Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
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Muraro A, Sublett JW, Haselkorn T, Nilsson C, Casale TB. Incidence of anaphylaxis and accidental peanut exposure: A systematic review. Clin Transl Allergy 2021; 11:e12064. [PMID: 34708943 PMCID: PMC8694181 DOI: 10.1002/clt2.12064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/14/2021] [Accepted: 08/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Peanut allergy (PA), a common food allergy, is increasing in prevalence and is associated with high rates of anaphylaxis. Prevalence of food-related anaphylaxis is higher in children and adolescents than in adults, and the pediatric incidence is increasing. We conducted a systematic literature review and meta-analysis to determine the incidence of peanut-induced anaphylaxis in children and/or adolescents with PA. METHODS Literature searches were conducted using the PubMed database and through supplemental methods. Eligible articles for inclusion were peer-reviewed studies published in English that reported the incidence of anaphylaxis in pediatric PA using the 2006 National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network criteria, sample size, and follow-up duration. Incidence rates were calculated as person-years at risk or a crude incidence rate was calculated. Meta-analyses of pooled data were conducted using the I2 statistic as the measure of heterogeneity. RESULTS A total of 830 citations were screened; 8 met the study inclusion criteria and were selected for review. Pooled meta-analysis estimates of the incidence of (1) anaphylaxis among children/adolescents with food allergies, (2) anaphylaxis among children/adolescents with PA, and (3) accidental exposure to peanuts among children/adolescents with PA were 3.72 cases per 100 person-years (95% confidence interval [CI] = 2.35, 5.10), 2.74 cases per 100 person-years (95% CI = 1.42, 4.05), and 12.28 cases per 100 person-years (95% CI = 11.51, 13.05), respectively. CONCLUSIONS The risks of anaphylaxis among children with food allergies and those with PA contribute to the serious overall burden of PA and food allergy for children and their families.
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Affiliation(s)
- Antonella Muraro
- Department of Woman and Child Health, Food Allergy Referral Centre Veneto Region, Padua University Hospital, Padua, Italy
| | | | | | - Caroline Nilsson
- Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Thomas B Casale
- Food Allergy Research and Education (FARE), University of South Florida, Tampa, Florida, USA
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Lieberman JA, Gupta RS, Knibb RC, Haselkorn T, Tilles S, Mack DP, Pouessel G. The global burden of illness of peanut allergy: A comprehensive literature review. Allergy 2021; 76:1367-1384. [PMID: 33216994 PMCID: PMC8247890 DOI: 10.1111/all.14666] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 10/30/2020] [Accepted: 11/14/2020] [Indexed: 01/05/2023]
Abstract
Peanut allergy (PA) currently affects approximately 2% of the general population of Western nations and may be increasing in prevalence. Patients with PA and their families/caregivers bear a considerable burden of self‐management to avoid accidental peanut exposure and to administer emergency medication (adrenaline) if needed. Compared with other food allergies, PA is associated with higher rates of accidental exposure, severe reactions and potentially fatal anaphylaxis. Approximately 7%–14% of patients with PA experience accidental peanut exposure annually, and one‐third to one‐half may experience anaphylaxis, although fatalities are rare. These risks impose considerably high healthcare utilization and economic costs for patients with PA and restrictions on daily activities. Measures to accommodate patients with PA are often inadequate, with inconsistent standards for food labelling and inadequate safety policies in public establishments such as restaurants and schools. Children with PA are often bullied, resulting in sadness, humiliation and anxiety. These factors cumulatively contribute to significantly reduced health‐related quality of life for patients with PA and families/caregivers. Such factors also provide essential context for risk/benefit assessments of new PA therapies. This narrative review comprehensively assessed the various factors comprising the burden of PA.
