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Anagnostou A, Warren C, Dantzer J, Dunn Galvin A, Phillips EJ, Khan DA, Banerji A. PATIENT-REPORTED OUTCOME MEASURES IN FOOD AND DRUG ALLERGY. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00461-6. [PMID: 38710408 DOI: 10.1016/j.jaip.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
A patient-reported outcome is directly reported by the patient without interpretation of the patient's response by anyone else. It refers to the patient's health (symptoms, feelings), quality of life, or functional status associated with health care or treatment. Patient-reported outcome measures (PROMs) are defined as the tools or instruments that are used to measure patient-reported outcomes. Health-related quality of life has been the most studied psychosocial PROM in food allergy, using validated questionnaires. In drug allergy, PROMs are useful in capturing patients' experiences of potential allergic reactions, including subjective symptoms like headache, dizziness or fatigue. PROMs can also help differentiate true allergies from side effects or other non-allergic reactions and inform decisions about drug challenges and de-labeling strategies. Ensuring the chosen tool is validated for the specific allergy context is crucial for accurate data collection. Integrating patient-reported experiences alongside traditional methods can lead to more accurate assessments and personalized care.
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Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, TX, USA; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, TX, USA.
| | - Christopher Warren
- Center for Food Allergy & Asthma Research, Institute for Public Health and Medicine; Northwestern University Feinberg School of Medicine
| | - Jennifer Dantzer
- Department of Pediatrics, Johns Hopkins University School of Medicine
| | | | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA
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Anagnostou A, Greenhawt M. Safety and efficacy not guaranteed: Separating fact from fiction regarding extensively heated egg and milk products. Ann Allergy Asthma Immunol 2024; 132:557-558. [PMID: 38432554 DOI: 10.1016/j.anai.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Aikaterini Anagnostou
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
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Alkotob S, Bégin P, Anagnostou A. The use of omalizumab in food allergy. Allergy 2024. [PMID: 38676406 DOI: 10.1111/all.16145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Shifaa Alkotob
- Department of Pediatrics, Section of Immunology Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas, USA
- Section of Allergy Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas, USA
| | - Philippe Bégin
- Department of Pediatrics, Section of Allergy, CHU Sainte-Justine, Montreal, Québec, Canada
- Department of Medicine, Division of Allergy & Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Aikaterini Anagnostou
- Department of Pediatrics, Section of Immunology Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas, USA
- Section of Allergy Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas, USA
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Anagnostou A, Yaworsky A, Brova M, Ibrahim N, Kakked S, Spite S, Duluc L, Shields AL, Lee T, Leonard S, Przywara K, Smith A. Evaluation and Modification of a Shared Decision-Making Tool for Peanut Allergy Management. Curr Allergy Asthma Rep 2024:10.1007/s11882-024-01146-w. [PMID: 38639896 DOI: 10.1007/s11882-024-01146-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE OF REVIEW Based on shared decision-making (SDM) principles, a decision aid was previously developed to help patients, their caregivers, and physicians decide which peanut allergy management approach best suits them. This study refined the decision aid's content to better reflect patients' and caregivers' lived experience. RECENT FINDINGS Current standard of care for peanut allergy is avoidance, although peanut oral immunotherapy has been approved by the Food and Drug Administration for use in patients 4-17 years old. An advisory board of allergy therapy experts (n = 3) and patient advocates (n = 3) informed modifications to the decision aid. The revised tool underwent cognitive debriefing interviews (CDIs) among adolescents (12-17 years old) with peanut allergy and caregivers of patients 4-17 years old with peanut allergy to evaluate its relevance, understandability, and usefulness. The 20 CDI participants understood the information presented in the SDM tool and reported it was important and relevant. Some revisions were made based on participant feedback. Results support content validity of the Peanut Allergy Treatment SDM Tool.
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Affiliation(s)
| | - Andrew Yaworsky
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA.
| | - Monica Brova
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Nazifa Ibrahim
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Siddharth Kakked
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Sasha Spite
- California State University San Marcos, San Marcos, CA, USA
| | - Linette Duluc
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Alan L Shields
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Tricia Lee
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
- American College of Allergy, Asthma, and Immunology, Arlington Heights, IL, USA
| | - Stephanie Leonard
- University of California San Diego, San Diego, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Kathy Przywara
- Asthma and Allergy Foundation of America, Arlington, VA, USA
| | - Amelia Smith
- Food Allergy and Anaphylaxis Connection Team, Liberty Twp, OH, USA
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Shaker M, Abrams EM, Oppenheimer J, Anagnostou A, Codispoti CD, Golden DBK, Greenhawt M, Stukus D, Moore-Clingenpeel M, Hughes SW, Mack DP, Mustafa SS, Lang DM. Food sensitization and cardiovascular mortality: An intriguing association in need of further study. J Allergy Clin Immunol 2024; 153:1163-1165. [PMID: 38260919 DOI: 10.1016/j.jaci.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Marcus Shaker
- Department of Medicine and Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Elissa M Abrams
- Section of Allergy and Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John Oppenheimer
- Division of Allergy, Department of Medicine, University of Medicine and Dentistry of New Jersey-Rutgers, Newark, NJ
| | - Aikaterini Anagnostou
- Division of Allergy and Immunology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Christopher D Codispoti
- Division of Allergy, Department of Internal Medicine, Rush University Medical Center, Chicago, Ill
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md
| | - Matthew Greenhawt
- Children's Hospital Colorado, Section of Allergy and Clinical Immunology, University of Colorado School of Medicine, Aurora, Colo
| | - David Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Sarah W Hughes
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - S Shahzad Mustafa
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Rochester Regional Health, Rochester, NY; Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
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Anagnostou A, Hearrell M, Timberlake D, Huang X, Staggers KA, Stukus D. Social media use among parents of children with food allergies. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00208-4. [PMID: 38570161 DOI: 10.1016/j.anai.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Section of Immunology, Allergy, and Retrovirology, Texas Children's Hospital, Houston, Texas; Section of Allergy, Immunology, & Retrovirology, Baylor College of Medicine, Houston, Texas.
| | - Melissa Hearrell
- Department of Pediatrics, Section of Immunology, Allergy, and Retrovirology, Texas Children's Hospital, Houston, Texas; Section of Allergy, Immunology, & Retrovirology, Baylor College of Medicine, Houston, Texas
| | - Dylan Timberlake
- Prevea Health Allergy, Asthma, and Immunology, Altoona, Wisconsin
| | - Xiaofan Huang
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Kristen A Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - David Stukus
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
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Laubach S, Kim EH, Greenhawt M, Bailey S, Anagnostou A. A Review of Shared Decision-Making, Published Protocols, and Post-desensitization Strategies in Oral Immunotherapy (OIT). Curr Allergy Asthma Rep 2024; 24:173-197. [PMID: 38441821 PMCID: PMC11008063 DOI: 10.1007/s11882-024-01132-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 04/12/2024]
Abstract
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. 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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Affiliation(s)
- Susan Laubach
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA.
