Oral Immunotherapy
An overview of key studies
DOI:
https://doi.org/10.58931/cait.2021.1112Abstract
Food allergy affects approximately 7% of the Canadian population and is a lifelong diagnosis for many patients. While fatal anaphylaxis is rare, accidental exposures are common, with many accidental reactions being moderate- to-severe. The fear of severe or fatal anaphylaxis is of major concern and food allergy represents a significant burden on the life of food-allergic families. Until recently, the standard of care for food allergy management in North America included avoidance of the allergenic food and epinephrine autoinjector carriage. However, additional proactive therapeutic options are becoming increasingly more commonplace. Oral immunotherapy (OIT) has been investigated through real worl evidence and in phase II and III clinical trials. Canadian experience with OIT is increasing with the publication of guidelines to support this clinical activity. OIT is an elective, non-curative procedure which carries a risk of allergic reaction. Comprehensive and effective education for families to ensure informed consent is essential as part of the shared decision making (SDM) process and is key to successful OIT implementation.
References
Clarke AE, Elliott SJ, St Pierre Y, Soller L, La Vieille S, Ben-Shoshan M. Temporal trends in prevalence of food allergy in Canada. J Allergy Clin Immunol Pract. 2020;8(4):1428-1430.e5. doi:10.1016/j.jaip.2019.10.021
Bock SA, Atkins FM. The natural history of peanut allergy. J Allergy Clin Immunol. 1989 May;83(5):900-904. doi:10.1016/0091-6749(89)90103-6
Cherkaoui S, Ben-Shoshan M, Alizadehfar R, Asai Y, Chan E, Cheuk S, et al. Accidental exposures to peanut in a large cohort of Canadian children with peanut allergy. Clin Transl Allergy. 2015;5:16. Published 2015 Apr 2;5:16 doi:10.1186/s13601-015-0055-x
Sicherer SH, Noone SA, Muñoz-Furlong A. The impact of childhood food allergy on quality of life. Ann Allergy Asthma Immunol. 2001 Dec;87(6):461-464. doi:10.1016/S1081-1206(10)62258-2
Warren CM, Otto AK, Walkner MM, Gupta RS. Quality of Life Among Food Allergic Patients and Their Caregivers. Curr Allergy Asthma Rep. 2016 May;16(5):38. doi:10.1007/s11882-016-0614-9
NIAID-Sponsored Expert Panel, Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010 Dec;126(6 Suppl):S1-58. doi:10.1016/j.jaci.2010.10.007
Anagnostou K, Islam S, King Y, Foley L, Pasea L, Bond S et al. Assessing the efficacy of oral immunotherapy for the desensitisation of peanut allergy in children (STOP II): a phase 2 randomised controlled trial. Lancet. 2014 Apr 12;383(9925):1297-1304. doi:10.1016/S0140-6736(13)62301-6
PALISADE Group of Clinical Investigators, Vickery BP, Vereda A, et al. AR101 Oral Immunotherapy for Peanut Allergy. N Engl J Med. 2018 Nov 22;379(21):1991-2001. doi:10.1056/NEJMoa1812856
Mack DP, Soller L, Chan ES, et al. A high proportion of Canadian allergists offer oral immunotherapy but barriers remain. J Allergy Clin Immunol Pract. 2020 Dec 23;S2213- 2198(20)31357-X. doi:10.1016/j.jaip.2020.12.025
Bégin P, Chan ES, Kim H, Wagner M, Cellier MS, Favron-Godbout C, et al. CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy. Allergy Asthma Clin Immunol. 2020 Mar 18;16:20 doi:10.1186/s13223-020-0413-7
Anagnostou A, Hourihane JO, Greenhawt M. The Role of Shared Decision Making in Pediatric Food Allergy Management. J Allergy Clin Immunol Pract. 2020 Jan;8(1):46-51. doi:10.1016/j.jaip.2019.09.004
Mack DP, Foster GA, Bouwers LM, Hanna MA. A counseling video with pre- and posttesting and checklist for oral immunotherapy consent improves participant knowledge. Ann Allergy Asthma Immunol. 2020 Oct;125(4):468-474.e4. doi:10.1016/j.anai.2020.06.044
Leonard SA, Laubach S and Wang J, Integrating Oral Immunotherapy into Clinical Practice. J Allergy Clin Immunol, 2021 Jan;147(1):1-13.
