Pediatric food allergy (#ACAAI19 Twitter summary)

Pediatric food allergy

Douglas Mack @DrDougMackMD: Dr. Hourihane @ascia_news recommends not applying food onto the skin prior to introduction!!

Dr. Hourihane in Australia, 94% of children have had peanut introduced by 12 month! A no-screening approach for peanut introduction is far more economical!!

Robert Rogers @choirdoc: @VenterCarina presenting impressive data showing that increasing diet diversity in infancy markedly reduces development of food allergy - "let the babies eat!"

Katherine Anagnostou @PedAllergyDoc: Increased diet diversity in infants at 6-12 months reduces likelihood of food allergy development, Venter. Not enough data for clear recommendations on diet diversity currently.

No definition of “diet diversity” either.

Carina Venter PhD RD @VenterCarina: Perhaps there is no such thing as the allergic march!

Food allergy sensitization is a predictor for asthma up to 26 years.

It still looks like “atopic march” but we call it “allergic trajectory” now.

Carina Venter PhD RD @VenterCarina: @AllergydocSA: Children in rural areas of South Africa, more probiotics (fermented milk), less fruit, less fried food (AGEs). Rural SA population has 1/5 less food allergy than Urban population.

Farm animals highly protective in rural environment in SA.

Dr. Ellis @DrAnneEllis We are far from understanding what constitutes as healthy gut #microbiome making interpretation of different microbiomes difficult.

@VenterCarina "It's not just about popping a pill" The microbiome is complex and not easily modified. Diet influences the gut microbiome, which influences the immune system.

Dr. Dave Stukus @AllergyKidsDoc Excellent review by @VenterCarina at #ACAAI19 regarding “treating” allergic conditions by altering our microbiome. There are many co-factors to take in to account when studying the gut microbiome.

Spoiler: Evidence is lacking. No quick fix. Many cofactors to consider. Cannot recommend specific probiotics/prebiotics at this time. (Despite their widespread use).

SherryColemanCollins @DietitianSherry Essential point by @VenterCarina : when considering microbial diversity, it depends greatly on the organ being considered. Diversity may be good in gut, but bad in lungs.

Calling for a novel study at next year’s conference, @VenterCarina is looking for funding to study impact of hotel food and alcohol on the microbiome of attendees from start to finish of 2020 conference.

WayneShreffler @WayneShreffler: Michael Levin reports out 2.5% food allergy prevalence in urban South Africa compared with 0.5% in rural population. Fascinating differences in direction of effect of some exposures depending upon rural/urban settings.

RDN @PeanutFarmers @PeanutRD: Exposure to nature, environment, animals, sunlight in rural communities all contribute protective effects as compared to urban living in SA study. Great comment @AllergydocSA re: the need to consider the terminology used for positive IgE tests and sensitization. Consider something like detectable IgE, since positive IgE not necessarily equal to clinical reactivity. Confuses patients (and sometimes non-allergists).

Carina Venter PhD RD @VenterCarina: Next up @WayneShreffler: OFC is the gold std of diagnosis: IgE, IgG4 and skin test explain only a portion of the variances. Ig repertoire, effector cell reactivity, barrier function etc will determine if someone with a spec IgE level will react to the food.

Food challenges remain the gold standard.

Robert Rogers @choirdoc: Dr. Anagnostou presented fascinating data during her "pro" argument for the need for oral challenge before starting food desensitization. There is a remarkably wide range of threshold doses needed to trigger reactions (peanut studies).

EleanorGarrowHolding @EleanorGarrow: Checkout Nationwide Children’s curricula podcasts on how to communicate evidence-based medicine in an online world! @AllergyKidsDoc

Pro-con debate: Carina Venter PhD RD @VenterCarina: #ACAAI19 attendees don’t think we need standard peanut OIT products. Attendees vote for EPIT over OIT.

Carina Venter PhD RD @VenterCarina Generally accepted that getting to 300 mg in OIT is success. Yes should say 300 mg protein. Wow POISED study got patients up to 16 peanuts.

RDN @PeanutFarmers @PeanutRD Which is approximately equal to one peanut.

Important reminders that OIT isn’t just take and go about your business. Requires precautions around behavior and illness, and awareness of potential (and common) reactions. Per @ATLergist

Carina Venter PhD RD @VenterCarina EPIT: 61% tolerated up to 1 g....younger children do better. Side effects in EPIT less often and milder vss. OIT.

RDN @PeanutFarmers @PeanutRD "OIT, EPIT, SLIT" a bit of an alphabet soup and so many things to consider, but exciting to see so many potential options coming for parents and individuals with peanut (and other food) allergies.

Immunotherapy for food allergy is long-term commitment with long-term impact - reactions happen even years in, food aversions develop, commitment may lag.

Great slide depicting the complexity of decision-making for potential treatment for #peanut allergy from @ATLergist

Carina Venter PhD RD @VenterCarina @ATLergist - Reliable biomarkers are urgently need...we will be doing OFCs for some time to come. Reliable biomarkers will also enable us to predict treatment response. We don't know what the right dose is...low and slow may be best - but we don't know. Future of OIT @ATLergist

SherryColemanCollins @DietitianSherry: Are you familiar with the concept of shared decision making in healthcare and treatment? What do you think? When might it work/not work? Any barriers?

Katherine Anagnostou @PedAllergyDoc I’ve had so many questions about shared decision making #ACAAI19 - our paper discusses it at length: The Role of Shared Decision Making in Pediatric Food Allergy Management. Anagnostou, Hourihane, Greenhawt, Online @ J Allergy Clin Immunol Pract. 2019.

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