- Division of Allergy, Immunology & Rheumatology, Rady Children's Hospital San Diego, San Diego, CA, USA.
| | - Edwin H Kim
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sally Bailey
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Georgetown University, Washington, DC, USA
- Allergy Associates of Northern Virginia, Arlington, VA, USA
| | - Aikaterini Anagnostou
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, TX, USA
- Section of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, TX, USA
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Mack DP, Dribin TE, Turner PJ, Wasserman RL, Hanna MA, Shaker M, Tang MLK, Rodríguez Del Río P, Sobolewski B, Abrams EM, Anagnostou A, Arasi S, Bajowala S, Bégin P, Cameron SB, Chan ES, Chinthrajah S, Clark AT, Detjen P, du Toit G, Ebisawa M, Elizur A, Factor JM, Greiwe J, O'B Hourihane J, Hughes SW, Jones DH, Muraro A, Nowak-Wegrzyn A, Patel NB, Scurlock AM, Shah AN, Sindher SB, Tilles S, Vickery BP, Wang J, Windom HH, Greenhawt M. Preparing Patients for Oral Immunotherapy (PPOINT): International Delphi consensus for procedural preparation and consent. J Allergy Clin Immunol 2024:S0091-6749(24)00238-0. [PMID: 38597862 DOI: 10.1016/j.jaci.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Despite the promise of oral immunotherapy (OIT) to treat food allergies, this procedure is associated with potential risk. There is no current agreement about what elements should be included in the preparatory or consent process. OBJECTIVE We developed consensus recommendations about the OIT process considerations and patient-specific factors that should be addressed before initiating OIT and developed a consensus OIT consent process and information form. METHODS We convened a 36-member Preparing Patients for Oral Immunotherapy (PPOINT) panel of allergy experts to develop a consensus OIT patient preparation, informed consent process, and framework form. Consensus for themes and statements was reached using Delphi methodology, and the consent information form was developed. RESULTS The expert panel reached consensus for 4 themes and 103 statements specific to OIT preparatory procedures, of which 76 statements reached consensus for inclusion specific to the following themes: general considerations for counseling patients about OIT; patient- and family-specific factors that should be addressed before initiating OIT and during OIT; indications for initiating OIT; and potential contraindications and precautions for OIT. The panel reached consensus on 9 OIT consent form themes: benefits, risks, outcomes, alternatives, risk mitigation, difficulties/challenges, discontinuation, office policies, and long-term management. From these themes, 219 statements were proposed, of which 189 reached consensus, and 71 were included on the consent information form. CONCLUSION We developed consensus recommendations to prepare and counsel patients for safe and effective OIT in clinical practice with evidence-based risk mitigation. Adoption of these recommendations may help standardize clinical care and improve patient outcomes and quality of life.
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Affiliation(s)
- Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center; and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | | | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center; and Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Mimi L K Tang
- Department of Allergy Immunology, Murdoch Children's Research Institute; the Department of Paediatrics, University of Melbourne, Australia; and the Department of Allergy and Immunology, the Royal Children's Hospital Melbourne, Melbourne, Australia
| | | | - Brad Sobolewski
- Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | | | - Stefania Arasi
- Pediatric Allergology Unit of the Allergy Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Philippe Bégin
- Department of Pediatrics, Section of Allergy, CHU Sainte-Justine; and the Department of Medicine, Section of Allergy, CHUM, Montreal, Canada
| | - Scott B Cameron
- Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, Canada
| | - Edmond S Chan
- Department of Pediatrics, Division of Allergy, University of British Columbia, BC Children's Hospital, Vancouver, Canada
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif
| | - Andrew T Clark
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | | | - George du Toit
- Department of Paediatric Allergy, Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London; and the Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Motohiro Ebisawa
- National Hospital Organization, Sagamihara National Hospital, Yokosuka, Japan
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center; and the Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Factor
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Conn
| | - Justin Greiwe
- Bernstein Allergy Group; the Department of Internal Medicine, Division of Immunology/Allergy Section, the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jonathan O'B Hourihane
- Paediatrics and Child Health, Royal College of Surgeons in Ireland; and Children's Health Ireland, Dublin, Ireland
| | | | | | - Antonella Muraro
- Food Allergy Referral Centre Padua, University Hospital, Padua, Italy
| | - Anna Nowak-Wegrzyn
- NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York; and the Department of Pediatrics, Gastroenterology, and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Nandinee B Patel
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Amy M Scurlock
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital and Research Institute, Little Rock, Ark
| | - Atul N Shah
- Center for Asthma & Allergy, New York Food Allergy & Wellness, New York, NY
| | - Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Stephen Tilles
- Aimmune Therapeutics, Brisbane; and the University of Washington, Seattle, Wash
| | - Brian P Vickery
- Emory University School of Medicine; and Children's Healthcare of Atlanta, Atlanta, Ga
| | - Julie Wang
- Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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Jara M, Walker E, Tilles S, Anagnostou A. Real-world safety experience with Peanut (Arachis hypogaea) Allergen Powder-dnfp in 2500 children with peanut allergy. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00142-X. [PMID: 38479712 DOI: 10.1016/j.anai.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Michele Jara
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, California.
| | - Ekaterina Walker
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, California
| | - Stephen Tilles
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, California
| | - Aikaterini Anagnostou
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
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Conway AE, Lieberman J, Codispoti CD, Mahdavinia M, Anagnostou A, Hsu Blatman KS, Lang DM, Oppenheimer J, Mosnaim GS, Bukstein D, Shaker M. Pharmacoequity & Biologics In The Allergy Clinic: Providing The Right Care, At The Right Time, Every time, To Everyone. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00264-2. [PMID: 38458435 DOI: 10.1016/j.jaip.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/10/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
Pharmacoequity refers to equity in access to pharmacotherapy for all patients and is an especially large barrier to biologic agents in patients with allergic diseases. Value-based care models can prompt clinicians to address social determinants of health, thereby promoting pharmacoequity. Pharmacoequity is influenced by numerous factors including socioeconomic status (SES), which may be mediated through insurance status, educational attainment, and access to specialist care. In addition to lower SES, race and ethnicity, age, locations isolated from care systems, and off-label indications for biologic agents all constitute barriers to pharmacoequity. While pharmaco-inequity is more apparent for expensive biologics, it also affects many other allergy treatments including epinephrine autoinjectors and Single Maintenance and Reliever Therapy (SMART) for asthma. Current programs aimed at alleviating cost barriers are imperfect, with Patient Assistance Programs, manufacturer-sponsored free drug programs, and rebates often increasing complexity of care, with resultant inequity, particularly for patients with lower health literacy. Ultimately, single "silver-bullet" solutions are elusive. Long-term improvement instead requires a combination of research, advocacy, and creative problem-solving to design more intelligent and efficient systems that provide timely access to necessary care for every patient, every time.
