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With new food allergy treatments comes a challenge: adherence
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HOUSTON — Not all children and teenagers will embrace maintenance food allergy treatments, such as the Viaskin Peanut epicutaneous patch or the biologic oral immunotherapy for peanut allergy known as AR101 — both of which are investigational therapies — according to a speaker at the American College of Allergy, Asthma and Immunology Annual Scientific Meeting.
“These are exciting times for allergists as we move into emerging food allergy treatments,” J. Wesley Sublett, MD, MPH, FAAACI, of Family Allergy & Asthma in Louisville, Kentucky, and vice chair of ACAAI’s Drug and Anaphylaxis Committee, told attendees. “But the reality is, you are going to have patients who are not compliant and discontinue those treatments.”
He referenced two recent studies to illustrate his point.
In a study he cited that appeared in The Journal of Allergy and Clinical Immunology: In Practice, 56 of 270 children with a mean age of 8.1 years withdrew before they completed their required peanut oral immunotherapy escalation. Their reasons included epinephrine-treated reaction, eosinophilic esophagitis-like oral immunotherapy-related syndrome and other GI complaints, taste aversion/resistance, too many visits, anxiety, irregular dosing and the mindset that the oral immunotherapy was causing other health problems.
In the other study, 551 patients aged 4 to 55 years (496 aged 4 to 17 years) were randomly assigned to an escalating dose of AR101 (Aimmune Therapeutics) or placebo. Sublett said 43 participants in the active-drug group and three in the placebo group withdrew because of a lack of time to devote to the study, therapy noncompliance, acute/chronic/recurrent GI disorders, systemic allergic reactions and respiratory system issues.
These findings are particularly worrisome because data show that some children and teens with food allergy who refuse maintenance treatments engage in behaviors that make them especially vulnerable to allergic reactions, Sublett continued.
“A large percentage of teenagers said they don’t read labels,” he said. “But more alarming is that about half said they ate foods that contain a food they are allergic to.”
Sublett encouraged physicians with food-allergic patients to make sure the patient wears a medical alert accessory; knows how to avoid cross contact with food allergens; understands that it is acceptable to say “no” when foods with relevant allergens are offered to them; avoids unknown foods when eating out; carries an epinephrine injector at all times; and reads labels effectively.
“The risk with the precautionary statements on food labels — verbiage like ‘may contain’ or ‘shared equipment’ — is that you don’t know what’s in the food,” Sublett explained. “The best thing to tell patients is that if the label even hints at something they are allergic to, they should avoid that food.”
These reminders must occur frequently too, he said.
“We need to educate our food-allergic patients on these things at every visit, regardless of whether or not treatment is in the patient’s future,” Sublett said. “These are all things that have been going on since the beginning of food allergy. These are not new, but they are best practices.” – by Janel Miller
Disclosures: Sublett reports relationships with Aimmune Therapeutics, ALK-Abelló, Allergy Therapeutics, AstraZeneca, BioCryst Pharmaceuticals, DBV Technologies, GlaxoSmithKline, Kaleo Pharmaceuticals, Mylan, Novartis, Optinose, Pearl Therapeutics, Perrigo, Pfizer, Roche, Sanofi, Stallergenes Greer and Teva Pharmaceuticals.
Reference: Sublett JW. Food allergy non-treatment. Presented at: American College of Allergy, Asthma and Immunology Annual Scientific Meeting; Nov. 7-11, 2019; Houston.