Real-World Safety Analysis of Preschool Tree Nut Oral Immunotherapy

Erdle, Stephanie; Cook, Victoria E.; Cameron, Scott; Yeung, Joanne; Kapur, Sandeep; McHenry, Mary; Chan, Edmond S.; Mak, Raymond; Rex, Gregory A.; Wong, Tiffany; Soller, Lianne

doi:10.1016/j.jaip.2023.01.031

Cited by 15 publications

(14 citation statements)

References 32 publications

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Section: Protocols From Key Research Studies Of Oitmentioning

confidence: 99%

“…Recently, several observational reports of multi-food OIT for tree nuts have been published [ 6 , 7 ]. One protocol conducted desensitization to each TN sequentially [ 6 ], whereas the other simultaneously dosed all relevant TN during a single multi-TN OIT build-up [ 7 ]. To simplify dosing for patients, one protocol [ 7 ] compounded the TN flour at local pharmacies into capsules or instructed patients to freeze TN milk into ice cubes which could be stored in the freezer for up to 3 months.…”

Section: Protocols From Key Research Studies Of Oitmentioning

confidence: 99%

“…The two real-world [ 6 , 7 ] studies started OIT with 1–10 mg of TN protein, whereas the Israeli group started with 0.1 mg. A retrospective report of hazelnut OIT started at 0.7 mg [ 57 ]. Most of the protocols used an IDE, with either 3 doses [ 6 ] given in a single day up to 3–10 mg of protein, or a 1–4 consecutive day IDE protocol [ 54 – 57 ] aimed at identifying the MTD up to 160–360 mg of protein.…”

Section: Protocols From Key Research Studies Of Oitmentioning

confidence: 99%

“…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 ]. Small studies on multiple-food OIT have suggested a similar safety and efficacy profile [ 6 , 7 ]. The effects of OIT may be dependent on the starting or maintenance dose (or goal), duration, and frequency of dosing as well as patient-specific factors, such as age and food-specific IgE levels [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Protocols From Key Research Studies Of Oitmentioning

confidence: 99%

Section: Protocols From Key Research Studies Of Oitmentioning

confidence: 99%

Section: Protocols From Key Research Studies Of Oitmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

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“…EoE was diagnosed in one patient. In the same project, the safety of low‐dose [300 mg] tree nut e‐OIT was assessed in 92 children aged 9–70 months 11 . Allergic reactions were described in 71% of participants.…”

Section: Evidence For Early Oral Immunotherapy Safetymentioning

confidence: 99%

Oral immunotherapy as a curative treatment for food‐allergic preschool children: Current evidence and potential underlying mechanisms

Barten,

Zuurveld,

Faber

et al. 2023

Pediatric Allergy Immunology

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The worldwide rising prevalence of food allergy is a major public health concern. Standard care consists of allergen avoidance and rescue medication upon accidental exposure. Oral immunotherapy (OIT) is increasingly being studied as a treatment option. Although desensitization (an increased reaction threshold) is often achieved during OIT, sustained unresponsiveness (SU; clinical nonreactivity after finishing OIT) is not achieved in most patients. A few studies have investigated the effectiveness of OIT in children younger than 4 years of age (early = e‐OIT) and have shown a much more favorable outcome in terms of SU development. Together with food allergy prevention studies, which have demonstrated high efficacy of early oral allergen exposure, the outcomes of e‐OIT studies indicate an early‐life window of opportunity to achieve SU, allowing unrestricted dietary intake. However, the underlying mechanism of the high effectiveness of e‐OIT is not understood yet. Both cohort and OIT studies indicate early‐life immune plasticity. An immature food‐allergic response in the first years of life seems to be a major driver of this immune plasticity, along with a higher tolerogenic immunological state. Allergy maturation can likely be disrupted effectively by early intervention, preventing the development of persistent food allergy. Upcoming studies will provide important additional data on the safety, feasibility, and effectiveness of e‐OIT. Combined with immune mechanistic studies, this should inform the implementation of e‐OIT.

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