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Contexts in source publication
Context 1
... eosinophilic esophagitis (EoE) reached consensus as a contraindication (94.3%; 1), with 57.6% considering this an absolute contraindication, but no consensus was reached about EoE in remission's being a contraindication (52.8%; 3) (Fig 2, and see Table E5 in the Online Repository available at www.jacionline.org). Uncontrolled asthma was unanimously considered a contraindication (100%; 1), with most participants considering it an absolute contraindication (88.9%). ...
Context 2
... factors, including parental discord (94.4%;1), poor parental communication (86.1%; 1), language barriers (77.8%; 1), and poor prior adherence (94.4%; 1), were all considered contraindications. Unwillingness to use epinephrine was a contraindication (97.2%; 1), with 94.3% considering this an absolute contraindication (Fig 2). ...
Context 3
... panel further agreed (83.3%; 1) on defining the scope of desensitization, including limiting consumption to freely eating allergenic foods. While remission (SU) as a discrete potential outcome reached consensus (77.8%; 1), free-text comments tempered its inclusion, given concerns regarding the rarity of SU, inconsistency of SU, its unclear definition, and its potential age dependence (see Fig E2 in the Online Repository). ...
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Citations
... According to an International Delphi consensus, odds of OIT outcomes are variable, poorly predictable, and may depend on the specific allergen [13]. The development of FA can be influenced by several factors including genetic, epigenetic, environmental, metabolomic, and microbiota-related factors, all of which may contribute to a better understanding of FA and OIT prognosis [14,15]. ...
... A total of 11 children dropped out of OIT, including two for personal reasons not related to OIT, and nine due to symptoms or difficulties associated with OIT, namely significant allergic symptoms, anxiety, and difficult compliance. These difficulties and challenges are similar to those reported by the international Delphi consensus, which include difficulty with adherence, food aversion, dose-related anxiety, and extended time taking the daily dose [13]. OIT is a long process requiring a significant commitment from both patients and caregivers. ...
Background and methods
The Zéro allergie research clinic (Saguenay, Canada) is a clinical and research initiative in oral immunotherapy (OIT) for managing IgE-mediated food allergy (FA). A total of 183 children with FA and 27 non-allergic siblings were recruited to date in the Zéro allergie cohort (ZAC) to better understand biological mechanisms underlying FA and OIT prognosis. The primary aims are to (a) better understand the genetic, epigenetic, transcriptomic, metabolomic, and microbial diversity associated with FA; (b) establish the multi-omics and microbial diversity profiles of children following OIT to identify predictive prognosis biomarkers, (c) make OIT more accessible to the population of the Saguenay–Lac-Saint-Jean region, and (d) build a biobank of data and biological material.
Results
The ZAC constitutes a unique and rich biobank of biological samples (blood, buccal swabs, microbiota samples [intestinal, buccal, nasal, and cutaneous]) combined with clinical data and more than 75 phenotypic characteristics.
Conclusions
This represents an innovative interdisciplinary initiative by researchers, allergists, and paediatricians to make FA care accessible to a greater number of children with IgE-mediated FA. Ultimately, it will contribute to provide more accessible treatment options with greater chances of success through a better understanding of the biological nature of FA and OIT.
... A recent international Delphi panel advised that patients should be prepared for the possibility of discontinuation before starting OIT as part of the counselling process. Many of the reasons cited by this panel included social reasons [28]. This speaks to the importance of clinicians asking about social factors and recognizing them as significant contributors to discontinuation [20]. ...
... Our clinics now refer for counselling prior to initiating OIT if anxiety is identified. This approach is consistent with recent recommendations regarding patient preparation for OIT [28]. Polloni et al. described that anxiety, mood disorders, increased distress and excessive worry/fear can affect compliance and the ability to progress through therapy and when addressed and treated appropriately all patients reported a moderate to great improvement in their situation [29]. ...
... These considerations become particularly important when evaluating adolescents, as recurrent adverse reactions can lead to missed days at school, and exercise limitations can affect their social life with the limitations to participation in extracurricular sports [8]. Families must be informed of the treatment burden before initiating OIT, and ongoing shared decision-making continues throughout the course of treatment [28]. There may be times where the goals and priorities of caregivers are not aligned with those of the adolescent. ...
Background
Oral immunotherapy (OIT) is an increasingly utilized management strategy for IgE-mediated food allergy. Despite promising efficacy and effectiveness, there is still a lack of data surrounding the reasons for discontinuation of OIT. The primary reason stated in the literature for discontinuation is adverse gastrointestinal effects. Social factors contributing to OIT discontinuation have not been well reported. We hypothesize that social considerations are significant contributors to treatment discontinuation.
Methods
We completed a retrospective chart review of 50 patients treated in community pediatric allergy practices who discontinued OIT out of 507 patients who were started on OIT between October 1, 2017-October 27, 2022. Reasons for discontinuation were identified and classified into five main categories: unsafe care decisions, anxiety, adverse effects of OIT, uncontrolled comorbidity and social factors. Categories were not exclusive.
