Thread by @AllergyKidsDoc

Lots of information surrounding yesterday's FDA meeting to approve the 1st treatment for peanut allergy.

As always, there is lots of misinformation as well.

I'll address some important points to consider in this #SaturdayMorning thread ⬇️

abcn.ws/2UV2PUZ

Results of Aimmune's Phase 3 trial were published in 2018: nejm.org/doi/full/10.10…

Primary outcome - 67% of participants could tolerate a single dose of 600 mg (total 1043 mg) peanut vs 4% in placebo after ~12 months of peanut oral immunotherapy (300 mg daily maintenance)

One peanut kernel contains about 250-300 mg of protein.

AR101 peanut immunotherapy has a goal daily dose of 300 mg.

There is a gradual build up starting with very small doses and then the maintenance dose must be taken daily. nejm.org/doi/suppl/10.1…

Some allergists have been using oral immunotherapy to peanut & other foods for years. Protocols and the type of commercially available food products used vary.

Main difference: AR101, now known as Palforzia, comes in a capsule and is manufactured in a dedicated facility.

Regardless of using commercial food or Palforzia, there are important things to understand surrounding oral immunotherapy for peanut.

1. It is not a cure
2. It is a desensitization readysetfood.com/blogs/communit…
3. It requires daily dosing for years
4. Allergic reactions can occur

The majority of people who receive OIT:
-Can achieve a level of increased tolerance
-Have less severe reactions with accidental ingestion of small amounts
-Cannot eat that food ad lib

EVERYONE must continue to have epinephrine available at all times, even on daily dosing.

Anyone considering OIT must understand the regimen involved, risk of side effects, & expected outcomes/goals of treatment.

Shared decision making is essential.

Some families love it & changes their lives.
Some discontinue.
Some prefer ongoing avoidance.

NOT one size fits all.

Oral immunotherapy for peanut requires daily treatment for years (possibly life long).

We still don't fully understand optimal dosing, duration, frequency - this will likely vary by patient but we currently don't know how to adjust accordingly.

Benefits of oral immunotherapy:
1. Improved quality of life (anxiety is a MAJOR part of living with peanut allergy)
2. Decreased risk for severe life-threatening reaction from accidental exposure
3. Liberalization of diet - likely cannot eat ad lib, but could include new foods

Risks of oral immunotherapy:
1. Anaphylaxis more likely compared with avoidance thelancet.com/journals/lance…
2. Chronic symptoms: abdominal pain, mild reactions
3. Nonadherence to the schedule (child/teen buy in for years is a major challenge)
4. Cost

Oral immunotherapy may not be suitable for everyone.

- Asthma MUST be under good control
- History of severe life-threatening reaction may increase risk for reactions during treatment
- Anyone who was diagnosed by testing alone should have oral challenge to confirm allergy

Important for ANYONE considering OIT to receive balanced information, including risks/benefits,& expected outcomes.

Try to learn from those who love it, those who stopped due to problems, & those who decided not to pursue.

This is an individualized decision - no right or wrong