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Affiliation(s)
| | - Jay Lieberman
- Department of Pediatrics, The University of Tennessee Health Sciences Center, Memphis Tennessee, USA
| | - Christopher D Codispoti
- Rush University Medical Center, Department of Internal Medicine, Division of Allergy, Chicago, IL, USA
| | - Mahboobeh Mahdavinia
- Rush University Medical Center, Department of Internal Medicine, Division of Allergy, Chicago, IL, USA
| | | | - Karen S Hsu Blatman
- Dartmouth Hitchcock Medical Center, Section of Allergy and Clinical Immunology, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Department of Medicine, Hanover, NH, USA
| | - David M Lang
- Cleveland Clinic, Department of Allergy and Clinical Immunology, Cleveland OH, USA
| | - John Oppenheimer
- UMDNJ Rutgers University School of Medicine, Newark, New Jersey, USA
| | - Giselle S Mosnaim
- Division of Allergyand Immunology, Department of Medicine, NorthShore University Health System, Evanston, IL, USA
| | - Don Bukstein
- Allergy, Asthma, and Sinus Center, Milwaukee, WI, USA
| | - Marcus Shaker
- Dartmouth Hitchcock Medical Center, Section of Allergy and Clinical Immunology, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Departments of Medicine and Pediatrics, Hanover, NH, USA.
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Anagnostou A. Shared decision-making in food allergy: Navigating an exciting era. Ann Allergy Asthma Immunol 2024; 132:313-320. [PMID: 37742794 DOI: 10.1016/j.anai.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is increasingly used in food allergy. We review its use in the areas of prevention, diagnosis, and management. DATA SOURCES PubMed and online SDM resources. STUDY SELECTIONS Studies and reviews relevant to SDM and areas in food allergy that decision-making may be applied were selected for discussion. RESULTS Food allergy represents an area with multiple opportunities for SDM. Patients, on one hand, need to obtain the necessary information and understanding of existing options from the allergist. The allergist, on the other hand, needs to understand "where the patient is coming from," their needs, preferences, and values, so that jointly they can reach a decision that is responsive to these. Benefits of SDM include a better understanding of disease by patients, improved compliance with medication, better health outcomes, decreased health care costs, and improved ability of patients to manage their disease and make informed choices. CONCLUSION In food allergy prevention, diagnosis, and management, multiple preference-sensitive options exist for patients where SDM may be used during allergy consultations, alongside decision aids. Decision aids are tools that assist and support patients during the SDM process, by supplementing the patient-physician interaction.
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Affiliation(s)
- Aikaterini Anagnostou
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas.
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Venter C, Meyer R, Bauer M, Bird JA, Fleischer DM, Nowak-Wegrzyn A, Anagnostou A, Vickery BP, Wang J, Groetch M. Identifying Children at Risk of Growth and Nutrient Deficiencies in the Food Allergy Clinic. J Allergy Clin Immunol Pract 2024; 12:579-589. [PMID: 38280452 DOI: 10.1016/j.jaip.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Food allergies affect growth in children by decreasing the availability of nutrients through decreased dietary intake, increased dietary needs, food-medication interactions, and psychosocial burden. Guidelines on food allergy management frequently recommend nutrition counseling and growth monitoring of children with food allergies. OBJECTIVE To provide clear guidance for clinicians to identify children with food allergies who are at nutritional risk and ensure prompt intervention. METHODS We provide a narrative review summarizing information from national and international guidelines, retrospective studies, population studies, review articles, case reports, and case series to identify those with food allergy at greatest nutritional risk, determine the impact of nutritional interventions on growth, and develop guidance for risk reduction in children with food allergies. RESULTS Children with food allergies are at increased risk of nutritional deficiencies and poor growth. Nutritional assessment and intervention can improve outcomes. Identifying poor growth is an important step in the nutrition assessment. Therefore, growth should be assessed at each allergy evaluation. Interventions to ensure adequate dietary intake for growth include appropriately prescribed elimination diets, breast-feeding support and assessment, supplemental formula, vitamin and/or mineral supplementation, appropriate milk substitutes, and timely introduction of nutrient-dense complementary foods. Access to foods of appropriate nutritional value is an ongoing concern. CONCLUSION Nutrition intervention or referral to registered dietitian nutritionists with additional training and/or experience in food allergy may result in improved growth and nutrition outcomes.
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Affiliation(s)
- Carina Venter
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colo.
| | - Rosan Meyer
- Department of Medicine, Imperial College London, London, United Kingdom; Department of Nutrition and Dietetics, University of Winchester, Winchester, United Kingdom; Department of Medicine, KU Leuven, Leuven, Belgium
| | - Maureen Bauer
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colo
| | - J Andrew Bird
- Department of Pediatrics, Division of Allergy and Immunology, UT Southwestern Medical Center, Dallas, Texas
| | - David M Fleischer
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colo
| | - Anna Nowak-Wegrzyn
- Hassenfeld Children's Hospital, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Aikaterini Anagnostou
- Section of Allergy and Immunology, Baylor College of Medicine, Houston, Texas; Section of Allergy and Immunology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Brian P Vickery
- Children's Healthcare of Atlanta, Atlanta, Ga; Department of Pediatrics, Emory University, Atlanta, Ga
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marion Groetch
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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13
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Anagnostou A, Greenhawt M, Shaker M. Improving food allergy management: Control asthma and decrease food allergy risk. Ann Allergy Asthma Immunol 2024; 132:265-266. [PMID: 38092090 DOI: 10.1016/j.anai.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 12/08/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Aikaterini Anagnostou
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas.
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Marcus Shaker
- Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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14
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Anagnostou A, Greenhawt M, Rodríguez Del Río P, Pickett G, Szafron V, Stukus D, Abrams EM. Addressing common questions on food oral immunotherapy: a practical guide for paediatricians. Arch Dis Child 2024:archdischild-2023-326225. [PMID: 38216305 DOI: 10.1136/archdischild-2023-326225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Abstract
Food allergy has been increasing in prevalence in most westernised countries and poses a significant burden to patients and families; dietary and social limitations as well as psychosocial and economic burden affect daily activities, resulting in decreased quality of life. Food oral immunotherapy (food-OIT) has emerged as an active form of treatment, with multiple benefits such as increasing the threshold of reactivity to the allergenic food, decreasing reaction severity on accidental exposures, expanding dietary choices, reducing anxiety and generally improving quality of life. Risks associated with food immunotherapy mostly consist of allergic reactions during therapy. While the therapy is generally considered both safe and effective, patients and families must be informed of the aforementioned risks, understand them, and be willing to accept and hedge these risks as being worthwhile and outweighed by the anticipated benefits through a process of shared decision-making. Food-OIT is a good example of a preference-sensitive care paradigm, given candidates for this therapy must consider multiple trade-offs for what is considered an optional therapy for food allergy compared with avoidance. Additionally, clinicians who discuss OIT should remain increasingly aware of the growing impact of social media on medical decision-making and be prepared to counter misconceptions by providing clear evidence-based information during in-person encounters, on their website, and through printed information that families can take home and review.
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Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Grant Pickett
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | | | - David Stukus
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Elissa M Abrams
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Mustafa SS, Anagnostou A, Greenhawt M, Lieberman JA, Shaker M. Patient partnerships and minimally disruptive medicine. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00004-8. [PMID: 38190962 DOI: 10.1016/j.anai.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Affiliation(s)
- S Shahzad Mustafa
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Rochester Regional Health, Rochester, New York; Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Aikaterini Anagnostou
- Division of Allergy and Immunology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Marcus Shaker
- Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
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16
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Tuano KTS, Seth N, Chinen J, Anagnostou A. Insights from a single center registry of infant and toddler anaphylaxis: Food and fire ants. J Allergy Clin Immunol Pract 2024; 12:223-225. [PMID: 37778632 DOI: 10.1016/j.jaip.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Karen Thursday S Tuano
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology and Retrovirology, Baylor College of Medicine, Houston, Texas
| | - Neha Seth
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology and Retrovirology, Baylor College of Medicine, Houston, Texas
| | - Javier Chinen
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology and Retrovirology, Baylor College of Medicine, Houston, Texas
| | - Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology and Retrovirology, Baylor College of Medicine, Houston, Texas.
