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Wong L, Kost L, Anderson B, Long A, Sindher SB, Chinthrajah RS, Collins WJ. Transitioning from epicutaneous to oral peanut immunotherapy. FRONTIERS IN ALLERGY 2023; 4:1089308. [PMID: 36814725 PMCID: PMC9939758 DOI: 10.3389/falgy.2023.1089308] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
Introduction Epicutaneous immunotherapy (EPIT) has been tested in clinical trials for children with peanut allergy (PA) for its safety and efficacy in inducing desensitization. Aside from peanut avoidance and symptom management, oral immunotherapy (OIT) is another option for PA patients. However, OIT can be associated with adverse events and pose safety concerns to children and their caregivers. Methods This study assessed 27 children who successfully completed a peanut EPIT trial. 18 of them transitioned to peanut OIT with starting doses ranging from 10-600 mg of peanut protein. Our aim was to learn more about the EPIT to OIT experience through descriptive survey responses and to gather information that may support the sequential use of the two immunotherapies for safe and positive outcomes that may not be achieved by either alone. Results Overall, children and their caregivers had less anxiety about starting OIT after having had peanut exposure through EPIT. Most children who transitioned from EPIT to OIT had no or minor symptoms initially, with symptoms lessening later in OIT. Most were also able to maintain or increase their peanut dose over time, achieving maintenance doses of 60-2,000 mg. Discussion In comparison with current literature on OIT for PA in children, the reported symptoms appeared less severe and less prevalent in the EPIT to OIT group. However, there were 3 participants who withdrew from OIT due to the development of intolerable symptoms. This study provides initial data in support of EPIT to OIT, and larger randomized controlled trials assessing effectiveness of the two therapies together are warranted.
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Affiliation(s)
- Lauren Wong
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - Laurie Kost
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - Brent Anderson
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - Andrew Long
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - Sayantani B. Sindher
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - R. Sharon Chinthrajah
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States
| | - William J. Collins
- Sean N Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, United States,Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States,Correspondence: William J. Collins
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3
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Tontini C, Bulfone-Paus S. Novel Approaches in the Inhibition of IgE-Induced Mast Cell Reactivity in Food Allergy. Front Immunol 2021; 12:613461. [PMID: 34456900 PMCID: PMC8387944 DOI: 10.3389/fimmu.2021.613461] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 06/23/2021] [Indexed: 01/21/2023] Open
Abstract
Allergy is an IgE-dependent type-I hypersensitivity reaction that can lead to life-threatening systemic symptoms such as anaphylaxis. In the pathogenesis of the allergic response, the common upstream event is the binding of allergens to specific IgE, inducing cross-linking of the high-affinity FcεRI on mast cells, triggering cellular degranulation and the release of histamine, proteases, lipids mediators, cytokines and chemokines with inflammatory activity. A number of novel therapeutic options to curb mast cell activation are in the pipeline for the treatment of severe allergies. In addition to anti-IgE therapy and allergen-specific immunotherapy, monoclonal antibodies targeted against several key Th2/alarmin cytokines (i.e. IL-4Rα, IL-33, TSLP), active modification of allergen-specific IgE (i.e. inhibitory compounds, monoclonal antibodies, de-sialylation), engagement of inhibitory receptors on mast cells and allergen-specific adjuvant vaccines, are new promising options to inhibit the uncontrolled release of mast cell mediators upon allergen exposure. In this review, we critically discuss the novel approaches targeting mast cells limiting allergic responses and the immunological mechanisms involved, with special interest on food allergy treatment.