Results
507 patients were started on OIT , with data available for 50 patients who discontinued OIT, aged 10 months to 18 years and 2 months. The overall discontinuation rate was 9.8%, of which 40 patients (80%) discontinued during buildup, 9 patients (18%) discontinued during maintenance and one patient on two food OIT discontinued one food during buildup and one during maintenance (2%). Thirty-four patients (68%) had multiple reasons for discontinuing OIT. Social factors were the most common reason for discontinuation and were identified in 32 patients (64%). Twenty-four patients (48%) discontinued OIT due to adverse effects. Gastrointestinal symptoms were the most prevalent, while anaphylaxis contributed to discontinuation in 15 patients (30%). Anxiety led to discontinuation in 17 patients (34%).
Conclusions
Our data highlights the importance of social factors and anxiety in the success of OIT completion. Our results support the need to consider not only the patient’s medical history, but also their social history and support networks when selecting patients who are good candidates for OIT to optimize the successful completion of OIT.
... 24,25 Since publication of these decision-aids, there has been a growing unmet need to develop a new decision-aid that broadly covers all forms of OIT (commercial and non-commercial) as well as all allergens to which OIT is offered (as both current decision-aids are limited to peanut). 26,27 Such a tool would be useful across practices that offer OIT (to any food) both in academic and private settings. This new decision-aid would incorporate the identified themes and expressed goals and (or) trade-offs of the original aid, supplemented with more recently published clinical trial outcomes, meta-analyses of treatment safety and efficacy, and multiple society-published treatment guidelines to help develop an easy to use clinical tool to better clarify patient values and support shared decision-making surrounding starting some form of OIT or to continue to practice strict allergen avoidance. ...
... 30,31 The decision-aid was comprised from grounded theory regarding therapy from direct stakeholder input, 28 published data from society guidelines and meta-analyzes regarding OIT risks and benefits, and expert opinion from clinicians with robust experience in providing OIT care and in SDM. [1][2][3][4]10,13,14,17,26,27 The decision-aid has undergone acceptability testing using 3 validated instruments in a sample of caregivers of food-allergic children, the target population who would be considering the decision to start OIT or continue food avoidance. [32][33][34] The decision-aid had good acceptability, as well as satisfied scoring on these instruments ...
Background
Limited decision‐support tools are available to help shared decision‐making (SDM) regarding food oral immunotherapy (OIT) initiation. No current tool covers all foods, forms, and pediatric ages for which OIT is offered.
Methods
In compliance with International Patient Decision Aid Standards criteria, this pediatric decision‐aid comparing OIT versus avoidance was developed in three stages. Nested qualitative data assessing OIT decisional needs were supplemented with evidence‐synthesis from the OIT literature to create the prototype decision‐aid content. This underwent iterative development with food allergy experts and patient advocacy stakeholders until unanimous consensus was reached regarding content, bias, readability, and utility in making a choice. Lastly, the tool underwent validated assessment of decisional acceptability, decisional conflict, and decisional self‐efficacy.
Results
The decision‐aid underwent 5 iterations, resulting in a 4‐page written aid (Flesch–Kincaid reading level 6.1) explaining therapy choices, risks and benefits, providing self‐rating for attribute importance for the options and self‐assessment regarding how adequate the information was in decision‐making. A total of n = 135 caregivers of food‐allergic children assessed the decision‐aid, noting good acceptability, high decisional self‐efficacy (mean score 85.9/100) and low decisional conflict (mean score 20.9/100). Information content was rated adequate and sufficient, the therapy choices wording balanced, and presented without bias for a “best choice.” Lower decisional conflict was associated with caregiver‐reported anaphylaxis.
Conclusions
This first pediatric OIT decision‐aid, agnostic to product, allergen, and age has good acceptability, limited bias, and is associated with low decisional conflict and high decisional self‐efficacy. It supports SDM in navigating the decision to start OIT or continue allergen avoidance.
Purpose of review
Ethical dilemmas are a common occurrence in the provision of care to individuals with food allergies. Thus, an understanding of medical ethics is essential for allergists/immunologists.
Recent findings
Despite the importance of medical ethics in the clinical practice of food allergy, there has been little published on this topic. Some international allergy societies have published ethical guidelines. Further investigation on medical ethics in food allergy is required.
Summary
This review describes key ethical principles in relation to food allergy testing, oral food challenges, and various management strategies, including avoidance, omalizumab and oral immunotherapy. This review demonstrates the necessity for education and research on medical ethics in food allergy.
Purpose of review
This review aims to provide an overview of the current and future treatment options for children with food allergies (FAs), highlighting the latest research findings and the potential impact of these new approaches on improving patients’ and caregivers’ quality of life.
Recent findings
In the last decade, many promising approaches have emerged as an alternative to the standard avoidance of the culprit food with the risk of severe accidental reactions. Desensitization through oral immunotherapy has been introduced in clinical settings as a therapeutic approach, and more recently also omalizumab. In addition, alternative routes of administration for immunotherapy, other biologics, small molecules, probiotics or prebiotics, microbiota transplantation therapy, IGNX001, and PVX108 are being investigated.
Summary
The portfolio of available treatment options for food allergies is increasing but several relevant unmet needs remain. This review aims to provide a brief overview of the existing and future treatment options for IgE-mediated food allergies.