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Affiliation(s)
- Jay A. Lieberman
- University of Tennessee Health Science Center/Le Bonheur Children’s Hospital Memphis TN USA
| | - Ruchi S Gupta
- Institute for Public Health and Medicine Ann & Robert H. Lurie Children's Hospital of ChicagoNorthwestern School of Medicine Chicago IL USA
| | | | | | | | - Douglas P. Mack
- Department of Pediatrics McMaster University Hamilton ON Canada
| | - Guillaume Pouessel
- Pneumology and Allergology Unit Children's HospitalLille University Hospital Jeanne de Flandre France
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Dufresne É, Poder TG, Samaan K, Lacombe‐Barrios J, Paradis L, Des Roches A, Bégin P. SF-6Dv2 preference value set for health utility in food allergy. Allergy 2021; 76:326-338. [PMID: 32533705 DOI: 10.1111/all.14444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/13/2020] [Accepted: 04/13/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The lack of a value set allowing the calculation of QALY is an important limitation when establishing the value of emerging therapies to treat food allergy. The aim of this study was to develop a Short-Form Six-Dimension version 2 (SF-6Dv2) preference value set for the calculation of health utility from the Canadian food-allergic population. METHODS Two hundred ninety-five parents of patients aged 0-17 years old and 154 patients aged 12 years old and above with food allergy were recruited in clinic and online. Participants were asked to complete a self-administered online questionnaire including generic health-related quality of life questionnaires. Various health states described by the SF-6Dv2 were valued with time-trade-off and discrete choice experiments. Data from elicitation techniques were combined using the hybrid regression model. RESULTS A total of 241 parents and 125 patients performed 3904 time-trade-off and 5112 discrete choice experiments. Utility decrements were estimated for each level of each SF-6Dv2 dimension. Utility values calculated based on the validated preference set were in average 0.15 lower (95%CI: 0.12-0.18) and were poorly correlated (R2 = 0.46) with those derived from the EQ-5D-5L generic questionnaire in the same cohort. CONCLUSION A representative preference value set for patients with food allergy was determined using the SF-6Dv2 generic questionnaire. This adapted preference set will contribute to improve the validity of future utility estimates in this population for the appraisal of upcoming potentially impactful but sometimes costly therapies.
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Affiliation(s)
- Élise Dufresne
- Department of Medicine Université de Montréal Montreal QC Canada
| | - Thomas G. Poder
- Department of Management, Evaluation and Health Policy School of Public Health Université de Montréal Montreal QC Canada
- Research center of the Institut universitaire de santé mentale de Montréal Montreal QC Canada
| | - Kathryn Samaan
- Departement of Pediatrics Centre Hospitalier Universitaire Sainte‐Justine Montreal QC Canada
| | | | - Louis Paradis
- Department of Medicine Université de Montréal Montreal QC Canada
- Departement of Pediatrics Centre Hospitalier Universitaire Sainte‐Justine Montreal QC Canada
| | - Anne Des Roches
- Departement of Pediatrics Centre Hospitalier Universitaire Sainte‐Justine Montreal QC Canada
| | - Philippe Bégin
- Department of Medicine Université de Montréal Montreal QC Canada
- Departement of Pediatrics Centre Hospitalier Universitaire Sainte‐Justine Montreal QC Canada
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Herbert L, Marchisotto MJ, Vickery B. Patients' Perspectives and Needs on Novel Food Allergy Treatments in the United States. CURRENT TREATMENT OPTIONS IN ALLERGY 2021; 8:9-20. [PMID: 33520599 PMCID: PMC7825384 DOI: 10.1007/s40521-020-00274-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Food allergy management places a daily psychosocial burden on patients and their caregivers. New food allergy treatments may positively impact their lives, but also introduce new stressors. The purpose of this paper is to provide an overview of the current state of the literature regarding patients' and caregivers' food allergy experiences and needs within the United States as well as a set of recommendations regarding how best to proceed with patient-centered development and evaluation of new food allergy treatments. RECENT FINDINGS The first pharmaceutical-grade product for peanut oral immunotherapy was approved in the United States for children aged 4-17 years following a successful international Phase 3 trial. This new treatment is only the first of several food allergy treatments currently under development. Patients will soon be presented with multiple options for food allergy treatment and will need to make decisions about what treatment is best for them. SUMMARY Allergy researchers and providers are encouraged to consider patients' perspectives and needs when developing and evaluating new food allergy treatments. Recommendations regarding next steps include the development of new patient-reported outcome tools, focus on psychosocial support, health disparities, and financial implications, and research harmonization and interdisciplinary collaboration.
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Affiliation(s)
- Linda Herbert
- Children’s National Hospital, 111 Michigan Ave, NW, Washington, DC 20010 USA ,George Washington University School of Medicine, Washington, DC USA
| | - Mary Jane Marchisotto
- MJM Advisory, New York, NY USA ,Mary H. Weiser Food Allergy Center, University of Michigan Medicine, Ann Arbor, MI USA
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Abstract
PURPOSE OF REVIEW To critically appraise the recent most relevant studies in the rapidly advancing field of food oral and sublingual immunotherapy. RECENT FINDINGS Food allergen-specific immunotherapy via oral (OIT) and sublingual route (SLIT) increases the threshold of reactivity to peanut, cow's milk, egg, wheat, and many other foods in the majority of the treated individuals. This desensitized state is contingent upon the continued ingestion of the maintenance doses of the food. Permanent oral tolerance is achievable in a smaller subset of the treated individuals. The optimal duration of therapy has not been firmly established but is likely dependent on the phenotype (severity and persistence). Efficacy of food-OIT is superior compared with SLIT, whereas the safety of OIT is less favorable. Standardization of treatment protocols, maintenance dosing, duration of therapy, target populations and harmonization of the outcomes are top priorities at this stage. SUMMARY OIT and SLIT represent two different routes of food allergen-specific immunotherapy. Although significant progress has been made in the last decade, both treatment modalities are still in the very early stages of development and further investigations are necessary to optimize the protocols and improve safety while maximizing efficacy.