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Affiliation(s)
- Chiara Tontini
- Lydia Becker Institute for Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Silvia Bulfone-Paus
- Lydia Becker Institute for Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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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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Brown-Whitehorn TF, de Blay F, Spergel JM, Green TD, Peillon A, Sampson HA, Campbell DE. Sustained unresponsiveness to peanut after long-term peanut epicutaneous immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 9:524-526. [PMID: 32835872 DOI: 10.1016/j.jaip.2020.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Frédéric de Blay
- Strasbourg University Hospital, Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | | | - Todd D Green
- DBV Technologies, Montrouge, France; UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | | | - Hugh A Sampson
- DBV Technologies, Montrouge, France; Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dianne E Campbell
- DBV Technologies, Montrouge, France; Children's Hospital at Westmead, Sydney, NSW, Australia
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Improvements in Quality of Life in Children Following Epicutaneous Immunotherapy (EPIT) for Peanut Allergy in the PEPITES and PEOPLE Studies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:216-224.e1. [PMID: 32841748 DOI: 10.1016/j.jaip.2020.08.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Food allergy quality of life (FAQL) is impaired in children with peanut allergy. Food Allergy Quality of Life Questionnaires (FAQLQs) provide disease-specific insight into the burden of peanut allergy and potential FAQL changes after peanut immunotherapy. OBJECTIVE To examine FAQL changes in children after treatment with epicutaneous immunotherapy for peanut allergy (250 μg, daily epicutaneous peanut protein; DBV712 250 μg). METHODS FAQL was prospectively measured using the FAQLQ parent proxy form (Food Allergy Quality of Life Questionnaire-Parent Proxy Form [FAQLQ-PF], for children aged ≤12 years) and child form (Food Allergy Quality of Life Questionnaire-Child Form [FAQLQ-CF], child rated if aged ≥8 years) during the 12-month double-blind, randomized, controlled Peanut EPIT Efficacy and Safety Study (PEPITES) trial and the initial 12 months of the open-label PEPITES Open Label Extension Study (PEOPLE) follow-up study. Data were analyzed for between-group differences after treatment unblinding. RESULTS FAQLQs from placebo participants (FAQLQ-PF: 96; FAQLQ-CF: 47) and treatment group participants (FAQLQ-PF: 209; FAQLQ-CF: 105) were analyzed. Twenty-four-month global FAQL scores (FAQLQ-PF/FAQLQ-CF) were significantly improved in the treatment group versus the placebo group (least squares mean, 0.34, P = .008, and 0.46, P = .023, respectively). At 24 months, there was significant FAQLQ-PF score improvement in participants initially randomized to treatment who met the efficacy primary end point (n = 74; least squares mean, 0.55; P < .001) and in participants with any eliciting dose increase (n = 127; least squares mean, 0.66; P < .001). FAQLQ-PF improvements were observed in social dietary limitations (P = .002), food-related anxiety (P = .029), and emotional impact (P = .048) domains. FAQLQ-CF improvements were observed in risk of accidental exposure (P = .002) and allergen avoidance (P = .04) domains. Nearly all outcomes met a nontreatment context minimal clinically important difference previously cited for FAQLQ. CONCLUSIONS Epicutaneous immunotherapy treatment was observed to be associated with significant global and domain-specific FAQL improvement (FAQLQ-PF/FAQLQ-CF), largely driven by increases in eliciting dose, in children with peanut allergy.
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Chan ES, Dinakar C, Gonzales-Reyes E, Green TD, Gupta R, Jones D, Wang J, Winders T, Greenhawt M. Unmet needs of children with peanut allergy: Aligning the risks and the evidence. Ann Allergy Asthma Immunol 2020; 124:479-486. [PMID: 32007568 DOI: 10.1016/j.anai.2020.01.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/05/2020] [Accepted: 01/22/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Peanut allergy is a potentially severe and lifelong allergy, with few effective treatments or preventive measures. OBJECTIVE To convene an expert panel of allergists, pediatricians, and advocates to discuss and highlight unmet needs in the prevention and management of peanut allergies. METHODS Literature searches of PubMed were performed. The panel evaluated published data on the prevention of peanut allergy, treatment of existing peanut allergy, and management of reactions after unintentional peanut exposures. RESULTS The following key unmet needs in the prevention and management of peanut allergy were identified: (1) enhancing and optimizing implementation of early peanut introduction as a means of preventing the development of peanut allergy, (2) developing knowledge translation strategies regarding the safety and efficacy data for current and emerging immunotherapies for peanut-allergic children to support their use in clinical practice, and (3) promoting understanding of true exposure risk in allergic individuals and ensuring access to epinephrine for unintentional exposures that provoke severe reactions. Practitioners should help educate caregivers about the actual risks associated with peanut allergy and its prevention and management so that treatment decisions can be evidence based rather than fear based. Support tools are needed to help address caregiver goals, expectations, and psychological barriers, as well as identify facilitators for prevention and treatment strategies. CONCLUSION There are significant unmet needs in our understanding of peanut allergy; addressing these needs will help to enhance understanding of how to most effectively prevent and treat peanut allergy, as well as educate the food-allergic and nonallergic community regarding current evidence-based practices.
