Food allergy, OIT and Epicutaneous immunotherapy (EPIT) - Twitter summary from #CSACI19 meeting

Dr. Ellis @DrAnneEllis: Epicutaneous immunotherapy - a "patch" is applied with standardized, controlled allergen content with an aim to increase tolerance to a food - peanut and milk best studied thus far. PEPITES was a pivotal Phase 3 study of EPIT, showed benefit of the peanut patch over placebo patch, but it didn't meet the FDA requirement for the confidence interval to claim true statistical significance. Adverse events to patch were common - (most, local irritation at the patch site) but almost completely matched numerically in the placebo arm.

Food allergy - Only 3 ways to treat allergies (click to enlarge the image).

Dr. Mariam Hanna, MD @PedsAllergyDoc: Dr Chan reviews EPIT- PEPITES reviewed, 5 Canadian co-authors - 356 peanut allergic children (age 4-11yo), intervention 250mcg protein - primary outcome 35% vs 13% didn’t meet FDA lower bound confidence interval (clinical relevance of this?).

Final comments from Dr. Chan re immunotherapy: 1) The ship has sailed, 2) Use of OIT outside research is a reality and 3) No one size fits all. Most importantly: Oral food challenges and OIT go hand in hand.

Stuart Carr @allergydoc4kidz: EPIT: Relatively small increase in peanut threshold but perhaps sufficient to protect against cross contamination and some evidence of improved QOL.

Dr. Ellis @DrAnneEllis: Many other trials underway with the EPIT technology developed by @DBVTechnologies We look forward to seeing the results!

AR101 and PALISADE trial evaluated the Peanut OIT product from @aimmune - 600mg of peanut protein allows 60% of patients to meet the primary outcome of tolerating a large dose of peanut on oral food challenge at the conclusion of trial.

Adverse events, including anaphylaxis, were unfortunately not uncommon - 14.2% had systemic allergic reactions in the active group. But this is not actually surprising based on other studies of OIT.

Lancet study by Dr. Derek Chu from @MacHealthSci highlights the issues with anaphylaxis from peanut OIT. Avoidance of peanut leads to less anaphylaxis, but avoidance doesn't improve the underlying condition the way OIT does...risks/benefits/SHARED DECISION MAKING key:).

Summary - OIT is very controversial. Pros and Cons to EPIT, OIT and avoidance. Once again, we need to talk or our patients and ensure Shared Decision Making is in place.

Quality of life improves throughout the entire journal of oral immunotherapy.

Wait times for oral food challenges in Canada are long. Even busy centers who do lots of them still face 1 to 2 year wait lists.

Dr. A for Allergy MD @Health_Ontario_: Chan: Systemic reactions and severe reactions strikingly low in young pre school children compared to the older children in #OIT.

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