Allergies, Author Interviews, Pediatrics / 10.05.2023
NEJM: Viaskin Patch Shows Promising Results for Toddlers with Peanut Allergy
MedicalResearch.com Interview with:
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Dr. Greenhawt[/caption]
Matthew Greenhawt, MD, MBA, MSc
Professor of Pediatrics
Section of Allergy and Immunology
Director, Food Challenge and Research Unit
Children’s Hospital Colorado
University of Colorado School of Medicine
Anschutz Medical Campus
Aurora, CO 80045
MedicalResearch.com: What is the background for this study? Is the incidence of peanut allergy in toddlers stabilizing with the earlier introduction of peanuts?
Response: There exists an urgent unmet medical need for infants and toddlers living with peanut allergy. Peanut allergy affects approximately 2% of U.S. children and has been a growing public health problem over the past 20 years. In fact, the number of kids affected by peanut allergy has tripled in that time span. Peanut allergy is not likely to be naturally outgrown, and reactions can be severe.
However, there is hope. There is growing evidence that the allergic immune system is more modifiable early in life. The EPITOPE study evaluated Viaskin Peanut in children ages 1 – 3 years of age. Viaskin Peanut is an investigational epicutaneous immunotherapy (EPIT) product, which uses the skin as a route to desensitize a patient to be less reactive to peanut. This is a daily therapy, worn between the shoulders on the back, which allows for non-oral peanut desensitization, which many parents find highly appealing.
Dr. Greenhawt[/caption]
Matthew Greenhawt, MD, MBA, MSc
Professor of Pediatrics
Section of Allergy and Immunology
Director, Food Challenge and Research Unit
Children’s Hospital Colorado
University of Colorado School of Medicine
Anschutz Medical Campus
Aurora, CO 80045
MedicalResearch.com: What is the background for this study? Is the incidence of peanut allergy in toddlers stabilizing with the earlier introduction of peanuts?
Response: There exists an urgent unmet medical need for infants and toddlers living with peanut allergy. Peanut allergy affects approximately 2% of U.S. children and has been a growing public health problem over the past 20 years. In fact, the number of kids affected by peanut allergy has tripled in that time span. Peanut allergy is not likely to be naturally outgrown, and reactions can be severe.
However, there is hope. There is growing evidence that the allergic immune system is more modifiable early in life. The EPITOPE study evaluated Viaskin Peanut in children ages 1 – 3 years of age. Viaskin Peanut is an investigational epicutaneous immunotherapy (EPIT) product, which uses the skin as a route to desensitize a patient to be less reactive to peanut. This is a daily therapy, worn between the shoulders on the back, which allows for non-oral peanut desensitization, which many parents find highly appealing.
Larissa K. Samuelson, PhD
Professor
Developmental Dynamics Lab
School of Psychology; UK 14th for Research Quality
Psychology, Psychiatry, and Neuroscience
University of East Anglia, United Kingdom
MedicalResearch.com: What is the background for this study?
Response: Words direct the attention of infants, children and adults to mentioned objects in the environment. When someone says “Can you find the candy,” you look to the candy sitting on the counter. This fact is the basis of many tests of infant cognition in laboratories. To find out if a child knows the word “bike” we put a picture of a bike and a truck on a TV screen, say the word “bike” and see if they look at the correct object.
There is also evidence that words can direct attention even if you don’t know what they mean yet. For example, in studies of learning in the lab novel made up words like “modi” can direct children’s attention to specific features of objects. One particular example of this is the “shape bias”. If a two-year-old is shown a novel object and told a novel name, for example “This is my blicket,” and then asked, “Can you get your blicket” and shown one object that matches the named one in shape and another that is made from the same material, they will attend to the one that matches in shape. Researchers think the naming event “This is my…” cues children to look at things that are the same shape because they already know many names for things in sets that are similar in shape; cups are all cup-shaped, keys are all key-shaped, spoons are all spoon-shaped, etc.
Prior research suggests there may be differences in the way children who struggle with language decide what a new word means. For example, children with Developmental Language Disorder do not pay attention to the same things when learning new words as children with typical language development. These children do not look to an object that matches a named exemplar in shape when asked to “get your blicket”. But you can’t diagnose children with DLD until they are 3 or 4. We want to see if we can identify these children earlier, so they can get early support.
