A High Proportion of Canadian Allergists Offer Oral Immunotherapy but Barriers Remain

Mack, Douglas P.; Soller, Lianne; Chan, Edmond S.; Hanna, Mariam; Terpstra, Collin; Leek, Timothy K. Vander; Bégin, Philippe

doi:10.1016/j.jaip.2020.12.025

Cited by 13 publications

(8 citation statements)

References 28 publications

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“…Lower risk infants may also undergo screening “creep" due to parental anxiety, physician concern, and overdiagnosis of severe eczema, and panel skin testing to multiple foods could lead to unnecessary and prolonged delay in the introduction of peanut and other foods while waiting for OFCs ( 24 ). The waiting time for allergist consultation, OFC, and OIT in countries, such as Canada can be multiple years ( 4 , 25 ), and resources to provide allergy services in the different regions around the world vary ( 26 , 27 ). These practical issues could lead to unnecessary and prolonged avoidance and increase the risk of developing food allergies, thus compromising the ability to implement early introduction for many children.…”

Section: Discussionmentioning

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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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: Discussionmentioning

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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“…[11][12][13] With the recent approval by European and USA regulators of Palforzia®, there are now commercial and non-commercial forms of OIT available for use in several countries. 12,[14][15][16] While OIT has consistently been shown to induce desensitization, it has rarely been shown to be curative; thus, long-term adherence to potentially daily, indefinite therapy may be required. 9 This requirement, as well as multiple other barriers including taste aversion, the potential for dose-related allergic symptoms and multiple restrictions on activities surrounding dosing may ultimately pose challenges to successful OIT adherence.…”

Section: Manuscrip Tmentioning

confidence: 99%

“…The literature reports durations of 40-60 min to achieve this even for clinicians skilled in SDM. 14,17,23 A checklist-based discussion has been reported to ensure complete coverage of all major topics for discussion, and ensure that patient goals are well identified. 17 Decisionaids are useful tools to help patients work through the elements of the decision and to clarify their values related to the treatment options.…”

Section: Key Messagesmentioning

confidence: 99%

“…These include EPIT, biologic therapies and sublingual immunotherapy. 14,57 Some of these alternatives are being studied for use as monotherapy, or for combined use with OIT to enhance OIT safety and (or) efficacy. 61 The option of active involvement in a clinical trial should also be considered if available or applicable.…”

Section: Alternative S To Oitmentioning

confidence: 99%

“…Given well‐published risks and considerable benefits associated with OIT, undertaking a “true” SDM process may require a significant amount of time to ensure all elements are covered. The literature reports durations of 40–60 min to achieve this even for clinicians skilled in SDM 14,17,23 . A checklist‐based discussion has been reported to ensure complete coverage of all major topics for discussion, and ensure that patient goals are well identified 17 .…”

Section: Shared Decision‐makingmentioning

confidence: 99%

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Information needs of patients considering oral immunotherapy for food allergy

Mack

Greenhawt

Turner

et al. 2022

Clin Experimental Allergy

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While the historic management of food allergy includes avoidance strategies and allergic reaction treatment, oral immunotherapy (OIT) approaches have become more commonly integrated into therapeutic approaches. International guidelines, phase 3 trials and real-world experience have supported the implementation of this procedure. However, OIT is an elective, rarely curative procedure with inherent risks that necessitates an increased degree of health literacy for the patients and families.Families assume the responsibility of amateur healthcare providers to ensure the daily safe administration of the allergenic food. As such, it is incumbent upon physicians to ensure that families are prepared for this role. A thorough educational and shared decision-making approach is necessary during the counselling and consent process to adequately inform the families. Educated discussion about the efficacy and patientcentred effectiveness, therapeutic alternatives and family goals is required to align physician and patient expectations. A frank discussion about the struggles, practical challenges, risks and contraindications can help to develop an understanding of the risk mitigation strategies employed to maintain safety. Physicians should develop a proactive approach to educate families about this, at times, burdensome procedure. This educational approach should encourage ongoing support starting prior to consent through the maintenance visits. By preparing families for their unique management role, physicians can help ensure the safe and successful integration of OIT into the therapeutic offering for the management of food allergies.

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