26 Feb Peanut Allergy: Predictors of Safety for Preschool Oral Immunotherapy
MedicalResearch.com Interview with:
Edmond S. Chan MD, FRCPC, FCSACI, FAAAAI
Head | Division of Allergy & Immunology | Department of Pediatrics, Faculty of Medicine
Clinical Professor, The University of British Columbia
Clinical Investigator, BC Children’s Hospital Research Institute
BC Children’s Hospital, Allergy Clinic
Vancouver, BC Canada
Treasurer, CSACI (Canadian Society of Allergy & Clinical Immunology)
MedicalResearch.com: What prompted you to look at the safety of peanut oral immunotherapy specifically in this patient population?
Response: Our previous research has investigated the overall safety of peanut oral immunotherapy (OIT) in preschool populations. However, we have not investigated the relationship between specific patient characteristics and the safety of OIT. Previous literature has shown that patient factors, such as age, gender, baseline sIgE levels, and atopic comorbidities have been shown to impact the safety of OIT for other food allergies and in older patients. However, no data exist on which factors predict safety of peanut OIT in preschool populations.
MedicalResearch.com: Of the predictive factors that you found, did any stick out to you as being surprising or unexpected?
Response: Two of the factors that we identified as predictive of decreased peanut oral immunotherapy safety were a reaction of Grade 2 or higher prior to OIT start, and lower eliciting dose. Limited research has explored these predictive factors and is an area that can be further researched.
MedicalResearch.com: What type of safety outcomes did you observe in this population following peanut OIT?
Response: During the build-up phase of OIT, increasing peanut doses were administered approximately every 2 weeks, and any symptoms were documented. These symptoms were classified using a modified World Allergy Organization Subcutaneous Immunotherapy Reaction Grading System (1 mildest, 5 fatal). Our multivariate logistic modeling was run with the safety outcome being maximum grade of reaction (grade 2+ vs. grade 1/no reaction) over the course of OIT.
MedicalResearch.com: Based on these findings, do you think clinicians should consider all of these factors before beginning peanut OIT in preschoolers? Should certain candidates be excluded from therapy if they have many risk factors for poor safety outcomes?
Response: Yes, we think clinicians should consider all of the predictive factors that were found to be significant in our study, before beginning preschool peanut OIT. However, since preschool OIT is overall so much safer than OIT in older children, we would use these predictors to decide who to offer a more cautious build-up phase rather than for deciding who to exclude from peanut oral immunotherapy. Actual exclusion criteria for immunotherapy have already been well established in guidelines, such as patients with uncontrolled asthma.
MedicalResearch.com: What are the next steps in research you would like to see conducted next on this topic?
Response: As our data set continues to expand, predictive modeling and machine learning can be used to recognize patterns, evaluate likelihood of severe reactions, and support clinical decision making via a personalized medicine approach. The predictive factors that were identified in our data set can be inputted into these models by clinicians and/or families to help guide how to use OIT to treat food allergy and enhance patient safety. An example would be choosing a lower starting dose and/or longer build-up interval for those at higher risk of reaction. The next step of this research will include evaluation of this model as a clinical tool, and its impact on OIT delivery across Canada.
Presented at February 2022 AAAAI meeting: https://annualmeeting.aaaai.org/
Predictors of Safety for Preschool Peanut Oral Immunotherapy that can help inform a Personalized Medicine Approach
Karunakaran, Duva et al.
Journal of Allergy and Clinical Immunology, Volume 149, Issue 2, AB139
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