Dr. Roca[/caption]
Anna Roca PhD
MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine
Fajara, The Gambia
MedicalResearch.com: What is the background for this study?
Response: Context specific interventions are needed to decrease the high burden of severe neonatal morbidity and mortality in sub-Saharan Africa. Severe bacterial infections are a main cause of neonatal mortality in the continent. Oral intra-partum azithromycin is a cheap intervention easily scalable. Before embarking on this trial, we conducted a proof-of-concept trial that showed the intervention reduced maternal and neonatal bacterial carriage of the most prevalent bacteria causing neonatal sepsis in the continent.
Yuxia Wei[/caption]
Yuxia Wei | PhD Student
Unit of Epidemiology
Institute of Environmental Medicine
Karolinska Institutet
Stockholm | Sweden
MedicalResearch.com: What is the background for this study?
Response: Diabetes is traditionally known for having two types (type 1 diabetes and type 2 diabetes). However, it is becoming increasingly clear that diabetes is much more complex than this traditional classification. Several attempts have been made to address this heterogeneity and in 2018, a Swedish ground-breaking study proposed that there are five distinct subtypes of diabetes in adults. They have been replicated in different populations and it has been shown that there are differences between the subtypes in terms of genetics and risks of complications. Another way of elucidating the relevance of these subtypes is to investigate whether the influence of known risk factors for diabetes is different on different subtypes. Our study is one of the first attempts to address this. We used a study design known as Mendelian randomization, to investigate the influence of childhood obesity on these diabetes subtypes that typically occur after age 35. This work was a collaboration between Karolinska institutet in Stockholm, University of Bristol in the UK and Sun Yat-Sen University in China.
Dr. Pierce[/caption]
Karen Pierce, Ph.D.
Professor, Department of Neurosciences, UCSD
Co-Director, Autism Center of Excellence, UCSD
MedicalResearch.com: What is the background for this study?
Response: The mean age of ASD diagnosis and eventual treatment remains at ~52 months in the United States1 - years beyond the disorder’s prenatal origins2, and beyond the age when it can be reliably diagnosed in many cases3.
Currently the only way to determine if a child has autism spectrum disorder (ASD) is to receive a developmental evaluation from an experienced clinician (usually a licensed clinical psychologist). There are often long waiting lists, and only a small number of clinicians have the experience required to make early-age (i.e., between 12-36 months) diagnoses of ASD. Thus, there are many places in the country as well as world wide wherein children wait months or years to receive a formal diagnosis due to a lack of available expertise. Moreover, diagnostic evaluations are expensive and usually cost the parent and/or insurance approximately ~$2,000 or more per evaluation. Finally, clinical evaluations usually take between 2-3 hours to complete and result in fatigue for both the parent and toddler.
Eye-tracking, which generates biologically-relevant, objective, and quantifiable metrics of both visual and auditory preference profiles in babies and toddlers in just minutes, is a technology that can dramatically change how ASD is diagnosed.
Dr. García Cenoz[/caption]
Manuel García Cenoz MD, PhD
Dr. Grandahl[/caption]
Maria Grandahl, Associate Professor, PhD, Senior lecturer
Director of Education in Nursing and Midwifery programs
Uppsala University
Department of Women’s and Children’s Health
on behalf of authors:
Dr Jenny Stern, Dr Eva-Lotta Funkquist and Dr Maria Grandahl
MedicalResearch.com: What is the background for this study?
Response: Conflicting advice and non-evidence-based recommendations have a negative effect on breastfeeding. Since 2011, the National Food Agency in Sweden has informed parents that they can introduce tiny tastings (1 mL of solid food, i.e. other sources of nutrition than breastmilk/formula) to infants from four months of age. It is unknown how national recommendations, which differ from the Word Health Organization’s recommendation, affect breastfeeding.
Dr. Wong[/caption]
Mitchell Wong, MD PhD
Professor of Medicine
Executive Vice Chair for Research Training
Department of Medicine
Executive Co-Director, Specialty Training and Advanced Research (STAR) Program
Director, UCLA CTSI KL2 Program
UCLA Division of General Internal Medicine and Health Services Research Los Angeles, CA 90024
MedicalResearch.com: What is the background for this study?