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Dufresne É, Poder TG, Bégin P. The value of oral immunotherapy. Allergy 2020; 75:1291-1293. [PMID: 31579934 DOI: 10.1111/all.14072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/20/2019] [Accepted: 09/26/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Élise Dufresne
- Departement of Medicine Université de Montréal Montreal QC Canada
| | - Thomas G. Poder
- Department of Management, Evaluation and Health Policy School of Public Health University of Montreal Montreal QC Canada
- Research Center of the Institut Universitaire de Santé Mentale de Montréal Montreal QC Canada
| | - Philippe Bégin
- Departement of Medicine Université de Montréal Montreal QC Canada
- Departement of Pediatrics Centre Hospitalier Universitaire Sainte‐Justine Montreal QC Canada
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15
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Abstract
Purpose of the Review Peanut oral immunotherapy (OIT) is one of the most studied experimental therapies for food allergy. With the recently FDA-approved peanut product, Palforzia, the goal of this article is to review the most recent data from clinical trials, discuss recent trends, and anticipate future developments. Recent Findings The latest research suggests that peanut OIT could be a promising option for peanut-allergic patients, with the majority of participants in research studies achieving the primary efficacy endpoint of desensitization, as well as sustained unresponsiveness in select populations. Some studies also showed improvements in food allergy-related quality of life. However, peanut OIT is not without risk or side effects, including potentially serious allergic reactions. Summary Future research will need to evaluate the short- and long-term effectiveness of the therapy in the real-world setting, predictors of important treatment outcomes, and the use of adjunctive therapies that may mitigate some of these allergic reactions.
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Affiliation(s)
- Meera Patrawala
- Emory University School of Medicine, 1400 Tullie Road NE 5th floor, Atlanta, GA 30329 USA
- Children’s Healthcare of Atlanta, 1400 Tullie Road NE 5th floor, Atlanta, GA 30329 USA
| | - Jennifer Shih
- Emory University School of Medicine, 1400 Tullie Road NE 5th floor, Atlanta, GA 30329 USA
- Children’s Healthcare of Atlanta, 1400 Tullie Road NE 5th floor, Atlanta, GA 30329 USA
| | - Gerald Lee
- Emory University School of Medicine, 1400 Tullie Road NE 5th floor, Atlanta, GA 30329 USA
- Children’s Healthcare of Atlanta, 1400 Tullie Road NE 5th floor, Atlanta, GA 30329 USA
| | - Brian Vickery
- Children’s Healthcare of Atlanta, 1400 Tullie Road NE 5th floor, Atlanta, GA 30329 USA
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16
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Long A, Borro M, Sampath V, Chinthrajah RS. New Developments in Non-allergen-specific Therapy for the Treatment of Food Allergy. Curr Allergy Asthma Rep 2020; 20:3. [PMID: 31950290 DOI: 10.1007/s11882-020-0897-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The prevalence of food allergy is increasing. At the current time, there are no approved treatments for food allergy. Major limitations of immunotherapy are long treatment periods (months or years), frequent clinic visits, high costs, increased risk of adverse events during treatment, and lack of durability of desensitization. Additionally, it is allergen-specific, and in those allergic to multiple allergens, the length and cost of treatment are further increased. In this review, we summarize recent developments in novel non-allergen-specific treatments for food allergy. RECENT FINDINGS A number of monoclonal antibodies that block IgE or specific pro-allergenic cytokines or their receptors have shown promise in clinical trials for food allergy. The insight we have gained through the use of one drug for the treatment of an atopic disease is quickly being translated to other atopic diseases, including food allergy. The future for food allergy treatment with biologics looks bright.
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Affiliation(s)
- Andrew Long
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Grant Building, S093, 300 Pasteur Dr., Stanford, CA, 94305-5101, USA.,Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA
| | - Matteo Borro
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Grant Building, S093, 300 Pasteur Dr., Stanford, CA, 94305-5101, USA.,Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA.,Department of Internal Medicine, Clinical Immunology Unit, University of Genoa and Policlinico San Martino, Genoa, Italy
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Grant Building, S093, 300 Pasteur Dr., Stanford, CA, 94305-5101, USA.,Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Grant Building, S093, 300 Pasteur Dr., Stanford, CA, 94305-5101, USA. .,Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA.
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