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17
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Anagnostou A. Reply to "Treating the patient in front of you". Ann Allergy Asthma Immunol 2024; 132:103-104. [PMID: 38123279 DOI: 10.1016/j.anai.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Aikaterini Anagnostou
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas.
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18
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Anagnostou A, Upton JEM, Chinthrajah RS. The promise of sublingual and other immunotherapy options for infants and toddlers with food allergy. J Allergy Clin Immunol 2024; 153:95-97. [PMID: 37992817 DOI: 10.1016/j.jaci.2023.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Tex
| | - Julia E M Upton
- Department of Paediatrics, Division of Immunology and Allergy, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif.
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19
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Anagnostou A. Reply to "Oral immunotherapy in US allergy practice". J Allergy Clin Immunol Pract 2023; 11:3815-3816. [PMID: 38065644 DOI: 10.1016/j.jaip.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy, and Retrovirology, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology, and Retrovirology, Baylor College of Medicine, Houston, Texas.
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20
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Anagnostou A, Rodríguez Del Río P. Food Immunotherapy: Dissecting Current Guidelines and Navigating the Gray Zone. J Allergy Clin Immunol Pract 2023; 11:3040-3046. [PMID: 37391019 DOI: 10.1016/j.jaip.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023]
Abstract
Food allergy is a common, chronic disease that is burdensome for patients and families, with multiple dietary and social limitations and a significant psychological impact stemming from the fear of accidental exposures and potentially severe, life-threatening reactions. Until recently, the only management option consisted of strict food avoidance. Food allergen immunotherapy (food AIT) has emerged as an alternative, active intervention to strict food avoidance, with a multitude of research studies supporting its efficacy and good safety profile. Food AIT results in a raise of allergenic threshold, which provides several benefits to food-allergic patients, including protection from accidental exposures, potentially decreased severity of allergic reactions on unintentional exposures, and improvement in quality of life. In the last few years, multiple independent reports have been published proposing strategies to implement food oral immunotherapy in U.S. clinics, although formal guidelines are currently lacking. Because food immunotherapy is gaining traction, popularity, and interest among both patients and health care providers, many physicians look for guidance on how to implement this intervention in their daily practice. In other parts of the world, use of this treatment has prompted the development of various guidelines from allergy societies. This rostrum discusses currently available guidelines on food AIT from different areas of the world, describes and comments on their similarities and differences, and highlights unmet needs in this area of therapy.
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Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas.
| | - Pablo Rodríguez Del Río
- Allergy Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; IIS La Princesa, Madrid, Spain
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21
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Pickett G, Gupta M, Anagnostou A. Delabeling antibiotic allergy: real-world experience from a pediatric cohort. Ann Allergy Asthma Immunol 2023; 131:530-531. [PMID: 37399903 DOI: 10.1016/j.anai.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Grant Pickett
- Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.
| | - Meera Gupta
- Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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22
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Affiliation(s)
- Aikaterini Anagnostou
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas.
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23
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Anagnostou A, Vickery B. Food Oral Immunotherapy: A Survey Among US Practicing Allergists Conducted as a AAAAI Leadership Institute Project and Work Group Report. J Allergy Clin Immunol Pract 2023; 11:2330-2334. [PMID: 37236350 DOI: 10.1016/j.jaip.2023.03.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/06/2023] [Accepted: 03/17/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Food oral immunotherapy (OIT) is an active form of treatment for food allergies. Although research in this area has been ongoing for many years, the first US Food and Drug Administration-approved product for peanut allergy treatment became available only in January 2020. Limited data exist on OIT services offered by physicians in the United States. OBJECTIVE This workgroup report was developed to evaluate OIT practices among allergists practicing in the United States. METHODS The authors developed an anonymous 15-question survey and was subsequently reviewed and approved by the American Academy of Allergy, Asthma & Immunology Practices, Diagnostics and Therapeutics Committee before distribution to the membership. The American Academy of Allergy, Asthma & Immunology electronically distributed the survey to a random sample of 780 members in November 2021. In addition to questions specific to food OIT, the survey included questions on demographics and professional characteristics of the responders. RESULTS A total of 78 members completed the survey, yielding a 10% response rate. Fifty percent of responders were offering OIT in their practice. There was a significant difference in experience in OIT originating from research trials in academic versus nonacademic centers. Generally, OIT practices were similar in both settings for the number of foods offered, the performance of oral food challenges before initiating treatment, the number of new patients to whom OIT was offered to per month, and age groups OIT to whom was offered. Almost all of the reported barriers to OIT were similar between settings: staff and time limitations, concerns about safety and anaphylaxis, the need for more education on how to perform, inadequate compensation, and that it was not a significant demand from patients. Clinic space limitations were significantly different and more prominent in academic settings. CONCLUSIONS Our survey revealed interesting trends in the practice of OIT across the United States, with some significant differences arising when academic and nonacademic settings were compared.
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Affiliation(s)
- Aikaterini Anagnostou
- Department of Allergy and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
| | - Brian Vickery
- Emory University and Children's Healthcare of Atlanta, Atlanta, Ga
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24
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Anagnostou A, Lieberman J, Greenhawt M, Mack DP, Santos AF, Venter C, Stukus D, Turner PJ, Brough HA. The future of food allergy: Challenging existing paradigms of clinical practice. Allergy 2023; 78:1847-1865. [PMID: 37129472 DOI: 10.1111/all.15757] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/05/2023] [Accepted: 04/25/2023] [Indexed: 05/03/2023]
Abstract
The field of food allergy has seen tremendous change over the past 5-10 years with seminal studies redefining our approach to prevention and management and novel testing modalities in the horizon. Early introduction of allergenic foods is now recommended, challenging the previous paradigm of restrictive avoidance. The management of food allergy has shifted from a passive avoidance approach to active interventions that aim to provide protection from accidental exposures, decrease allergic reaction severity and improve the quality of life of food-allergic patients and their families. Additionally, novel diagnostic tools are making their way into clinical practice with the goal to reduce the need for food challenges and assist physicians in the-often complex-diagnostic process. With all the new developments and available choices for diagnosis, prevention and therapy, shared decision-making has become a key part of medical consultation, enabling patients to make the right choice for them, based on their values and preferences. Communication with patients has also become more complex over time, as patients are seeking advice online and through social media, but the information found online may be outdated, incorrect, or lacking in context. The role of the allergist has evolved to embrace all the above exciting developments and provide patients with the optimal care that fits their needs. In this review, we discuss recent developments as well as the evolution of the field of food allergy in the next decade.
