An Approach to the Office-Based Practice of Food Oral Immunotherapy

Wasserman, Richard L.; Factor, Jeffrey M.; Windom, Hugh; Abrams, Elissa M.; Bégin, Philippe; Chan, Edmond S.; Greenhawt, Matthew; Hare, Nathan; Mack, Douglas P.; Mansfield, Lyndon E.; Ben‐Shoshan, Moshe; Stukus, David R.; Leek, Timothy Vander; Shaker, Marcus

doi:10.1016/j.jaip.2021.02.046

Cited by 65 publications

(85 citation statements)

References 112 publications

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“…For example, some allergists may elect to offer licenced OIT for PA alongside tree nuts, egg, and milk for patients with those allergies. Our intent is not to neglect these other OIT practices, but rather to complement them with information specific to licenced peanut OIT while referring interested readers to prior reviews for descriptions of un-approved forms of OIT [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Palforzia ® [Peanut ( Arachis hypogaea) Allergen Powder-dnfp; defatted powder of Arachis hypogaea L., semen (peanuts); previously known as AR101; Aimmune Therapeutics, Brisbane, California, USA] is a licenced peanut oral immunotherapy (peanut OIT) indicated for individuals aged 4–17 years with a confirmed PA diagnosis. Although there are several published reviews summarizing how to administer food OIT in everyday practice [ 11 , 12 ], most allergists have not chosen to prescribe food OIT to their patients [ 13 ]. Several reasons for low adoption rates have been identified, including the time commitment and concerns about Palforzia’s safety [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Eight tips for the implementation of the first licenced peanut allergy oral immunotherapy into clinical practice

Portnoy

Ciaccio

Beausoleil

et al. 2022

Allergy Asthma Clin Immunol

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Background Shared learnings from the early use of novel therapies can aid in their optimization. The recent introduction of peanut oral immunotherapy (peanut OIT; Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp]) for peanut allergy addresses a significant unmet need but also highlights the requirement for consideration of several factors by both prescribers and patients. Objective To provide guidance for prescribers of licenced peanut OIT to facilitate treatment delivery and improve outcomes. Methods Clinicians with experience of licenced peanut OIT (United States n = 6, United Kingdom n = 1) participated in a series of interviews and group discussions designed to elicit tips for successful implementation. Results Clinicians identified 8 tips that were considered the most relevant, practical, and impactful for prescribers of Peanut (Arachis hypogaea) Allergen Powder-dnfp: (1) preparing to provide treatment, (2) assessing the medical indication for treatment and (3) shared decision making, (4) staff education, (5) establishing office processes, (6) managing patient expectations and using anticipatory guidance, (7) optimising adherence and (8) maintaining flexibility throughout the treatment process. In addition, a range of supporting materials (e.g., checklists and action plans) are provided. Conclusion The introduction of a novel therapy often requires healthcare providers to modify or adopt practices to effectively employ the treatment. The provision of guidance based upon early real-world experiences of licenced peanut OIT may help inform clinical practice and improve treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Eight tips for the implementation of the first licenced peanut allergy oral immunotherapy into clinical practice

Portnoy

Ciaccio

Beausoleil

et al. 2022

Allergy Asthma Clin Immunol

View full text Add to dashboard Cite

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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%

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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“…Due to the accessibility of food formulations suitable for OIT and the ability to individualize desensitization protocols, OIT has gained popularity in clinical practice in the last decade and accelerated the understanding of best practices [ 25 ]. As the food products used in OIT are frequently purchased over the counter, practitioners can make small adjustments to the amount of allergen given in a dose and the speed at which allergen exposure is increased with the goal of increasing tolerability of the desensitization process.…”

Section: Immunotherapymentioning

confidence: 99%

New and emerging concepts and therapies for the treatment of food allergy

Hwang

Nagler

Ciaccio

2022

Immunotherapy Advances

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Food allergy is an increasingly common disease that often starts in early childhood and lasts throughout life. Self-reported food allergy has risen at a rate of 1.2% per decade since 1988, and by 2018, the prevalence of food allergy in the United States was estimated to be 8% in children and 11% in adults. - This prevalence has led to an economic burden of almost $25 billion annually. Despite these staggering statistics, as of the time of this writing, the Food and Drug Administration (FDA) has only approved one treatment for food allergy, which is limited to use in children with peanut allergy. Fortunately, a new horizon of therapeutic interventions, in all stages of development, lay ahead and hold promise for the near future.

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An Approach to the Office-Based Practice of Food Oral Immunotherapy

Cited by 65 publications

References 112 publications

Eight tips for the implementation of the first licenced peanut allergy oral immunotherapy into clinical practice

Eight tips for the implementation of the first licenced peanut allergy oral immunotherapy into clinical practice

Information needs of patients considering oral immunotherapy for food allergy

New and emerging concepts and therapies for the treatment of food allergy

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