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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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Gordon J, Detjen P, Nimmagadda S, Rogers L, Patel S, Thompson J, Reboulet R, Gandhi P. Bedroom exposure to airborne allergens in the Chicago area using a patient-operated sampling device. Ann Allergy Asthma Immunol 2018; 121:211-217.e3. [PMID: 29860049 DOI: 10.1016/j.anai.2018.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/24/2018] [Accepted: 05/23/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND In current practice, allergens in vacuum-collected dust are used as surrogates for inhalable allergens. We developed an air-sampling device that can be used by patients for direct measurement of airborne allergen concentrations in their own homes. OBJECTIVE To demonstrate the use of this device to establish allergen concentration reference ranges in a target population and to evaluate associations between patient-reported information and measured allergen concentrations. METHODS Patients from 5 allergist's practices in the Chicagoland region were provided with instructions, questionnaires, informed consent forms, and samplers to run for 5 days in their bedrooms. Samples were collected from cartridges and assayed by multiplex immunoassays for 12 common household allergens and enzyme-linked immunosorbent assay for ragweed. RESULTS Unique allergen profiles were obtained for 102 patient homes. Samples with allergen concentrations above the limit of detection were as follows: total dust mite, 28%; cat, 61%; dog, 64%; mouse, 12%; rat, 0%; cockroach, 4%; Alternaria, 6%; Aspergillus, 21%; birch pollen 1%; grass, 8%; and ragweed, 5%. Of those, 75 completed questionnaires, providing meta-data for further analysis. Pet allergens correlated significantly with number of pets owned. Humidity correlated with dust mite allergens, open windows with Alternaria and mouse allergens, and high-efficiency particulate air filter use with reduced levels of several allergens. Many other variables showed no significant correlations. CONCLUSION The combination of ease of use, high air-sampling rate, and sensitive immunoassays permitted the measurement of airborne allergen concentrations in homes and establishment of reference ranges. Patient-reported information permitted identification of factors that could relate to allergen concentrations and suggested remedial measures.
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Affiliation(s)
| | - Paul Detjen
- Kenilworth Medical Allergy & Immunology, Kenilworth, Illinois
| | - Sai Nimmagadda
- Associated Allergy and Asthma Specialists Ltd, Chicago, Illinois
| | | | | | - James Thompson
- Associated Allergy and Asthma Specialists Ltd, Chicago, Illinois
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Patel B, Sheridan P, Detjen P, Donnersberger D, Gluck E, Malamut K, Whyte S, Miller A, Qing H. Success of a comprehensive school-based asthma intervention on clinical markers and resource utilization for inner-city children with asthma in Chicago: the Mobile C.A.R.E. Foundation's asthma management program. J Asthma 2007; 44:113-8. [PMID: 17454325 DOI: 10.1080/02770900601182343] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Children with asthma in low-income households in Chicago were participants in a school-based mobile van clinic, Mobile C.A.R.E. Our objective was to investigate whether long-term follow-up changed clinical markers and resource utilization. Children were evaluated by a pediatrician in a mobile allergy clinic and classified and treated based on National Asthma Education and Prevention Program (NAEPP) guidelines. Intervention consisted of assessment of allergic environment with avoidance recommendations, institution of appropriate controller therapy and inhaler technique, education on asthma and asthma management, and expectations for asthma control. Over 20,000 children were screened, 2041 were examined at least once, and 677 children had four follow-up visits. With follow-up, there was a decrease in hospitalizations and emergency room visits. Symptomatic markers (daytime and nighttime cough, wheezing, and dyspnea symptoms), frequency of rescue inhaler use, and a quality-of-life score improved from baseline. These findings suggest that ongoing school interventions may reduce resource utilization and improve clinical symptoms. Primary care physicians may be able to deliver specialized care to large numbers of inner-city children with asthma.
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Affiliation(s)
- Bina Patel
- Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine. Evanston, Illinois, USA.
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