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Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas, USA
- Section of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas, USA
| | - Jay Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, LeBonheur Children's Hospital, Memphis, Tennessee, USA
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Douglas Paul Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Courses Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service and Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK
| | - Carina Venter
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Denver, Colorado, USA
| | - David Stukus
- Section of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas, USA
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Ohio, USA
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Courses Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service and Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK
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25
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Anagnostou A, Muraro A. Can we identify patients at risk of severe reactions to food? Expert Rev Clin Immunol 2023; 19:1427-1430. [PMID: 37753864 DOI: 10.1080/1744666x.2023.2265069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/26/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, TX, USA
- Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, TX, USA
| | - Antonella Muraro
- UOSD Department of Pediatric and Adult Food Allergies, University Hospital of Padua
- Center for the Study and Cure of Allergies and Food Intolerance of the Veneto Region, University Hospital of Padua
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26
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Anagnostou A, Upton J, Nowak-Wegrzyn A. Novel therapies for food allergy: The search continues. Ann Allergy Asthma Immunol 2023; 131:2-3. [PMID: 37394249 DOI: 10.1016/j.anai.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Aikaterini Anagnostou
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas.
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, Hassenfeld Children's Hospital, New York University Grossman School of Medicine, New York, New York; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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Upton J, Anagnostou A, Nowak-Wegrzyn A. Oral food challenges: Measuring what counts. J Allergy Clin Immunol 2023; 152:50-52. [PMID: 37207800 DOI: 10.1016/j.jaci.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Julia Upton
- Department of Pediatrics, Division of Immunology and Allergy, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario.
| | - Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Tex; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Tex
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, Hassenfeld Children's Hospital, NYU R. Grossman School of Medicine, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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Mack DP, Greenhawt M, Anagnostou A. Reply to "Don't put all your eggs (and milk) in one basket". J Allergy Clin Immunol Pract 2023; 11:1982-1983. [PMID: 37295864 DOI: 10.1016/j.jaip.2023.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Douglas Paul Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Aikaterini Anagnostou
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
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29
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Anagnostou A. Food immunotherapy: current status and future needs. Expert Rev Clin Immunol 2023; 19:561-563. [PMID: 37038747 DOI: 10.1080/1744666x.2023.2201438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, TX, USA
- Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, TX, USA
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Mack DP, Greenhawt M, Anagnostou A. Are There Hidden Dangers Associated With Milk and Egg Dietary Advancement Therapy? J Allergy Clin Immunol Pract 2023; 11:1056-1062. [PMID: 36581070 DOI: 10.1016/j.jaip.2022.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022]
Abstract
Dietary advancement therapies (DATs) constitute a continuum spanning extensively heated item ingestion, progressive milk or egg ladders, and oral immunotherapy (OIT). These represent an evolution in food allergy management from strict avoidance to an active therapy that may modulate the immune system to develop tolerance to particular forms of the allergen. Many egg or milk individuals are tolerant to baked egg or milk at baseline, and regular consumption (at home ingestion) of baked milk or egg is a safe process with potential quality of life and immunologic benefit. Milk and egg ladders, developed for non-IgE mediated allergy, are increasingly being adapted to IgE-mediated allergy as a potentially safe at-home option for gradual dietary advancement. However, data are limited regarding how safe and effective these approaches are or what patient is best suited for which DAT. It is also unclear whether extensively heated allergen consumption and ladders are susceptible to the same patient-specific factors that affect day-to-day tolerance and safety in OIT. Several recent events involving near-fatal or fatal reactions to milk or egg products (all among patients with asthma) have highlighted that DATs are not risk-free, and that physician guidance in these therapies is essential. Such guidance may include obtaining informed consent before starting any DAT and instituting the same safe dosing rules for OIT across any form of DAT. This rostrum discusses practical concerns about the safety of DAT, and considerations regarding how clinicians can maximize patient protection while defining the safety and efficacy of real-world implementation of these concepts.
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Affiliation(s)
- Douglas Paul Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Aikaterini Anagnostou
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
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Anagnostou A. Lipid transfer protein allergy. Ann Allergy Asthma Immunol 2023; 130:413-414. [PMID: 37005051 DOI: 10.1016/j.anai.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Aikaterini Anagnostou
- Division of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology, and Retrovirology, Baylor College of Medicine, Houston, Texas.
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Anagnostou A, Abrams E. Is it food poisoning or allergy? Ann Allergy Asthma Immunol 2023; 130:403-404. [PMID: 37005046 DOI: 10.1016/j.anai.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 04/03/2023]
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Cole MC, Raphael JL, Katkin JP, Yenduri NJS, Gazzaneo MC, Revana A, Anagnostou A, Farber HJ. Asthma outcomes in pediatric patients with 30-day follow-up after an asthma hospitalization in a Medicaid-managed care program. J Asthma 2023:1-7. [PMID: 36893220 DOI: 10.1080/02770903.2023.2185155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND National asthma guidelines recommend an outpatient follow-up after hospitalization for asthma. Our aim is determine if a follow-up visit within 30 days after an asthma hospitalization impacts risk for re-hospitalization and emergency department visits for asthma within the following year. METHODS This was a retrospective cohort study of claims data of Texas Children's Health Plan (a Medicaid managed care program) members age 1 to <18 years and hospitalized for asthma between January 1, 2012, and December 31, 2018. Primary outcomes were days to re-hospitalization and emergency department visit between 30 days and 365 days following the index hospitalization. RESULTS We identified 1,485 children age 1 to <18 years hospitalized for asthma. Comparing those with a 30 day follow-up to those without, there was no difference in days to re-hospitalization (adjusted hazard ratio 1.23, 95% Confidence Interval (CI) 0.74-2.06) or emergency department visit for asthma (aHR 1.08, 95% CI 0.88-1.33). Inhaled corticosteroid and short acting beta agonist dispensing were greater in the group completing the 30 day follow-up (means of 2.8 and 4.8 respectively for those with follow-up, 1.6 and 3.5 respectively for those without, p < 0.0001). CONCLUSION Having a follow-up outpatient visit within 30 days of an asthma hospitalization is not associated with a decrease in asthma re-hospitalization or emergency department visit in the 30-365 day period following the index hospitalization. Non-adherence to regular use of inhaled corticosteroid medication was high in both groups. These findings suggest need for improvement in the quality and quantity of post hospital asthma follow-up.
