Georgia AAP Nutrition Symposium 2019: Food Allergy Immunotherapy

This year’s Georgia AAP Nutrition Symposium featured lectures targeting the NICU graduates (yesterday) and children with allergies. My notes from these lectures could contain errors of omission or transcription.

Luqman Seidu — Food Allergy Immunotherapy: it’ll drive you nutty

Key Points:

  • Currently, it is hard to quantitate food-related mortality/anaphylaxis. It is much more common to have anaphylaxis due to medications.
  • Immunotherapy –can establish tolerance but needs to be considered in terms of efficacy, safety, ease of compliance.   Goal is sustained unresponsiveness so that there is an end in sight to treatment.
  • Multiple modalities, SLIT (sublingual and then swallowed), OIT (oral), EPIT (Epicutaneous therapy), OIT with anti-IgE therapy
  • 1 peanut =250-300 mg (important number to keep in mind, as many studies aim for ~1000 mg, which is ability to ingest ~3 peanuts).
  • EPIT -peanut patch.  1-yr study –goal was 1000 mg or 10-fold increase in tolerance without reaction.  97% compliance with study. Safer approach and better adherence but takes longer to get response.  Lower response at 1 yr –takes ~2 yr to get similar response
  • OIT therapy allows more rapid attainment of tolerance but lower compliance and higher rates of systemic reactions compared to EPIT.  A standardized product will be available soon; an FDA advisory committee has approved a peanut product (Palforzia). (NPR has reported on this as well: Peanut Allergy Treatment Palforzia)
  • Anti-IgE therapy (eg. Xolair).  Can use to desensitize for multiple foods at the same time.

Though not discussed in this talk, it is important for GI physicians to recognize that oral immunotherapy has been shown to trigger new onset EoE in 2.7% (AJ Lucendo et al. Ann Allergy Asthma Immunol 2014; 113: 624-9).

Related blog posts:

 

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) and changes in diet should be confirmed by prescribing physician.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

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