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Addressing common questions on food oral immunotherapy: a practical guide for paediatricians
  1. Aikaterini Anagnostou1,2,
  2. Matthew Greenhawt3,
  3. Pablo Rodríguez del Río4,
  4. Grant Pickett1,2,
  5. Vibha Szafron2,
  6. David Stukus5,
  7. Elissa M Abrams6,7
  1. 1 Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
  2. 2 Baylor College of Medicine, Houston, Texas, USA
  3. 3 Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
  4. 4 Allergy Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
  5. 5 The Ohio State University College of Medicine, Columbus, Ohio, USA
  6. 6 Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
  7. 7 Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Aikaterini Anagnostou; Aikaterini.Anagnostou{at}bcm.edu

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.

  • Paediatrics
  • Allergy and Immunology
  • Child Health
  • Global Health

https://doi.org/10.1136/archdischild-2023-326225

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    Footnotes

    • Contributors AA coordinated the group, amalgamated sections and references, wrote the abstract and the OIT risks and benefits section, created the tables and wrote the conclusions. EMA wrote the introduction and OIT definition sections and created the OIT figure. VS wrote the early-life OIT section. MG wrote the shared decision-making section. PRdR wrote the guidelines section. GP wrote the OIT contraindications section. DS wrote the misconceptions section. All authors reviewed, edited and provided input into the final manuscript, tables and figures, and checked references.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer Views expressed are of the authors and not those of the Public Health Agency of Canada.

    • Competing interests AA reports institutional funding from Aimmune Therapeutics, Novartis and FARE (Food Allergy Research and Education), and personal fees (consultation and speaker services) from DBV Technologies, ALK and FARE. MG is a consultant for Aquestive; is a member of physician/medical advisory boards for DBV Technologies, Sanofi/Regeneron, Nutricia, Novartis, Aquestive, Allergy Therapeutics, AstraZeneca, ALK-Abello and Prota; is an unpaid member of the scientific advisory council for the National Peanut Board and medical advisory board of the International Food Protein Induced Enterocolitis Syndrome Association; is a member of the Brighton Collaboration Criteria Vaccine Anaphylaxis 2.0 working group; is the senior associate editor for the Annals of Allergy, Asthma, and Immunology; and is member of the Joint Taskforce on Allergy Practice Parameters. He has received honorarium for lectures from ImSci, MedLearningGroup, RMEI Medical Education and multiple state/local allergy societies. He received past research support ending in 2020 from the Agency for Healthcare Quality and Research (K08-HS024599). PRdR reports research grant from Aimmune Therapeutics and FAES; speakers honoraria from GSK, FAES, Novartis, ALK, LETI, Aimmune Therapeutics, Sanofi, Stallergenes and DBV. DS reports consultant fees from ARS Pharmaceuticals, Before Brands, Novartis and ParentMD; research support from DBV Technologies; is a social media editor for the American Academy of Allergy, Asthma and Immunology; is a member of the Board of Regents for the American College of Allergy, Asthma and Immunology; is a member of the Joint Task Force on Practice Parameters for Allergy/Immunology; and is an associate editor of Annals of Allergy, Asthma and Immunology. EMA is an employee of Public Health Agency of Canada. GP and VS report no conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.