Desensitization Programs in the US -- OIT SLIT SCIT

[LinksEtc]

"Prolonged Avoidance of Peanuts after Peanut Oral Immunotherapy May Reverse Its Effects"
http://annualmeeting.aaaai.org/UserFiles/file/ProlongedAvoidanceofPeanutsafterOralImmunotherapy.pdf

The 20 subjects in the study all passed the food challenge, but the results of the second food challenge differed between the group who avoided peanut for one month and the group who avoided it for three months. Of the subjects that avoided peanut for one month following the first food challenge, 16 of 16 passed the second food challenge. However, only one of four subjects who avoided peanut for three months passed the second food challenge.

[LinksEtc]

"Safety Of Pediatric Peanut Oral Immunotherapy Is Complicated By High Adverse Event Rates"
Yamini Virkud, MD, MA, , , ,
https://aaaai.confex.com/aaaai/2014/webprogram/Paper11185.html

Symptom diaries showed 54% of subjects received treatment at home for likely related events at some point during OIT, 53% with antihistamines, 18% with albuterol, 9% with epinephrine, and 15% had an emergency room visit.  Over the course of OIT, 37% of subjects should have received epinephrine based on symptom severity yet were not given any.

[LinksEtc]

"Course and Outcome Of Patients With Asthma During Oral Immunotherapy To Cow's Milk Protein"
Arnon Elizur, MD, , , ,
https://aaaai.confex.com/aaaai/2014/webprogram/Paper12009.html

Patients with asthma experience more adverse reactions and are less likely to reach full desensitization, but most reach a protective dose during milk-OIT.

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"Efficacy and safety of oral desensitization in children with cow's milk allergy according to their serum specific IgE level"
http://www.annallergy.org/article/PIIS108112061300046X/abstract?rss=yes&buffer_share=47019&utm_source=buffer

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"Clinical predictors for favorable outcomes in an oral immunotherapy program for IgE-mediated cow's milk allergy"
http://tinyurl.com/k7cysh7

[LinksEtc]

"B-Fahf-2 Pretreatment Reduces OIT Adverse Reactions and Improves Outcomes In a Murine Model Of Multiple Nut Allergy"
Xiu-Min Li, MD, , , , ,
https://aaaai.confex.com/aaaai/2014/webprogram/Paper12602.html

Conclusions: BFAHF-2 pretreatment reduced adverse reactions during OIT, and produced greater post-OIT protection and a beneficial immunregulation. Addition of BFAHF-2 to an OIT regimen for human food allergy may improve its safety and efficacy.

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"Special Report: Top Research from the 2014 AAAAI Meeting"
http://allergicliving.com/index.php/2014/03/18/special-report-top-research-from-the-2014-aaaai-meeting/

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"Assessing the efficacy of oral immunotherapy for the desensitisation of peanut allergy in children (STOP II): a phase 2 randomised controlled trial"
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62301-6/abstract?utm_content=buffer2f347&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

[CMdeux]

"Safety Of Pediatric Peanut Oral Immunotherapy Is Complicated By High Adverse Event Rates"
Yamini Virkud, MD, MA, , , ,
https://aaaai.confex.com/aaaai/2014/webprogram/Paper11185.html

Symptom diaries showed 54% of subjects received treatment at home for likely related events at some point during OIT, 53% with antihistamines, 18% with albuterol, 9% with epinephrine, and 15% had an emergency room visit.  Over the course of OIT, 37% of subjects should have received epinephrine based on symptom severity yet were not given any.

WOW.


Yeah, I'd say that vindicates the Mount Sinai position on this, at least for now.   

[twinturbo]

"B-Fahf-2 Pretreatment Reduces OIT Adverse Reactions and Improves Outcomes In a Murine Model Of Multiple Nut Allergy"
Xiu-Min Li, MD, , , , ,
https://aaaai.confex.com/aaaai/2014/webprogram/Paper12602.html

Conclusions: BFAHF-2 pretreatment reduced adverse reactions during OIT, and produced greater post-OIT protection and a beneficial immunregulation. Addition of BFAHF-2 to an OIT regimen for human food allergy may improve its safety and efficacy.

