Efficacy and safety of oral immunotherapy for peanut, cow's milk, and hen's egg allergy: A systematic review of randomized controlled trials

Lodge, Caroline; Waidyatillake, Nilakshi T; Peters, Rachel L.; Netting, Merryn; Dai, Xin; Burgess, John A.; Hornung, Catherine J.; Perrett, Kirsten; Koplin, Jennifer J.; Tang, Mimi L.K.

doi:10.1002/clt2.12268

Cited by 8 publications

(6 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When less than 3 RCT exist for a food, we also include non-randomized reports. The reader is directed to review the specific studies or one of several meta-analyses of HE, CM, and peanut OIT for more granular details about these trials [ 4 , 5 , 26 ].…”

Section: Protocols From Key Research Studies Of Oitmentioning

confidence: 99%

“…Of all food OIT, the most high-quality data exists for OIT to peanut [ 4 ]. The variety in protocols is more narrow, so we highlight 5 RCT and one open-label high-dose study for review [ 25 , 27 – 31 ].…”

Section: Protocols From Key Research Studies Of Oitmentioning

confidence: 99%

“…There is strong evidence in favor of the safety and efficacy of OIT. In a recent meta-analysis, 8 high-quality randomized clinical trials (RCTs) for peanut, 6 for hen’s egg (HE), and 4 for cow’s milk (CM) were identified, and the data supports the efficacy of OIT to induce desensitization for peanut, HE, and CM, and sustained unresponsiveness (SU) for peanut and HE [ 4 ]. Adverse reactions during OIT occur more frequently than during avoidance; however, these reactions are typically mild, and few patients discontinue OIT because of them [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Review of Shared Decision-Making, Published Protocols, and Post-desensitization Strategies in Oral Immunotherapy (OIT)

Laubach,

Kim,

Greenhawt

et al. 2024

Curr Allergy Asthma Rep

View full text Add to dashboard Cite

Purpose of Review The aim of this review is to highlight key published oral immunotherapy (OIT) protocols and post-desensitization strategies for the major food allergens and to cover important concepts to consider when evaluating OIT for food-allergic patients. Shared decision-making should help identify patient and family values which will help influence the type of evidence-based protocol and maintenance strategy to use. Recent Findings With food OIT emerging as a treatment option, there is a pressing need for patients, physicians, and other providers to have a nuanced understanding of the management choices available to them. There are now randomized controlled trials (RCT) of OIT for peanut, egg, milk, and wheat, and reports of cohorts of patients who have undergone OIT for tree nuts and sesame clinically. The current published protocols contain significant diversity in terms of starting dose, build-up schedule, maintenance dose, and even the product used for desensitization. Emerging data can help direct the long-term maintenance strategy for patients on OIT. Summary Based on patient and family values elicited through the shared decision-making process, an OIT protocol may be selected that balances the level of desensitization, potential side effects, frequency of clinic visits, and potential to induce sustained unresponsiveness, among other factors. Once maintenance dosing is reached, most patients will need to maintain regular exposure to the food allergen to remain desensitized. The option to transition to commercial food products with equivalent amounts of food protein as the OIT maintenance dose would simplify the dosing process and perhaps improve palatability as well. Less frequent or decreased OIT dosing can provide practical benefits but may affect the level of desensitization and safety for some patients.

show abstract

Section: Protocols From Key Research Studies Of Oitmentioning

confidence: 99%

Section: Protocols From Key Research Studies Of Oitmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Review of Shared Decision-Making, Published Protocols, and Post-desensitization Strategies in Oral Immunotherapy (OIT)

Laubach,

Kim,

Greenhawt

et al. 2024

Curr Allergy Asthma Rep

View full text Add to dashboard Cite

show abstract

“…Oral immunotherapy (OIT) for food, involving the oral administration of allergens to induce tolerance, has proven to be an effective treatment for persistent food allergies in children, despite the occurrence of frequent adverse reactions [ 7 - 9 ]. In typical OIT protocols, incremental doses of the allergenic food are administered in a hospital setting, and once tolerated, these doses are continued daily at home.…”

Section: Introductionmentioning

confidence: 99%

Mobile App/Web Platform for Monitoring Food Oral Immunotherapy in Children: Longitudinal Clinical Validation Study

