Food Oral Immunotherapy - PowerPoint Presentation

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Food Oral Immunotherapy (Food Desensitization)

Yale University ECHO SeriesSession 5Stephanie Leeds, MD FAAAAI

Disclosure

The following individuals have no conflicts of interest to disclose relevant to this activity:Stephanie Leeds, MD - PresenterGunjan Tiyyagura, MD - ReviewerSandra Selzer, MSHQ - PlannerKris Samara - Planner

Theresa Barrett, PhD, CMP, CAE - Planner

Accreditation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the New Jersey of Academy of Family Physicians and Hezekiah Beardsley Connecticut Chapter of the American Academy of Pediatrics. The New Jersey Academy of Family Physicians is accredited by the ACCME to provide continuing medical education for physicians.

The New Jersey Academy of Family Physicians designates this live activity for a maximum of 1.0

AMA PRA Category 1 Credit(s)™

.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Learning Objectives

Identify the foods for which oral immunotherapy is available. Understand the basic indications and protocols for food allergen oral immunotherapy.Appreciate the quality of life factors associated with initiation of food oral immunotherapy.

Clinical Cases:

Patient calls and wants to know what “desensitization” for food allergy means. What do you tell them?

Patient calls and wants to know if anyone with food allergy is eligible for desensitization. What do you tell them?

Patient calls to ask if there is someone you can refer them to for desensitization to shellfish. What do you tell them?

What is Food Immunotherapy?

Food immunotherapy is the induction of some level of desensitization with chronic or repeated exposure to a food.

Kobernick

and Burks. Allergology International 2016.

Immunotherapy Model

Nowak A. J Allergy

Clin

Immunol 2011.

Oral Immunotherapy

Oral immunotherapy (OIT) refers to feeding an allergic individual an increasing amount of an allergen with the goal of increasing the threshold that triggers a reaction.PeanutEgg MilkWheat

Tree Nuts

Seafood

Multi-food

PALISADE Trial

PALISADE Group Clinical Investigators, NEJM 2018.

Palforzia- FDA Approved Peanut Oral Immunotherapy

Palforzia Description

Source: www.palforzia.com

Palforzia Dosing

Source: www.palforzia.com

Oral Immunotherapy and Quality of Life

Blumchen

et al, J Allergy

Clin

Immunol 2019.

Oral Immunotherapy and Adverse Reactions

Adverse reactions range from mild to life-threateningMajority of patients will have some adverse reaction from OITStudy drop out rates can be as high as 25-30%Adverse reactions are more common during build up phase, but can also happen during maintenance phaseAdverse reactions often decrease in frequency with longer duration of therapy

Biggest concerns: anaphylaxis and induction of eosinophilic esophagitis

Risk Factors for Adverse Reactions

Dosing on an empty stomachExercising after dosingConcurrent illness during dosingSuboptimal control of asthma while dosingMenses, hot showers, dental work….

Oral Immunotherapy and Anaphylaxis

Chu et al, Lancet 2019.

Oral Immunotherapy and Adverse Reactions

Chu et al, Lancet 2019.

Misconceptions About Oral Immunotherapy

It’s easyIt’s a cure“MY CHILD WON’T NEED TO CARRY AROUND AN EPIPEN ANYMORE”

Future Directions for Oral Immunotherapy

Identifying biomarkers (both for preselection and efficacy)

Identifying adjunct therapies to increase safety and efficacy

Omalizumab

Dupilumab

Probiotics

Prebiotics

Microbial Components

Clinical Cases:

Patient calls and wants to know what “desensitization” for food allergy means. What do you tell them?

Desensitization is the regular administration of small amounts of food allergen (most commonly by oral route) such that patients have reduced reactivity/no reactivity with subsequent exposures to the food. The goal of immunotherapy is actually to induce sustained unresponsiveness, rather than “desensitization.”

Patient calls and wants to know if anyone with food allergy is eligible for desensitization. What do you tell them?

Right now, there is only one food for which there is an FDA approved oral immunotherapy agent- peanut. Patients must be 4-17 years of age, and they must be able to pass initial in office dose of peanut powder. While many people may be eligible, it makes good sense to consider how OIT would affect overall quality of life.

Patient calls to ask if there is someone you can refer them to for desensitization to shellfish. What do you tell them?

There is no FDA approved oral immunotherapy for shellfish, although trials are undergoing. Private practice allergists may offer this therapy off-label.

Take Home Points

Food immunotherapy is an exciting new interventional therapy for food allergy.Peanut is the only food for which FDA approved oral immunotherapy exists.Patients may experience adverse reactions, including anaphylaxis, when going through build up and maintenance stages of oral immunotherapy.There is ongoing research to determine if oral immunotherapy increases or decreases quality of life for food allergic patients.

Future research is looking at biomarkers and adjunct therapies to increase safety and efficacy of oral immunotherapy.

Q&A