How to Incorporate Oral Immunotherapy into Your Clinical Practice

Abrams, Elissa M.; Erdle, Stephanie; Cameron, Scott; Soller, Lianne; Chan, Edmond S.

doi:10.1007/s11882-021-01009-8

Cited by 15 publications

(6 citation statements)

References 55 publications

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“…This case series did not warrant formal ethics review, since the University of British Columbia ethics committee categorized it as quality improvement. Parents were advised to introduce peanut starting from 10 mg peanut protein on a daily basis with a gradual dose increased to 320 mg ~2 weeks apart according to the previously published peanut OIT protocols that showed a low risk of anaphylaxis ( 2 , 13 ). Patients could start the OIT at a lower dose if the cumulative threshold was ≤10 mg based on OFC.…”

Section: Methodsmentioning

confidence: 99%

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Home-Based Peanut Oral Immunotherapy for Low-Risk Peanut-Allergic Preschoolers During the COVID-19 Pandemic and Beyond

et al. 2021

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The coronavirus disease 2019 (COVID-19) pandemic has led to the deprioritization of non-emergency services, such as oral food challenges and the initiation of oral immunotherapy (OIT) for food-allergic children. Recent studies have suggested that home-based peanut OIT could be a safe and effective option for low-risk peanut-allergic children. In the period between September 1, 2020, and January 31, 2021, nine preschoolers with a history of mild allergic reactions to peanut underwent home-based peanut OIT. Eight of them (88.9%) completed the build-up phase at home in 11–28 weeks, tolerating a daily maintenance dose of 320 mg peanut protein. During the build-up, six patients (75.0%) reported urticaria, three (33.3%) reported gastrointestinal tract symptoms, and one (14.3%) reported oral pruritis. None of the patients developed anaphylaxis, required epinephrine, or attended emergency services related to OIT. One or two virtual follow-up visits were completed per patient during the build-up phase. Our case series shows that home-based OIT could be offered to the low-risk preschoolers during the COVID-19 pandemic when non-emergency services are limited and could be considered beyond the pandemic, especially for the families living in the rural or remote areas that may otherwise be unable to access OIT.

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Section: Methodsmentioning

confidence: 99%

“… * World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System ( 13 ) . # Suggest introduce peanut at home or arrange observed ingestion/oral food challenge .…”

Section: Methodsmentioning

confidence: 99%

Home-Based Peanut Oral Immunotherapy for Low-Risk Peanut-Allergic Preschoolers During the COVID-19 Pandemic and Beyond

et al. 2021

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“…As a result, several guidelines, published for OIT in recent years, indicated that OIT is efficient in children, but referred to OIT in adults only as "may be indicated," due to insufficient data. [9][10][11][12] Unfortunately, alternative forms of immunotherapy for this population, such as epicutaneous immunotherapy, are currently unavailable 13 .…”

Section: Backg Rou N Dmentioning

confidence: 99%

Efficacy and safety of food allergy oral immunotherapy in adults

Epstein‐Rigbi

Levy

Nachshon

et al. 2022

Allergy

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Background Oral immunotherapy (OIT) is an emerging method for treating food allergy in children. However, data regarding adults undergoing this process are lacking. Methods We retrospectively analyzed the medical records of patients with food allergy aged ≥17 years who completed OIT treatment between April 2010 and December 2020 at Shamir Medical Center. Data were compared with that of children aged 4 to <11 years and adolescents aged ≥11 to 17 treated during the same time period. Results A total of 96 adults at a median age of 22.3 years who underwent OIT for milk (n = 53), peanut (n = 18), sesame (n = 7), egg (n = 5), and tree nuts (n = 13) were analyzed and compared with 1299 children and 309 adolescents. Adults experienced more adverse reactions requiring injectable epinephrine, both during in‐clinic up‐dosing (49% vs. 15.9% and 26.5% for children and adolescents, respectively, p < 0.0001) and during home treatment (22.9% vs. 12.4%, p = 0.007 for children, and 17.5%, p = 0.23 for adolescents). Most adults (61.5%) were fully desensitized, but the rates of full desensitization were significantly lower than children (73.4%, p = 0.013). Significantly more adults (28.3%) undergoing milk OIT failed treatment than children (14.3%, p = 0.015) and adolescents (14.1%, p = 0.022), while failure rates in adults undergoing OIT for other foods were low (9.3%) and comparable with children and adolescents. Conclusions OIT is successful in desensitizing most adults with IgE‐mediated food allergy. Adults undergoing milk OIT are at increased risk for severe reactions and for OIT failure while failure rates in adults undergoing OIT for other foods are low.

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“…Before initiating OIT, patients should have a personalized action plan to guide them in the management of adverse effects. Families should be equipped with an algorithm providing guidance for situations such as missed doses or illness (49). They should also be able to contact a professional to whom they can address questions and concerns during treatment.…”

Section: Patient Safetymentioning

confidence: 99%

“…In the build-up phase, patients are generally monitored for 1 h after up-dosings (49), but the timeframe can vary depending on the clinical practice and increased surveillance could be necessary in higher-risk patients (e.g. patient with previous delayed reaction to up-dosing).…”

Section: Patient Safetymentioning

confidence: 99%

Transitioning peanut oral immunotherapy to clinical practice

2022

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Peanut allergy is on the rise in industrialized countries, affecting 1%–4.5% of children and generally persisting into adulthood. It is associated with a risk of severe anaphylaxis and is one of the major causes of food allergy-induced deaths. Health-related quality of life is significantly impaired for patients and affected families due to food restrictions attributable to omnipresent precautionary allergen labeling, constant risk of potentially life-threatening reactions, and limitation of social activities. Oral immunotherapy (OIT) has emerged as a valid treatment option for patients with IgE-mediated peanut allergy, with randomized controlled trials and real-life studies showing a high rate of desensitization and a favorable safety profile, especially in young children. Ultimately, the decision to initiate peanut OIT relies on a multidisciplinary shared decision-making process, involving open, personalized and evidence-based discussions with patients and their caregivers.

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How to Incorporate Oral Immunotherapy into Your Clinical Practice

Cited by 15 publications

References 55 publications

Home-Based Peanut Oral Immunotherapy for Low-Risk Peanut-Allergic Preschoolers During the COVID-19 Pandemic and Beyond

Home-Based Peanut Oral Immunotherapy for Low-Risk Peanut-Allergic Preschoolers During the COVID-19 Pandemic and Beyond

Efficacy and safety of food allergy oral immunotherapy in adults

Transitioning peanut oral immunotherapy to clinical practice

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