Desensitization Programs in the US -- OIT SLIT SCIT

[twinturbo]

That's interesting. I have to debrief with DH first but I think that was a strikingly similar theme from APCAACI conference but sometimes with SLIT instead of OIT, with some ACAAI presence in attendance. Outcomes were proposed starting at a younger age, for longer and with SLIT. He has to clean up the audio on the presentations but we'll post them all later via Dropbox for anyone interested to listen to.

I think this is somewhat of a subtle gamechanger for us that the longer term favorable outcomes should aim for a more deft touch in desensitization, starting with SLIT (possibly SCIT) for environmental allergens at least. I'm not sure we'd ever go for fast-tracked MFA OIT with DS2.

[CMdeux]

That's what I'm getting out of things, too, TT-- that there may be distinct etiology in patient subpopulations, and that outcomes depend heavily on which patient subpopulation the person is a member of, ultimately...

which is why rush-OIT may just not be ready for roll-out to general clinical practice.

Maybe SLIT isn't either...  {sigh} 

[twinturbo]

Yes, but I'd like to have this conversation again after I post some audio and more papers re: the integrative theme of the AP region congress this month. The more the 'picture' develops in context the more compelling I find the approach that allergic disease worldwide is epidemic, and at its root-level mechanism needs to be attacked and torn for a cure for food anaphylaxis (amongst other allergic diseases)--as oversimplistic as that is from Capt. Obvious Me here, but in the meantime we can look at what is related and successfully mediated and treatable. In a sense, it's truly an approach you had before the assorted allergy congresses have reached consensus on, IMHO.

I see less as a 'peanut allergy' first world/industrialized nation problem and more as a global problem presenting differently amongst the world's population. Where I feel the greatest contextual revision is what food allergy and anaphylaxis means and whether we concentrate root-level at allergic disease, or attack the food allergy itself, or look at the model of allergic disease per individual and environment as a whole with the goal of maximim desensitization to possibly alter the allergic march starting from a younger age rather than forcing tolerance of individual foods.

The accuracy of reporting allergic responses varies so much between cultures and definitions. In brief so I won't be late to an appt I think USA overreports on 'food allergy' because it is conflated with fad diets, artisan foods, health improvement as a form of conspicuous consumption. In Asia (and I'm generalizing like mad, I know) it's far underreported, unacknowledged, likely vastly undertreated and good food trumps fad diets in regard to conspicuous consumption. An IgE-mediated allergy or rhinitis is more likely to be blown off, attributed to something else, self-diagnosed as something else, assumed it's transitory, and then there's the reality that they have as a population a very different of allergens. In that sense yes, peanut is OUR problem and that does make a world of difference... but, this assumption we were building as a whole that it's only a phenomenon in USA, Australia, UK, I think that's done. Bunk. There are epidemic levels of allergic disease in the AP region but it presents differently therefore the approach is different. At the end of the day to bring it all back to what is in common are the rapid increase of allergic disease in further generations and the rate of sensitization.

Someone let me know when I sound off my rocker. DH and I are going through the material at home.

[hedgehog]

Just posted about this in WAYDT thread, but wanted to put it here as well, in case anyone wants more info.  My nephew's fiancée just started a desensitization study for PA adults in Boston. She is being paid for participating.  It is for adults only, and she said tey are still looking for participants.  There is a chance of being put in the placebo group, but those people will get the real treatment after they are done with te placebo. If anyone is interested in participating, I can get more info to pass along.  Just pm me if you are interested. 

[Macabre]

DS sees Dr. Mary Morris in La Crosse. She has been doing slow SLIT for environmentals and food for years and years and has seen very good outcomes. Her father had the practice before and did environmentals.

It is very slow--at least four years. The goal is not consumption but a tolerance to accidental exposure. I am good with that.

I am going to start it in January. 

[twinturbo]

Do you think she'd consult with another allergist? Namely mine we're going to ask him to talk to other allergists performing long term SLIT for DS2.

[Macabre]

I will be happy to ask her. I'll PM you before I go to my appt mid-January.

[twinturbo]

Thank you.

[LinksEtc]

oral treatment for peanut allergy, is it prime time?


peanut allergy cure in uk dr clarke.


Oral desensitization for milk allergy loses effectiveness over time


Can True Tolerance be Achieve in FA Patients?


NE Food Allergy Treatment Center claims a 95% success rate


Administration of a probiotic with peanut oral immunotherapy: A randomized trial

[LinksEtc]

"Safety and feasibility of oral immunotherapy to multiple allergens for food allergy"
http://www.ncbi.nlm.nih.gov/pubmed/24428859

Preliminary data show oral immunotherapy using multiple food allergens simultaneously to be feasible and relatively safe when performed in a hospital setting with trained personnel.

[LinksEtc]

ooh, this looks really interesting!


"Blood Test Might Help Tell When Peanut Allergy Is Gone: Study"
http://www.medicinenet.com/script/main/art.asp?articlekey=176499&utm_content=buffer149b1&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Our new finding can help us try to determine whether, for the long term, someone's allergy has truly been shut off so people can eat ad lib.

Nadeau said this test might one day help doctors in deciding whether a person "can safely go off of immunotherapy, or if they need to continue to eat the food every day."

[LinksEtc]

http://multiplefoodallergyhelp.com/?p=2137

James Tarbox, MD @Mjj289 · 2h ago
#AAAAI 98% have a reaction occur during oral immunotherapy;10% at home, 4% needed epi

Priya Bansal, MD @Allergygal1 · 2h ago
5-20% of patients on oral immunotherapy have been going on to develop ‪#‎eosinophilic‬ esophagitis. #AAAAI

Dr. Dave Stukus @AllergyKidsDoc Feb 28
Only 35% who were successfully desensitized passed an oral challenge after 3 mos of stopping daily peanut#foodallergy #AAAAI

[lakeswimr]

NE is now taking many types of insurance. 

We are strongly considering doing it. 

[aggiedog]

Regarding the stat that only 35% passed a challenge 3 mos after stopping their dose - I'm ok with that.  Meaning, I'm ok with dd taking a dose of PB daily for as long as she wants to.  Maybe FA's are like diabetes, or hypertension.  Some conditions don't have cures but they certainly have methods of managing them that keeps you healthy and safe.  Obviously, I'd love for her to be cured and rid of her PA forever, but if the next best thing is something that keeps her safe from accidental exposure that would be life threatening, then so be it.

If, at some point, she decides she'd rather stop the dosing and just live a life of avoidance, that will be her decision (and depending on her age, with more or less input from us.)  She still gladly takes her PB every day, because she remembers the fear and exclusion she lived with prior to OIT. 

[CMdeux]

Absolutely-- the only troubling thing is the (apparently) high percentage of patients who can't seem to establish a stable maintenance dose.  That's not to say that nobody can-- just that it's not yet clear exactly what separates those who CAN from those who CAN'T, if there is even such a clear distinction between them.