Wasserman RL, Hague AR, Pence DM, Sugerman RW, Silver SK, Rolen JG, et al. Real-World Experience with Peanut Oral Immunotherapy: Lessons Learned From 270 Patients. J Allergy Clin Immunol Pract. 2019 Feb;7(2):418-426.e4. doi:10.1016/j.jaip.2018.05.023
Wasserman RL, Jones DH, Windom HH. Oral immunotherapy for food allergy: The FAST perspective. Ann Allergy Asthma Immunol. 2018 Sept;121(3):272-275. doi:10.1016/j.anai.2018.06.011
Wasserman RL, Factor JM, Baker JW, Mansfield LE, Katz Y, Hague AR, et al. Oral immunotherapy for peanut allergy: multipractice experience with epinephrine-treated reactions. J Allergy Clin Immunol Pract. 2014 Jan-Feb;2(1):91-96. doi:10.1016/j.jaip.2013.10.001
Blumchen K, Trendelenburg V, Ahrens F, Gruebl A, Hamelmann E, Hansen G, et al. Efficacy, Safety, and Quality of Life in a Multicenter, Randomized, Placebo-Controlled Trial of Low-Dose Peanut Oral Immunotherapy in Children with Peanut Allergy. J AllergyClin Immunol Pract. 2019 Feb;7(2):479-491.e10. doi:10.1016/j.jaip.2018.10.048
Trendelenburg V, Blumchen K, Bellach J, Ahrens F, Gruebl A, Hamelmann E, et al. Peanut oral immunotherapy protects patients from accidental allergic reactions to peanut. J Allergy Clin Immunol Pract. 2020Jul-Aug;8(7):2437-2441.e3. doi:10.1016/j.jaip.2020.03.043
Vickery BP, Berglund JP, Burk CM, Fine JP, Kim EH, Kim JI, et al. Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective. J Allergy Clin Immunol. 2017 Jan;139(1):173-181.e8. doi:10.1016/j.jaci.2016.05.027
Herlihy L, Kim EH, Burks AW, Barber H, Cook Q, Yang L, et al. Five-year follow-up of early intervention peanut oral immunotherapy. J Allergy Clin Immunol Pract. 2021 Jan;9(1):514-517. doi:10.1016/j. jaip.2020.07.009
Soller L, Abrams EM, Carr S, Kapur S, Rex GA, Leo S, et al. First Real-World Safety Analysis of Preschool Peanut Oral Immunotherapy. J Allergy Clin Immunol Pract. 2019 Nov-Dec;7(8):2759-2767.e5. doi:10.1016/j.jaip.2019.04.010
Soller L, Abrams EM, Carr S, et al. First Real-World Effectiveness Analysis of Preschool Peanut Oral Immunotherapy. J Allergy Clin Immunol Pract. 2021 Mar;S2213-2198(20)31199-5. doi:10.1016/j.jaip.2020.10.045
Afinogenova Y, Rubin TN, Patel SD, Powell RL, Gilo JM, Denno MN, et al. Community Private Practice Clinical Experience with Peanut Oral Immunotherapy. J Allergy Clin Immunol Pract. 2020 Sep;8(8):2727- 2735. doi:10.1016/j.jaip.2020.03.016
Greenhawt MJ, Vickery BP. Allergist-reported trends in the practice of food allergen oral immunotherapy. J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):33-38. doi:10.1016/j.jaip.2014.06.023
Chu DK, Wood RA, French S, Fiocchi A, Jordana M, Waserman S, et al. Oral immunotherapy for peanut allergy (PACE): a systematic review and meta-analysis of efficacy and safety. Lancet. 2019 Jun 1;393(10187):2222-2232. doi:10.1016/S0140- 6736(19)30420-9
Chong KW, Turner PJ. Food allergy desensitisation: a hard nut to crack?. Arch Dis Child. 2019 Nov;104(11):1021-1022 doi:10.1136/archdischild-2019-317690
Eiwegger T, Anagnostou K, Arasi S, Begin P, Ben-Shoshan M, Beyer K, et al. ICER report for peanut OIT comes up short. Ann Allergy Asthma Immunol. 2019 Nov;123(5):430- 432. doi:10.1016/j.anai.2019.09.001
Blackman AC, Anagnostou A. Identification of goals and barriers to treatment from 92 consecutive consultations with families considering peanut oral immunotherapy. Ther Adv Vaccines Immunother. 2019 Aug 26;7:2515135519869763. doi:10.1177/2515135519869763.
Greenhawt M, Marsh R, Gilbert H, Sicherer S, DunnGalvin A, Matlock D. Understanding caregiver goals, benefits, and acceptable
risks of peanut allergy therapies. Ann Allergy Asthma Immunol. 2018 Nov;121(5):575-579. doi:10.1016/j.anai.2018.06.018
Howe LC, Leibowitz KA, Perry MA, Bitler JM, Block W, Kaptchuk TJ, et al. Changing Patient Mindsets about Non- Life-Threatening Symptoms During Oral Immunotherapy: A Randomized Clinical Trial. J Allergy Clin Immunol Pract. 2019 May-Jun;7(5):1550-1559. doi:10.1016/j.jaip.2019.01.022
Goldberg MR, Nachshon L, Levy MB, Elizur A, Katz Y. Risk Factors and Treatment Outcomes for Oral Immunotherapy-Induced Gastrointestinal Symptoms and Eosinophilic Responses (OITIGER). J Allergy Clin Immunol Pract. 2020 Jan;8(1):125-131. doi:10.1016/j.jaip.2019.07.034
O’B Hourihane J, Beyer K, Abbas A, Fernandez-Rivas M, Turner PJ, Blumchen K, et al. Efficacy and safety of oral immunotherapy with AR101 in European children with a peanut allergy (ARTEMIS): a multicentre, double-blind, randomised, placebo-controlled phase 3 trial. Lancet Child Adolesc Health. 2020 Oct;4(10):728- 739. doi:10.1016/S2352-4642(20)30234-0
Nachshon L, Schwartz N, Tsviban L, Levy MB, Goldberg MR, Epstein-Rigby N, et al. Patient Characteristics and Risk Factors for Home Epinephrine-Treated Reactions During Oral Immunotherapy for Food Allergy. J Allergy Clin Immunol Pract. 2021 Jan;9(1):185-192. e3. doi:10.1016/j.jaip.2020.07.034
Dunn Galvin A, McMahon S, Ponsonby AL, Hsiao KC, Tang MLK; PPOIT study team. The longitudinal impact of probiotic and peanut oral immunotherapy on health-related quality of life. Allergy. 2018 Mar;73(3):560-568. doi:10.1111/all.13330
Epstein-Rigbi N, Goldberg MR, Levy MB, Nachshon L, Elizur A. Quality of Life of Food- Allergic Patients Before, During, and After Oral Immunotherapy. J Allergy Clin Immunol Pract. 2019 Feb;7(2):429-436.e2. doi:10.1016/j.jaip.2018.06.016