That is worded with incredible care, consistent with some of the thought from the pan-Asia allergy congress that it may be limited to symptom control. Not to take away its efficacy of safety profile.

[LinksEtc]

"6 New Frontiers in Food Allergy Treatment"
http://www.medpagetoday.com/AllergyImmunology/Allergy/44840?xid=nl_mpt_DHE_2014-03-20

What's next in food allergy immunotherapy?

Wood laid out six new frontiers for the field

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"State of the art on food allergen immunotherapy: Oral, sublingual, and epicutaneous."
http://tinyurl.com/mct29zw

Here we review recent progress and areas of concern for the role of these forms of immunotherapy as an emerging treatment for food allergy.

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Articles tweeted by A Russell BSN RN AEC

[LinksEtc]

http://asthmaallergieschildren.com/2014/04/01/compliance-challenges-for-the-next-generation-of-food-allergy-treatments/

I think we're about to enter a new dimension of compliance issues because of burgeoning research into treating food-allergies, whether through desensitization—oral immunotherapy (OIT)—or immune modulation via the traditional Chinese medicine-based treatments of Dr. Xiu-Min Li.

I think this is true.

This issue is very complicated and not easily addressed.

[twinturbo]

I have no idea why TCM is the darling of medical speculation in America. FAHF is hardly a blip on the radar across Asia. We know because we went to the 2013 conference.

Compliance issues are a problem even with conventional treatments, which are frontline treatments by allergists across nations on the Asian continent and various surrounding "Pacific Rim" nations. Therefore it's based on populations' ability to commit to any compliance that would need a foundation of education and support.

I don't know who this guy is but I've got less than zero confidence in anything he writes about Dr. Li, TCM, and FAHF. He's welcome to follow the trail I've brought to FAS in terms of resources of allergy, asthma and atopy from conferences and peer reviewed journals from mainland China, Hong Kong, Taiwan, Japan, Singapore, and also pharmacognosy efforts and challenges between sourcing from China to our FDA, staffed by highly specialized persons whose professional backgrounds include high level pharmacognosy from the biggest and best mainland Chinese institutions. People who are also on the shortlist on international circles regarding FAHF. It's all here for him to broaden his scope starting with the 2010 symposium for pharmacognosy, then the 2013 allergy congress.

[twinturbo]

 When the defensive anecdata of second hand experience piles high you'll be able to recognize concession. It will always begin and end with "My wife/friend/colleague is Asian/Chinese/other ethnicity..." or something about self-study TCM and challenges to disprove a negative regarding not truly understanding all that's out there. Sure, let's start with what we do know which I banked here at FAS. I paid good money for a congress that required 20k kilometer international travel, but I made sure all the open access papers were here as a follow up. DH and I merely have context based on attendance and talking to the docs, researchers and journal editors. The fruit of the effort is at anyone's fingertips to review first hand.

[LinksEtc]

TT, I know nothing about this subject & you know I  and respect you.

A lot of people wrote good reviews:

Jessica Martin, Food Allergy Sleuth
Anne F. Russell, BSN, RN, AE-C
Gwen Smith, editor-in-chief, Allergic Living
Susan Weissman, author of Feeding Eden
Caroline Moassessi, gratefulfoodie.com
Dr. Arnold I. Levinson Emeritus Professor of Medicine, Perelman School of Medicine
foreword by John Lehr, CEO of FARE

Hasn't he met with Dr. Li?  Have you spoken with her about how she feels (not that you should post that here) ... just for yourself.

I'm not endorsing the book.  I'm not qualified to judge it.

[twinturbo]

Endorsing what? His amazing knowledge of Chinese medicine? I would be perplexed and vexed that if by talking to one doctor, the same one I saw, that he's become a more trusted source than a host of allergists in Asia serving some of the largest populations globally and also putting out major discovery and research contributions.

Maybe he's a crack biographer. No argument from me there. An expert on pharmacognosy? Based on what? Perhaps Dr. Li is the most prominent name in USA, but none of this is center stage in Asian research, nor is it of great interest for research. I greatly respect and trust Dr. Li, the very reason I put myself in her care. I am hopeful that more discovery comes out. But when you expand the scope and look at native populations and the body of research it occupies a very different point on a continuum.