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Affiliation(s)
- Melissa C Cole
- Pediatrics, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jean L Raphael
- Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Julie P Katkin
- Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Naga Jaya Smitha Yenduri
- Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Maria C Gazzaneo
- Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Amee Revana
- Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Aikaterini Anagnostou
- Pediatrics, Division of Allergy and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Harold J Farber
- Pediatrics, Division of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Oriel RC, Shah A, Anagnostou A, Greenhawt M, Khan F, Leeds S, Ravindran M, Stoffels G, Vickery BP, Virkud YV, Sicherer SH. Food Allergy Management Practices Utilizing Individual Patient Thresholds: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee. J Allergy Clin Immunol Pract 2023; 11:1083-1086.e1. [PMID: 36773718 DOI: 10.1016/j.jaip.2023.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
The paradigm for food allergy management has been strict avoidance of the food allergen. There is literature supporting a "high-threshold" phenotype, those who tolerate a small-to-modest amount of allergen but react to larger amounts. There is no consensus for best practice for these "high-threshold" individuals. We sought to understand management practices of "high-threshold" reactors using a survey that was distributed to a random sample of fellows and members of the American Academy of Allergy, Asthma, and Immunology. There were 89 respondents from the United States and Canada (11% response rate), with 64 (72%) answering all questions. Participants worked in private (52%) and academic practice (38%) and saw a median of 30 food allergic patients monthly. Eighty-one percent of respondents reported management strategies other than strict avoidance. When threshold was known, strategies ranged from allowing ingestion up to a specified amount (57%), proactively advising ingestion to a certain amount (56%), or oral immunotherapy (47%). Participants were more likely to choose a permissive approach for a mild reaction in a high-threshold milk-allergic patient compared with a peanut-allergic patient (83% vs 71%, p=.01). Important factors that influenced the approach included severity of reaction (52%), comfort with family/patient using emergency medications (42%), and family/patient preferences (41%). These survey results suggest that food allergy management recommendations are no longer binary in nature, with clinicians solely recommending avoidance for those who are allergic and ingestion for those who may not be.
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Affiliation(s)
- Roxanne C Oriel
- Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ami Shah
- Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aikaterini Anagnostou
- Division of Allergy, Immunology and Retrovirology, Baylor College of Medicine & Texas Children's Hospital, Houston, Texas
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Fatima Khan
- Department of Pediatrics, Division of Allergy and Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Stephanie Leeds
- Department of Pediatrics, Yale School of Medicine, New Haven, Conn
| | - Mayuran Ravindran
- Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Guillaume Stoffels
- Division of Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brian P Vickery
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Yamini V Virkud
- Department of Pediatrics, University of North Carolina - Chapel Hill, Chapel Hill, NC
| | - Scott H Sicherer
- Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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Tuano KT, Seth N, Chinen J, Anagnostou A. Food-induced Anaphylaxis In Infants Following Early Introduction Guidelines And Recommendations. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Blackmon W, Su BB, Ames H, Anvari S, Anagnostou A. Alteration of Cellular and Cytokine Profiles in Response to Shrimp Allergens in Peripheral Blood Mononuclear Cells from Shrimp Allergic Patients. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ames H, Blackmon W, Saxena R, Anvari S, Anagnostou A, Su BB. Stability of Major Shrimp Allergens in a Food Manufacturing Facility for Drug Delivery. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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38
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Szafron V, Anagnostou A. Impact of Maternal Factors on Presence of Peanut Allergy in Children. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Su BB, Blackmon W, Jackson T, Ames H, Anvari S, Anagnostou A, Li HJ. Alteration of the Transcriptome in Response to Shrimp Allergens in Shrimp Allergic Peripheral Blood Mononuclear Cells. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Anagnostou A, Upton J, Nowak-Wegrzyn A. Cow's milk formula each day may keep milk allergy away. Ann Allergy Asthma Immunol 2023; 130:151-152. [PMID: 36737157 DOI: 10.1016/j.anai.2022.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Aikaterini Anagnostou
- Division of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology, and Retrovirology, Baylor College of Medicine, Houston, Texas.
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, Temerty Faculty of Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, New York; Department of Pediatrics, Gastroenterology, and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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41
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Galvin AD, Vereda A, del Río PR, Muraro A, Jones C, Ryan R, Norval D, Jobrack J, Anagnostou A, Wang J. Children and caregiver proxy quality of life from peanut oral immunotherapy trials. Clin Transl Allergy 2022; 12:e12213. [PMID: 36573312 PMCID: PMC9762119 DOI: 10.1002/clt2.12213] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is significantly and substantially reduced in individuals with peanut allergy due to many factors associated with unanticipated or potentially fatal reactions. Further insight on the impact of peanut oral immunotherapy in managing peanut allergy on HRQoL is needed. The aim of this analysis was to assess effects of peanut (Arachis hypogaea) allergen powder-dnfp (PTAH), a biologic drug for peanut oral immunotherapy, on HRQoL from three phase 3 and two follow-on trials of PTAH. METHODS HRQoL assessments from participants aged 4-17 in the PALISADE (ARC003), ARC004 (PALISADE follow-on), ARTEMIS (ARC010), RAMSES (ARC007), and ARC011 (RAMSES follow-on) trials were included in this analysis. Responses on the Food Allergy Quality of Life Questionnaire (FAQLQ) and Food Allergy Independent Measure (FAIM) were evaluated by age group and respondent (self or caregiver proxy). Data were analyzed with descriptive statistics and Student t tests. RESULTS Baseline FAQLQ and FAIM total scores appeared comparable between PTAH- and placebo-treated participants. Self and caregiver proxy-reported total scores on the FAQLQ for PTAH-treated participants generally improved at trial exit versus baseline; FAIM total scores improved throughout all trials. The tendency for improvement in FAQLQ total scores from baseline for PTAH appeared larger in self versus caregiver proxy-reports. Between treatment groups, PTAH was generally favored in the PALISADE and ARTEMIS trials; differences varied in the RAMSES trial based on age and respondent types. CONCLUSIONS PTAH for the management of peanut allergy in children appeared to have a beneficial effect on HRQoL in trials. Improvements were seen despite rigors of trial participation.
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Affiliation(s)
| | - Andrea Vereda
- Aimmune Therapeutics, a Nestlé Health Science CompanyLondonUK
| | | | | | | | - Robert Ryan
- Aimmune Therapeutics, a Nestlé Health Science CompanyLondonUK
| | - David Norval
- Aimmune Therapeutics, a Nestlé Health Science CompanyLondonUK
| | | | | | - Julie Wang
- Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Blackman AC, Staggers KA, Anagnostou A. Anaphylaxis during Peanut Oral Immunotherapy: Looking beyond dose escalation. Pediatr Allergy Immunol 2022; 33:e13888. [PMID: 36564873 DOI: 10.1111/pai.13888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 12/07/2022]
Affiliation(s)
- Andrea C Blackman
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas, USA.,Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas, USA
| | - Kristen A Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas, USA.,Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas, USA
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Wang J, Rodriguez del Rio P, Vereda A, Ryan R, Norval D, Jobrack J, Anagnostou A, Galvin AD. HEALTH-RELATED QUALITY OF LIFE IN CHILDREN AND CAREGIVER PROXIES FROM TRIALS OF PEANUT ORAL IMMUNOTHERAPY. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ciaccio C, Goldsobel AB, Anagnostou A, Beyer K, Casale TB, Deschildre A, Fernández-Rivas M, Hourihane JO, Krawiec M, Lieberman J, Scurlock AM, Vickery BP, Smith A, Tilles SA, Adelman DC, Brown KR. Participant Characteristics and Safety Outcomes of Peanut Oral Immunotherapy in the RAMSES and ARC011 Trials. Ann Allergy Asthma Immunol 2022; 129:758-768.e4. [PMID: 35973655 DOI: 10.1016/j.anai.2022.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical trials (PALISADE [ARC003], ARTEMIS [ARC010]) proving efficacy and safety of peanut (Arachis hypogaea) allergen powder-dnfp (PTAH) used double-blind, placebo-controlled food challenges (DBPCFCs) to screen for eligibility and to evaluate efficacy. In routine clinical practice, individuals with peanut allergy do not always undergo food challenges to confirm diagnosis or determine candidacy for treatment. OBJECTIVE To describe PTAH safety/tolerability in participants selected by clinical history and peanut sensitization parameters not undergoing DBPCFC during trails and to compare findings with previously published data. METHODS RAMSES (ARC007) was a 6-month, phase 3, randomized, double-blind, placebo-controlled trial in children aged 4 to 17 years with physician-confirmed peanut allergy. ARC011 was the subsequent 6-month follow-on maintenance PTAH study. The primary endpoint for RAMSES and ARC011 was frequency of treatment-emergent adverse events (AEs). We descriptively compared baseline characteristics and safety outcomes from RAMSES/ARC011 to participants undergoing DBPCFCs in phase 3 PALISADE/ARTEMIS trials. RESULTS In 506 patients randomized to study treatment, baseline characteristics appeared balanced between groups. Proportion of participants with ≥1 AE was 55% for PTAH versus 33.9% for placebo during initial dose escalation and 98.8% versus 94.0%, respectively, during updosing. Most participants with AEs had mild/moderate events. The most common AEs were gastrointestinal. Comparisons to pooled PALISADE and ARTEMIS data showed higher baseline median peanut-specific immunoglobulin E and skin prick test values for RAMSES participants. Safety outcomes during trial periods were comparable. CONCLUSION Safety data from clinically selected children with peanut allergy receiving PTAH do not appear different from those in phase 3 trials requiring DBPCFC to enter trials.
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Affiliation(s)
| | - Alan B Goldsobel
- Allergy and Asthma Associates of Santa Clara Valley Research Center, San Jose, CA, USA
| | | | | | | | - Antoine Deschildre
- Université de Lille, CHU Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Lille, France
| | | | | | - Marta Krawiec
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jay Lieberman
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Amy M Scurlock
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA
| | | | - Alex Smith
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA, USA
| | - Stephen A Tilles
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA, USA
| | - Daniel C Adelman
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA, USA; Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kari R Brown
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA, USA.
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Blackman AC, Thapa S, Venkatachalam A, Horvath TD, Runge JK, Haidacher SJ, Hoch KM, Haag AM, Luna RA, Anagnostou A. Insights into Microbiome and Metabolic Signatures of Children Undergoing Peanut Oral Immunotherapy. Children 2022; 9:children9081192. [PMID: 36010081 PMCID: PMC9406383 DOI: 10.3390/children9081192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
Background: Peanut oral immunotherapy has emerged as a novel, active management approach for peanut-allergic sufferers, but limited data exist currently on the role of the microbiome in successful desensitization. Objective: We examined the oral and gut microbiome in a cohort of 17 children undergoing peanut oral immunotherapy with the aim to identify the microbiome signatures associated with successful desensitization. We also set out to characterize their fecal metabolic profiles after successful therapy. Methods: Participants gradually built up their daily dose from 2 mg (starting dose) to 300 mg (maintenance dose) within approximately 40 weeks. We collected a buccal and stool specimen from each subject at two different time points: at baseline and post-therapy (1 month after reaching maintenance). The oral (buccal) and gut (fecal) microbiome was characterized based on sequencing of 16S rRNA gene amplicons with Illumina MiSeq. Fecal short chain fatty acid levels were measured using liquid chromatography-tandem mass spectrometry. Results: We report increased alpha diversity of the oral microbiome post-therapy and have also identified a significant increase in the relative abundance of oral Actinobacteria, associated with the desensitized state. However, the baseline gut microbiome did not differ from the post-therapy. Additionally, fecal short chain fatty acids increased after therapy, but not significantly. Conclusion: Our research adds to the limited current knowledge on microbiome and metabolic signatures in pediatric patients completing oral immunotherapy. Post-therapy increased trends of fecal fatty acid levels support a role in modulating the allergic response and potentially exerting protective and anti-inflammatory effects alongside successful desensitization. A better understanding of the microbiome-related mechanisms underlying desensitization may allow development of smarter therapeutic approaches in the near future. Clinical implication: The oral microbiome composition is altered following successful peanut oral immunotherapy, with a significant increase in alpha diversity and the relative abundance of phylum Actinobacteria. Capsule summary: Significant microbiome changes in children completing peanut immunotherapy include increase in alpha-diversity and overrepresentation of Actinobacteria in the oral microbiome, and increased trends for fecal short chain fatty acids, suggesting a protective effect against the allergic response.
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Affiliation(s)
- Andrea C. Blackman
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children’s Hospital, Houston, TX 77030, USA
- Section of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Santosh Thapa
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Microbiome Center, Department of Pathology, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Alamelu Venkatachalam
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Microbiome Center, Department of Pathology, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Thomas D. Horvath
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Microbiome Center, Department of Pathology, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Jessica K. Runge
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Microbiome Center, Department of Pathology, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Sigmund J. Haidacher
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Microbiome Center, Department of Pathology, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Kathleen M. Hoch
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Microbiome Center, Department of Pathology, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Anthony M. Haag
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Microbiome Center, Department of Pathology, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Ruth Ann Luna
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX 77030, USA
- Texas Children’s Microbiome Center, Department of Pathology, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Aikaterini Anagnostou
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children’s Hospital, Houston, TX 77030, USA
- Section of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-832-824-1319
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Anagnostou A, Lawrence C, Tilles SA, Laubach S, Donelson SM, Yassine M, Nowak-Wegrzyn A. Qualitative interviews to understand health care providers' experiences of prescribing licensed peanut oral immunotherapy. BMC Res Notes 2022; 15:273. [PMID: 35941597 PMCID: PMC9358114 DOI: 10.1186/s13104-022-06161-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Objective This research sought to explore health care providers’ (HCPs) experiences of delivering the first US Food and Drug Administration (FDA) and European Commission (EC) approved peanut oral immunotherapy (peanut OIT; Palforzia). Semi-structured qualitative interviews with HCPs who had initiated treatment with ≥ 3 patients in the first nine months following FDA approval sought to identify challenges faced and successful implementation strategies. Results Eight allergists and three nurse practitioners from eight sites based in the United States participated. The HCPs included in this research were motivated to implement this novel treatment, however, entered the process with some reservations. HCPs described how successful implementation of peanut OIT requires them to be thoughtful about their clinic’s abilities to integrate complex, time-consuming treatments into their daily practice. Prior experience of OIT was deemed beneficial, but not essential for implementation and learning from others’ experience was suggested as a way of helping new prescribers overcome perceived and actual implementation challenges. Delivering licensed peanut OIT during the COVID-19 pandemic posed both challenges and unexpected opportunities for implementation. The experiences described have the potential to benefit the wider allergy community by providing practical solutions, successful implementation strategies and opportunities to enhance training and resources. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-06161-6.
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Affiliation(s)
| | | | - Stephen A Tilles
- Aimmune Therapeutics, A Nestlé Health Science Company, Brisbane, CA, USA
| | - Susan Laubach
- Rady Children's Hospital, University of California San Diego (UCSD), San Diego, CA, USA
| | - Sarah M Donelson
- Aimmune Therapeutics, A Nestlé Health Science Company, Brisbane, CA, USA
| | - Mohamed Yassine
- Aimmune Therapeutics, A Nestlé Health Science Company, Brisbane, CA, USA
| | - Anna Nowak-Wegrzyn
- Grossman School of Medicine, Hassenfeld Children's Hospital, New York, USA.,Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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Anvari S, Watkin LB, Minard CG, Schuster K, Hassan O, Anagnostou A, Orange JS, Corry DB, Davis CM. Reduced pro-inflammatory dendritic cell phenotypes are a potential indicator of successful peanut oral immunotherapy. PLoS One 2022; 17:e0264674. [PMID: 35617270 PMCID: PMC9135258 DOI: 10.1371/journal.pone.0264674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Dendritic cells are important mediators in the early presentation of antigen and regulation of the differentiation of T cells. Peanut oral immunotherapy (POIT) results in desensitization in most peanut allergic individuals (responders), but not in others due to allergic reactions (non-responders). Delineation of early immunologic changes contributing to desensitization would help clarify the POIT mechanism of action. We analyzed dendritic cells in 15 pediatric subjects (5–12 years) undergoing a phase 1 single-center POIT study. We examined dendritic cells at baseline, 6-, 12-, 18- and 24-weeks after initiation of POIT and responders of therapy were compared to non-responders and healthy controls. The distribution frequency of myeloid DCs (mDCs) and plasmacytoid DCs (pDCs) from peripheral blood samples were measured in vitro. A general linear mixed model was used, and included fixed effects for cohort (responder, non-responder, or healthy control), time (0-, 6-, 12-, 18-, and 24-weeks), and the cohort-time interaction term. P-values were adjusted for multiple hypothesis testing using Tukey’s method. We observed that POIT responders had reduced TNFa producing myeloid dendritic cells (mDCs) compared to non-responders. Additionally, non-responders had increased OX40L expressing mDCs at 18-weeks compared to responders. In conclusion, our findings suggest that a reduced pro-inflammatory phenotype in DCs could potentially serve as a predictor of early outcome and success of POIT desensitization.
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Affiliation(s)
- Sara Anvari
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
- William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, United States of America
- * E-mail:
| | - Levi B. Watkin
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
- William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, United States of America
| | - Charles G. Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, United States of America
| | - Kimberly Schuster
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
- William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, United States of America
| | - Oluwatomi Hassan
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
- William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, United States of America
| | - Aikaterini Anagnostou
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
- William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, United States of America
| | - Jordan S. Orange
- Department of Pediatrics, Vagelos College of Physicians and Surgeons Columbia University, New York, New York, United States of America
| | - David B. Corry
- Department of Medicine Section of Immunology, Allergy and Rheumatology and Biology of Inflammation Center, Baylor College of Medicine, Houston, Texas, United States of America
- Michael E. DeBakey VA Medical Center for Translational Research in Inflammatory Diseases, Baylor College of Medicine, Houston, Texas, United States of America
| | - Carla M. Davis
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, United States of America
- William T. Shearer Center for Human Immunobiology, Texas Children’s Hospital, Houston, Texas, United States of America
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Davis CM, Anagnostou A, Devaraj S, Vita DT, Rivera F, Pitts K, Hearrell M, Minard C, Guffey D, Gupta M, Watkin L, Orange JS, Anvari S. Maximum Dose Food Challenges Reveal Transient Sustained Unresponsiveness in Peanut Oral Immunotherapy (POIMD Study). J Allergy Clin Immunol Pract 2022; 10:566-576.e6. [PMID: 34890827 PMCID: PMC10404846 DOI: 10.1016/j.jaip.2021.10.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The maximum tolerated dose of peanut protein following peanut oral immunotherapy (POIT) is unknown because most research studies have not examined very high thresholds. OBJECTIVE To define the maximum dose tolerated by patients on POIT and severity of allergic reactions after a 1-month period of treatment discontinuation. METHODS In a phase 2 3-year POIT open-label study, we enrolled participants age 5 to 13 years with a 1-year build-up period followed by a 2-year daily maintenance dose of 3900 mg with assessment of the maximum tolerated dose using double-blind placebo-controlled food challenges (DBPCFCs) of 26,225 mg cumulative dose of peanut protein. The DBPCFC was performed at baseline, after 12-month build-up, at 2 year of maintenance, and after a 1-month period of treatment discontinuation. Biomarkers were assessed every 6 weeks for the first 6 months of therapy. A general linear mixed model was used for analysis. RESULTS The mean maximum cumulative tolerated dose after 12 months increased by 12,063 mg (P < .001) (n = 12), slightly decreased during maintenance (n = 11), and significantly decreased by 7593 mg after avoidance for 1 month (P = .03) (n = 6). Biomarker analysis revealed decreases in cytokine expression within the first 6 weeks of initiation of POIT and decreased peanut-IgG4 and increased cytokine expression after 1 month of discontinuation. The DBPCFC reaction severity, examined through a symptom score with 1 point for each defined symptom, decreased after 12 months, but did not significantly change after 1 month of POIT discontinuation. CONCLUSIONS The evaluation of POIT and sustained unresponsiveness by maximum tolerated dose by DBPCFCs in this small phase 2 trial showed that desensitization is diminished, with 100% loss of tolerated dose after 1 month of avoidance following 3 years of treatment.
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Affiliation(s)
- Carla M Davis
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Section of Immunology, Allergy and Retrovirology, Houston, Texas.
| | - Aikaterini Anagnostou
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Section of Immunology, Allergy and Retrovirology, Houston, Texas
| | - Sridevi Devaraj
- Baylor College of Medicine, Texas Children's Hospital, Department of Pathology and Immunology, Houston, Texas
| | - Daisy T Vita
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Section of Immunology, Allergy and Retrovirology, Houston, Texas
| | - Fabian Rivera
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Section of Immunology, Allergy and Retrovirology, Houston, Texas
| | - Kathleen Pitts
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Section of Immunology, Allergy and Retrovirology, Houston, Texas
| | - Melissa Hearrell
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Section of Immunology, Allergy and Retrovirology, Houston, Texas
| | - Charles Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Meera Gupta
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Section of Immunology, Allergy and Retrovirology, Houston, Texas
| | - Levi Watkin
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Section of Immunology, Allergy and Retrovirology, Houston, Texas
| | - Jordan S Orange
- Columbia University, Vagelos College of Physicians and Surgeons, New York-Presbyterian, Morgan Stanley Children's Hospital, New York, NY
| | - Sara Anvari
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Section of Immunology, Allergy and Retrovirology, Houston, Texas
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49
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Blackman A, Anagnostou A. Anaphylaxis Episodes during Peanut Oral Immunotherapy. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Noroski L, Pitts K, Aldape T, Tran D, Anagnostou A, Kronisch L, Lyter-Reed L, Anvari S, User A, Davis C. Innovative Educational-Empowerment-Empathy Networks for/by Allergic-Immunodeficient Children/Teens/Adults – Inclusive Model towards Health Literacy Reproducible across Chronic Diseases. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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