Sánchez-Fernández,

Lasa,

Terrados

et al. 2024

JMIR Pediatr Parent

View full text Add to dashboard Cite

Background Milk and egg allergies significantly impact the quality of life, particularly in children. In this regard, food oral immunotherapy (OIT) has emerged as an effective treatment option; however, the occurrence of frequent adverse reactions poses a challenge, necessitating close monitoring during treatment. Objective This study aims to evaluate the ability of a new mobile/web app called OITcontrol to monitor milk and egg OIT. Methods Patients undergoing milk or egg OIT were recruited and divided into 2 groups: the active group used the OITcontrol app in conjunction with standard written monitoring methods, whereas the control group relied solely on written diaries. Investigators documented hospital doses, hospital reactions, and administered treatments on the website. Patients recorded their daily allergen home-dose intake, home reactions, and administered treatments using the app. The following variables were compared between both groups: number and severity of hospital and reported home reactions, patient’s adhesion to the OITcontrol app or written diary or both in terms of daily home-dose intake and home reactions recording, and treatment and dose adjustment compliance at home in case of reaction. Results Sixteen patients were assigned to be monitored using the OITcontrol app along with additional written methods (active group), while 14 patients relied solely on a written paper diary (control group). A similar distribution was observed in terms of sex, age, basal characteristics, allergen treated in OIT, premedication, and sensitization profile. Active patients reported a comparable number of hospital and home reactions compared with the control group. In terms of recording system usage, 13/16 (81%) active patients used the OITcontrol app, while 10/14 (71%) control patients relied on the written diary. Among active patients, 6/16 (38%) used both methods, and 1 active patient used only written methods. However, control patients recorded home reactions more frequently than active patients (P=.009). Among active patients, the app was the preferred method for recording reactions (59/86, 69%), compared with the written diary (15/86, 17%) or both methods (12/86, 14%; P<.001). Treatment compliance in home-recorded reactions was similar between both groups (P=.15). However, treatment indications after an adverse reaction were more frequently followed (P=.04) in reactions recorded solely in the app (36/59, 61%) than in the written diary (29/71, 41%) or both systems (4/12, 33%). Moreover, compliance with dose adjustments after a moderate-severe reaction in home-recorded reactions was higher in the active group than in the control group (P<.001). Home reactions recorded only in the app (16/19, 84%) were more likely to follow dose adjustments (P<.001) than those recorded in the written diary (3/20, 15%) or using both methods (2/3, 67%). Conclusions The OITcontrol app appears to be a valuable tool for monitoring OIT treatment in children with food allergies. It proves to be a suitable method for recording daily home dose intakes and reactions, and it seems to enhance adherence to treatment indications following an adverse reaction as well as compliance with dose adjustments in home reactions. However, additional studies are necessary to comprehensively grasp the benefits and limitations of using the OITcontrol app in the management of OIT.

show abstract

“…1 A high level of evidence for its efficacy and safety has been elaborated throughout the recent decades for various forms of application, sublingual (SLIT) and subcutaneous (SCIT), as well as oral immunotherapy (OIT), the latter being used in managing food allergies, especially peanut, cow's milk and hen's egg allergy (Table 1). [2][3][4][5][6][7] Also, new administration routes, like patches applied on back-epicutaneous immunotherapy (EPIT) or direct injection into lymph nodes (intralymphatic immunotherapy [ILIT])-are clinically effective. [8][9][10][11] The major aim of AIT is achieving immune tolerance to allergens, which can be defined as a long-term clinical tolerance towards natural exposure or in vivo challenges, including allergen exposure chambers (AEC).…”

Section: Introductionmentioning

confidence: 99%

Hot topics in allergen immunotherapy, 2023: Current status and future perspective

Zemelka‐Wiacek,

Agache,

Akdis

et al. 2023

Allergy

View full text Add to dashboard Cite

The importance of allergen immunotherapy (AIT) is multifaceted, encompassing both clinical and quality‐of‐life improvements and cost‐effectiveness in the long term. Key mechanisms of allergen tolerance induced by AIT include changes in memory type allergen‐specific T‐ and B‐cell responses towards a regulatory phenotype with decreased Type 2 responses, suppression of allergen‐specific IgE and increased IgG1 and IgG4, decreased mast cell and eosinophil numbers in allergic tissues and increased activation thresholds. The potential of novel patient enrolment strategies for AIT is taking into account recent advances in biomarkers discoveries, molecular allergy diagnostics and mobile health applications contributing to a personalized approach enhancement that can increase AIT efficacy and compliance. Artificial intelligence can help manage and interpret complex and heterogeneous data, including big data from omics and non‐omics research, potentially predict disease subtypes, identify biomarkers and monitor patient responses to AIT. Novel AIT preparations, such as synthetic compounds, innovative carrier systems and adjuvants, are also of great promise. Advances in clinical trial models, including adaptive, complex and hybrid designs as well as real‐world evidence, allow more flexibility and cost reduction. The analyses of AIT cost‐effectiveness show a clear long‐term advantage compared to pharmacotherapy. Important research questions, such as defining clinical endpoints, biomarkers of patient selection and efficacy, mechanisms and the modulation of the placebo effect and alternatives to conventional field trials, including allergen exposure chamber studies are still to be elucidated. This review demonstrates that AIT is still in its growth phase and shows immense development prospects.

show abstract

Efficacy and safety of oral immunotherapy for peanut, cow's milk, and hen's egg allergy: A systematic review of randomized controlled trials

Cited by 8 publications

References 46 publications

A Review of Shared Decision-Making, Published Protocols, and Post-desensitization Strategies in Oral Immunotherapy (OIT)

A Review of Shared Decision-Making, Published Protocols, and Post-desensitization Strategies in Oral Immunotherapy (OIT)

Mobile App/Web Platform for Monitoring Food Oral Immunotherapy in Children: Longitudinal Clinical Validation Study

Hot topics in allergen immunotherapy, 2023: Current status and future perspective

Contact Info

Product

Resources

About