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Affiliation(s)
- Edmond S Chan
- BC Children's Hospital, The University of British Columbia, Vancouver, Canada
| | | | | | - Todd D Green
- UPMC Children's Hospital of Pittsburgh, Pennsylvania; DBV Technologies, Montrouge, France
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Northwestern Medicine Feinberg School of Medicine, Chicago, Illinois; Ann & Robert H Lurie Children's Hospital of Chicago, Illinois
| | | | - Julie Wang
- The Mount Sinai Hospital, New York, New York
| | | | - Matthew Greenhawt
- Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
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Eiwegger T, Anagnostou K, Arasi S, Bégin P, Ben-Shoshan M, Beyer K, Blumchen K, Brough H, Caubet JC, Chan ES, Chen M, Chinthrajah S, Davis CM, Des Roches A, Du Toit G, Elizur A, Galli SJ, Håland G, Hoffmann-Sommergruber K, Kim H, Leung DYM, Long A, Muraro A, Nurmatov UB, Pajno GB, Sampath V, Saxena J, Sindher S, Upton J, Worm M, Nadeau KC. Conflicting verdicts on peanut oral immunotherapy from the Institute for Clinical and Economic Review and US Food and Drug Administration Advisory Committee: Where do we go from here? J Allergy Clin Immunol 2019; 145:1153-1156. [PMID: 31678426 DOI: 10.1016/j.jaci.2019.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas Eiwegger
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada; Research Institute, Translational Medicine, Hospital for Sick Children, Toronto, Canada; Department of Immunology, University of Toronto, Toronto, Canada
| | - Katherine Anagnostou
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Tex; Baylor College of Medicine, Houston, Tex
| | - Stefania Arasi
- Department of Pediatric Medicine, Pediatric Allergology Unit, Bambino Gesù Children's research Hospital (IRCCS), Rome, Italy
| | - Philippe Bégin
- Division of Immunology and Allergy, Department of Pediatrics, CHU Ste-Justine, Montreal, Canada; Division of Immunology and Allergy, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, Canada
| | - Kirsten Beyer
- Department of Pediatric Pneumology, Immunology and Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Blumchen
- Department of Children and Adolescent Medicine, Division of Pneumology, Allergology and Cystic fibrosis, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Helen Brough
- 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
| | - Jean-Christoph Caubet
- Division of Pediatric Allergy, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Meng Chen
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif
| | - Carla M Davis
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Tex; Baylor College of Medicine, Houston, Tex
| | - Anne Des Roches
- Division of Immunology and Allergy, Department of Pediatrics, CHU Ste-Justine, Montreal, Canada
| | - George Du Toit
- 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
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center and Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stephen J Galli
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Department of Pathology and Department of Microbiology and Immunology, Stanford, Calif
| | - Geir Håland
- Department of Paediatric Allergy and Pulmonology, Oslo University Hospital, Oslo, Norway
| | | | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Canada
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, and the Department of Pediatrics, University of Colorado at Denver Health Sciences Center, Aurora, Colo
| | - Andrew Long
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif
| | - Antonella Muraro
- Food Allergy Centre-Veneto Region, Department of Woman and Child Health Padua University Hospital, Padua, Italy
| | - Ulugbek B Nurmatov
- Division of Population Medicine, School of Medicine, National Centre for Population Health and Wellbeing Research, Swansea, United Kingdom
| | - Giovanni B Pajno
- Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif
| | - Jamie Saxena
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif
| | - Julia Upton
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Stanford, Calif; Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, Calif.
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