The health and economic benefits of approaches for peanut introduction in infants with a peanut allergic sibling

Abstract

Turner P. Time to abandon the hygiene hypothesis: new perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene.

Addressing risk management difficulties in children with food allergies

“…36 Similar screening models applied to early egg introduction or introducing peanut to the younger sibling of a peanut allergic child resulted in higher costs and fewer cases of allergy prevented. 37,38 Finally, the potential cost-effectiveness of a commercially approved peanut oral immunotherapy product and a peanut epicutaneous immunotherapy product awaiting a decision on approval are somewhat narrow, and dependent on annual price, rates of attaining sustained unresponsiveness, rates of reduction in the risk of anaphylaxis, and gain in health utility that have yet to be demonstrated. 38 Collectively, when exploring policies, treatment strategies, and recommended actions to help prevent food-induced fatality, most actions are costly and have limited effectiveness.…”

“…37,38 Finally, the potential cost-effectiveness of a commercially approved peanut oral immunotherapy product and a peanut epicutaneous immunotherapy product awaiting a decision on approval are somewhat narrow, and dependent on annual price, rates of attaining sustained unresponsiveness, rates of reduction in the risk of anaphylaxis, and gain in health utility that have yet to be demonstrated. 38 Collectively, when exploring policies, treatment strategies, and recommended actions to help prevent food-induced fatality, most actions are costly and have limited effectiveness. In trying to understand how this may have evolved, it may be in part that fatality is rare outcome, very difficult outcome to shift, and unlikely altered by most strategies we recommend.…”

Engaging patient partners in state-of-the-art allergy care

“…Adding complexity is the larger societal perspective of value-based care, which can also inform potentially wasteful medical practices that may be cognitively satisfying or psychologically comfortable. 5,6,8,9,[40][41][42][43][44] For example, although advising patients to activate emergency medical services or undergo extended clinical observation after resolved anaphylaxis may appear the safest management strategy, these universal management approaches are not cost-effective. 5,8 Life experiences and developmental stages (eg, adolescence) influence risk tolerance.…”

“…60 Formal decision aids can streamline the process of SDM SMART communication (ie, specific, measurable, achievable, realistic, and time-sensitive). 12,14 To date, patient decision aids have been developed for AIT, severe asthma, and atopic dermatitis, 12 but additional areas in which decision aids could be successfully leveraged include eosinophilic esophagitis management, 48 food allergy screening and prevention, [42][43][44] drug allergy skin testing vs direct oral challenge, 32,33 and postanaphylaxis management. 5,8 More work is needed to better understand how decision aids can be incorporated into a busy allergy clinic, where they are stored, and how to ensure decision aids are kept up to date.…”

A primer on cost-effectiveness in the allergy clinic

“…26,29 Considering international contexts in economic evolutions is also important, because both opportunity and resource costs may vary, and the same care can have drastically different value based on the context of where in the world it may be provided. 26,28,39…”