Response: It is estimated that social factors like poverty, education, and housing have a large impact on health. Yet, there are few interventions that exist to directly address those issues. Schools are a promising solution since society already invests heavily in education and schools are an everyday part of most children’s lives.
Dr. Robbins[/caption]
Rebecca Robbins, Ph.D.
Instructor in Medicine
Associate Scientist, Division of Sleep and Circadian Disorders
Investigator, Division of Sleep and Circadian Disorders
Departments of Medicine and Neurology
Brigham and Women's Hospital
MedicalResearch.com: What is the background for this study?
Response: Teens face myriad challenges to sleep, ranging from biological factors, including a preference for later bedtimes and increased need for sleep, to social factors, including social pressures and increased academic workloads, all limiting teenagers in their ability to keep a healthy sleep schedule.
In a nationally representative sample, we explored the prevalence of another potential barrier to sleep among teens, which are a set of beliefs that are held in the population, yet are actual counter to scientific principles regarding sleep and circadian rhythms.
Dr. Soriano[/caption]
Victoria Soriano PhD
Research Assistant/Officer, Population Allergy
University of Melbourne
MedicalResearch.com: What is the background for this study?
Response: Peanut allergy is one of the most common childhood food allergies, and children rarely grow out of it. The only proven way to prevent peanut allergy is to give infants age-appropriate peanut products in the first year of life.
We previously showed there was a dramatic increase in peanut introduction from 2007-11 to 2018-19, following changes to infant feeding guidelines. We wanted to know if earlier peanut introduction would reduce peanut allergy in the general population (in Melbourne, Australia).
Dr. Stingone[/caption]
Jeanette Stingone PhD
Assistant Professor, Epidemiology
Mailman School of Public Health
Columbia University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Lead is a well-established neurotoxin, particularly when exposure occurs early in life and in childhood. Associations between elevated blood lead levels and lower scores on tests of neurodevelopment and cognition are seen consistently across studies, even when examining lower levels of exposure.
While reducing exposure to lead is the primary intervention to prevent these adverse outcomes, there aren’t many interventions designed to support the neurodevelopment of children who have been exposed to lead. Some municipalities consider elevated blood lead levels as a criteria for inclusion in Early Intervention programs. Early Intervention programs are mandated under the Individuals with Disabilities Education Act and provide services for children younger than 3 years old with disabilities or developmental delays.
The objective of this study was to compare 3rd grade standardized test scores among children who had elevated blood lead levels early in life to see if children who had received Early Intervention services performed better on these tests than those who did not receive services. Using matching methods and an existing administrative data linkage of children who were born and attended public school in New York City, we observed that children exposed to lead who received Early Intervention services scored higher on standardized tests in both math and English Language arts than children exposed to lead who did not receive services. 
Dr. Fernandez-Mendoza[/caption]
Julio Fernandez-Mendoza, PhD, CBSM, DBSM
Associate Professor of Psychiatry & Behavioral Health
Sleep Research & Treatment Center
Director, Behavioral Sleep Medicine Program
Penn State Health Milton S. Hershey Medical Center
MedicalResearch.com: What is the background for this study? Is insomnia familial?
Response: Consistent research has shown that about 25% of school-age children have insomnia symptoms consisting of difficulties initiating or maintaining sleep. However, what has remained unknown is to what extent those insomnia symptoms persist all the way into adulthood, or whether they developmentally remit (go away with age) as the child grows into adolescence or young adulthood. This is the question that our study focused on.
Dr. Aris[/caption]
Izzuddin M Aris, PhD
Assistant Professor
Department of Population Medicine, Harvard Medical School
Division of Chronic Disease Research Across the Lifecourse
Harvard Pilgrim Health Care Institute
Boston, MA
MedicalResearch.com: What is the background for this study?
Response: Puberty is a key stage during child development. Previous research indicates that children in the United States are entering puberty at younger ages. These children may be in danger of developing certain diseases, such as type 2 diabetes, later in life. A better understanding of how early life factors affect puberty development is important for combating earlier puberty onset. .
