Advances, Practical Implementation, and Unmet Needs Regarding Oral Immunotherapy for Food Allergy

Perrett, Kirsten P.; Sindher, Tina; Bégin, Philippe; Shanks, Josiah; Elizur, Arnon

doi:10.1016/j.jaip.2021.10.070

Cited by 22 publications

(20 citation statements)

References 89 publications

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“…OIT is a patient-preference-sensitive treatment option that may decrease risk for allergic reactions, and even allow re-introduction of culprit food allergens in some patients. 15,34,53 OIT is indicated for well-informed, engaged patients and families with sufficient understanding to partner in their own care their child's care. 15 In children, parents are surrogate decision-makers, though this may conflict with the child's desires in some instances.…”

Section: Indic Ations and Contr Aindic Ationsmentioning

confidence: 99%

“…While some patients may be able to eat their trigger food ad libitum following OIT, many will need to maintain avoidance strategies, although often in a less restrictive manner. There is no agreement about removal of adrenaline autoinjector carriage 53 . Therefore, avoidance therapy (vs. OIT) is a reasonable alternative that will be preferred by many families 9,15 .…”

Section: Alternatives To Oitmentioning

confidence: 99%

“…Patients on OIT will need regular follow‐up with an allergist—potentially for very long periods of time—to continue to provide education, review adherence and offer support 69 . Ideally, clinics will review the basics and specifics of OIT risk mitigation, anaphylaxis management to ensure longer‐term safety.…”

Section: How Can Physicians Provide Ongoing Support During Oit and In...mentioning

confidence: 99%

“…There is no agreement about removal of adrenaline autoinjector carriage. 53 Therefore, avoidance therapy (vs. OIT) is a reasonable alternative that will be preferred by many families. 9,15 Indeed, it has been estimated that some of the improvement in HRQL seen in peanut OIT can be attributed to the baseline food challenge providing perspective about an individual's reaction threshold.…”

Section: Alternative S To Oitmentioning

confidence: 99%

“…Monitoring for atopic and non-atopic comorbidities that arise Patients on OIT will need regular follow-up with an allergistpotentially for very long periods of time-to continue to provide education, review adherence and offer support. 69 Ideally, clinics will review the basics and specifics of OIT risk mitigation, anaphylaxis management to ensure longer-term safety. Similarly, as our understanding of OIT evolves, protocols may change and routine follow-up is critical to inform patients.…”

Section: How C An Phys I Cian S Provide Ong Oing Supp Ort During Oit ...mentioning

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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Section: Indic Ations and Contr Aindic Ationsmentioning

confidence: 99%

Section: Alternatives To Oitmentioning

confidence: 99%

Section: How Can Physicians Provide Ongoing Support During Oit and In...mentioning

confidence: 99%

Section: Alternative S To Oitmentioning

confidence: 99%

Section: How C An Phys I Cian S Provide Ong Oing Supp Ort During Oit ...mentioning

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

Lodge

Waidyatillake

Peters

et al. 2023

Clinical & Translational All

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Background Oral immunotherapy (OIT) is a promising treatment for food allergies; however, safety is a concern. We synthesized evidence from the best randomized controlled trials (RCTs) on efficacy/safety of OIT for desensitization (DS) and remission (sustained unresponsiveness (SU)) in IgE mediated allergy to peanut, hen's eggs, and cow's milk. Body We searched Pubmed, EMBASE, and Cochrane databases (Until Oct 22) identifying 16 eligible RCTs published in English measuring food allergy by food challenge at the beginning and at the end of the study. The Cochrane Risk of Bias tool was used to assess study quality. We found 18 eligible studies. There was evidence of efficacy for DS for all allergens: peanut (RR 11.32; 95% CI 5.93, 21.60, I2 49%, 8 studies); hen's egg (RR 4.67; 2.66, 8.21, I2 0%, 5 studies); cow's milk (RR 13.98; 3.51, 55.65, I2 0%, 4 studies) and evidence for SU for peanut (RR 7.74; 2.90, 20.69, I2 0%, 3 studies) and hen's egg (RR 6.91; 1.67, 28.57, I2 0%, 2 studies). Allergic events were increased with intervention, and risk of adrenaline use increased for peanut RR 2.96; 1.63, 5.35, I2 0%, 8 studies; egg RR 1.71; 0.42, 6.92, I2 0%, 6 studies; and milk RR 8.45; 2.02, 35.27, I2 0%, 4 studies. Conclusion We found strong evidence that peanut, hen's egg, and cow's milk OIT can induce DS and some evidence for remission. There was a high risk of allergic reactions. Generalizability to the entire food allergic population is not known.

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