OIT for food allergy treatment (#ACAAI19 Twitter summary)

Joao Pedro Lopes, MD @JPLopesMD This may tell you part of the story, look at the peanut ara h 2 IgG4 levels change in the patients who had a successful treatment.

KristinSokolMD @kristinkrasnow “It’s a great time to be a food allergist!” - Dr. Hourihane.

Oral immunotherapy vs other routes. These will be available. It’s not our decision to make. It will be a shared decision with families on which approach to food allergy treatment is best.

RDN @PeanutFarmers @PeanutRD There’s balance to do and shared decision making should be used to determine what is the best treatment for each patient. Oral immunotherapy more efficacious with higher risk, other routes less effective with lower risk. Dr. Hourihane

Carina Venter PhD RD @VenterCarina OIT protocols

Shared decision making in OIT: https://twitter.com/VenterCarina/status/1192863140125560835

Barriers to OIT: lack of insurance; 2 hour exercise restrictions; cost; time involvement.

During OIT, need to monitor: AE, SPT, IgE, QoL.

TeamAllergy @TeamAllergy Dr. Schreiber started doing OIT because the patients wanted it. They asked her, they begged her for another option besides just avoidance. 2.5 years later, still a process of shared decision making with every single family.

Dr. Ellis @DrAnneEllis A big knowledge gap is not many families realize how critical it is for asthma to be well controlled while taking OIT. Also, the exercise restrictions were not expected.

Next up - @DrDougMackMD "Implementation of Food Allergy Therapy in a Clinical Practice Setting".

History of food allergy management "Diagnose and Adios!" Here is what you are allergic to - avoid it. Now we are moving into active management of food allergy

First visit to @DrDougMackMD and @PedsAllergyDoc for consideration of OIT - no one is signed up that day. Too many other things to do - history, SPT, asthma workup, EoE screening and more.

Next patients/caregivers return for a 2hr counseling session that includes and educational video with pre and post tests.

Shared Decision Making Counselling lasts also an hour minimum to ensure full understanding and agreement.

@DrDougMackMD and @PedsAllergyDoc have developed oral immunotherapy manuals for their patients /parents.

Additional resource requirements adopting OIT into a practice - space, nurses, admin staff.

@DrDougMackMD does 12 oral food challenges a day. Wow. Ah - correction - he BOOKS 12 OFC's per day - actually completes an average of 8 per day due to no shows/rescheduling due to illness.

KristinSokolMD @kristinkrasnow @DrDougMackMD wow! A video, a 50-page OIT manual, and multiple visits with each patient prior to starting.

Carina Venter PhD RD @VenterCarina Mindset change in OIT:

May need more than one consultation before signing patient up for OIT - there is so much to cover!

Each visit during IOT involves MD assessment - would love to involve RD too but so few of us around at the moment - watch this space though!.

Joao Pedro Lopes, MD @JPLopesMD Interesting discussion right now on how to risk stratify patients for OIT. A point not to forget: if you don’t know the patient’s reaction threshold and start OIT it is difficult (impossible?) to claim that your success is due to OIT. If a patient tolerates similar or higher amounts of protein than what you get with maintenance OIT, starting OIT, with all its implications, is… you can guess it, right? Repeat after me: “Food challenges are the gold standard to clarify if someone is allergic to a particular food.”

Dr Alexei Gonzalez @alexeigonzmd Walnut OIT in walnut was able to desensitization subjects to walnut but also to hazelnut, pecan, and cashew.

In a large French registry, 18 food related fatalities were noted between 2002-2018, mainly in children, whose commonly has asthma, didn’t have epinephrine, had prior anaphylaxis, and reacted to a known trigger.

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