Rather than giving it the frame of mystery and magic of TCM because we're America and therefore Americans supposedly can't understand it truly I'd rather see it as a region-specific population answer because our group of allergens and how allergic disease manifest in America might benefit more from FAHF in concert with OIT.

FAHF is TCM but not all pharmacognosy is FAHF and as far as implementing TCM into large population treatment with proven efficacy and interest, not the case in Asia although joint US-Asia symposiums in China on the topic of FAHF began in 2010. Not a whiff of it at the largest congress in Asia 2014.

The problem isn't whether or not Dr. Li is talking to him. The problem is scientific. We need replication in different populations and if the population to which TCM is native is different in manifestations, has not seen the value of this one formula and has scant research on other formulae (see congress papers), then the argument becomes one here of ethnicity, technology, perceived belief on culture, pretty much anything that does nothing than get further away from the science.

She is a great source--here in USA. When she is treated as the sole source globally by others the narrative and belief system get at best myopic.

No one needs to respect my opinion on it. If anything I'd rather they read all the credible resources I've gathered on FAS to expand the scope and gain a stable, realistic perspective rather than flowery orientalist philosophical entries such as the 'resource' I've seen him blog about.

Flat out I don't consider him a credible source. The data will bear out efficacy, mechanisms and safety in the long run. For that we're on the right track. Because FAHF seems to be a safe and effective symptom controller its role may be one where it assists and raises the success and safety of long term OIT. My husband asked Dr. Li via email directly years ago when I first established with her. She's Mt. Sinai and our kids saw Sicherer. Having used pharmacognosy in the past it's a normal part of our lives and our cultural perspective of medicine. However, what it's short on is mechanism and lack of any known effect on sensitization or root level allergic disease effect.

The best guess of prominent researchers from around the Australasian nations was no data on mechanisms strongly suggests it's a symptom controller. In Taiwan and Hong Kong there are other pharmacognosy formulae under research. But the biggest front of discovery remains anti-IgE with the same researcher who discovered Xolair working on the next generation there.

But no, I have to keep reading garbage about some guy's wife who is Chinese get him turtle blood while dining out then navel gaze how much 'we' don't know about Chinese medicine. That's where the divide is: people who are wanting to consider the validity but want to treat it as any other medical answer (that includes me, the FDA, most scientists Asian or not and Dr. Li herself), and people who want it to be 'other' which looks no different than willful ignorance.

[LinksEtc]

Am I missing any relevant links?

2013 APCAACI conference

Asia Pacific Allergy Open Access papers

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ETA:

I just wanted to add that I personally have learned a lot from him & I think the asthma/allergy website has some excellent info ...... the book / that topic - it's not really an area that I know much about or am too interested in - so I'm not going to judge without reading / knowing more about it.

We all have our own opinions here and that is ok.  For a critical review, I personally would tend to use softer language so as to not hurt feelings more than necessary, but again, I support FAS members being able to say what they want, how they want, within the limits of board rules. 

I suspect that if I read both the book & TT's resources she brought over, I'd learn a lot from both.

[twinturbo]

Some isolated posts that I will have to dig up, and some of the asthma and allergy resources from Korea, Taiwan and Singapore. You're good at clearinghouse threads I could feed you the stream of what I have.  I have some slides and recorded presentations I haven't posted yet. Am absolutely willing to share but I have not had time to clean up and put in drop box.

Please, anyone who wants a perspective on populations, manifestations of allergic disease, epigenetics and whatever else I am forgetting at the moment amongst Asian populations--read what's there. If I get the chance I'll look for my other posts on the 2010 symposium and the bio of FDA personnel for pharmacognosy.

The one person I would go to who isn't Mt Sinai personnel on FAHF is booandbrimom because she's been through the protocols in clinical trial. Her blog and experiences I would trust.

[LinksEtc]

Tweeted by @Aller_MD

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"Oral Immunotherapy for Treatment of Immunoglobulin E-Mediated Food Allergy: The Transition to Clinical Practice"

http://online.liebertpub.com/doi/abs/10.1089/ped.2014.0332?utm_content=bufferb6e5d&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer