scholarly journals White paper on peanut allergy: treatment pathway

2021 ◽  
Author(s):  
Ludger Klimek ◽  
Lars Lange ◽  
Lea Alexandra Blum ◽  
Felix Klimek ◽  
Katja Nemat ◽  
...  
Keyword(s):  
Peanut Allergy ◽  
Care Pathway ◽  
Incidental Finding ◽  
Therapeutic Option ◽  
Skin Prick Testing ◽  
Treatment Algorithm ◽  
Specific Ige ◽  
White Paper ◽  
Double Blind ◽  
History Of

Summary Background Peanuts are a member of the legume family (botanical family Leguminosae) and peanut allergies are the most common cause of food anaphylaxis in many countries. The prevalence of peanut allergy is increasing. Methods Experts from Germany and Austria performed a standardized literature search and published their consensus recommendations in a White Paper on Peanut Allergy, which this care pathway is based upon, thus, providing a comprehensive diagnosis and treatment algorithm. Results The most important diagnostic key elements include a detailed clinical medical history, evidence of peanut-specific sensitization by means of skin prick testing and/or in vitro determination of the peanut (extract)-specific IgE and/or the molecular component diagnostics (most important Ara h 2-specific IgE, sometimes also Ara h1-, 3-, 6-, 8- and 9-specific IgE) as well as the gold standard, the double-blind, placebo-controlled food challenge. The diagnostic algorithms were created for the following constellations: Suspected primary peanut allergy with a clear history of systemic immediate-type reaction, suspected primary peanut allergy with questionable symptoms, suspected secondary (possibly pollen-associated) peanut allergy with a history of solely oropharyngeal symptoms and incidental finding of sensitization and no peanut ingestion so far. Conclusions After established diagnosis the standard of care is counseling to avoid peanut contact and prescription of emergency medications (oral antihistamines, oral steroids, inhaled β2-agonists, injectable intramuscular epinephrine) as needed. Instruction on the use of these emergency medications should be provided. A preparation for oral immunotherapy (OIT) for 4 to 17 years old peanut allergic children/ adolescents has been recently approved by the regulatory authorities. OIT for peanut allergy shows high efficacy and an acceptable safety profile, improves quality of life, and health economic aspects. Thus it offers a therapeutic option for peanut allergic children and adolescents.

Egg Hypersensitivity and Measles-Mumps-Rubella Vaccine Administration

PEDIATRICS ◽  
1991 ◽  
Vol 88 (5) ◽  
pp. 913-917
Author(s):  
Suzanne A. Beck ◽  
Larry W. Williams ◽  
M. Annette Shirrell ◽  
A. Wesley Burks
Keyword(s):  
Atopic Dermatitis ◽  
Skin Prick Testing ◽  
Skin Testing ◽  
Screening Method ◽  
Negative Control ◽  
Mmr Vaccine ◽  
Double Blind ◽  
Intradermal Testing ◽  
Vaccine Administration ◽  
History Of

Because reports have described egg-sensitive individuals in whom anaphylaxis developed after measles vaccination, current recommendations include delaying administration of egg-derived vaccines until skin testing can be performed. Specifically, the 1988 Red Book recommends skin testing via scratch, prick, or puncture with 1:10 dilution of the vaccine and, if the result is negative, intradermal testing is suggested. The purpose of this study was to evaluate the likelihood of reaction to measles-mumps-rubella (MMR) vaccine in patients with documented egg sensitivity and to delineate the efficacy of skin-prick testing (SPT) to MMR as a predictor of hypersensitivity to the vaccine. Egg sensitivity was documented by initial SPT to egg and then, if possible, double-blind placebo-controlled food challenge (DBPCFC). Patients with a positive DBPCFC to egg or a history of anaphylactic egg sensitivity had a SPT with the MMR vaccine and then were given the MMR vaccine. Additionally, children with atopic dermatitis who had been previously proven egg sensitive via DBPCFCs were evaluated retrospectively for sensitivity to the MMR vaccine. Sixteen children with a history of egg sensitivity underwent SPT to egg, with a positive result 3 mm greater than the negative control found in 12 patients. Eight of these children had a positive DBPCFC to egg. The SPT to MMR vaccine was negative in all 16 children; vaccine administration followed with no resultant systemic problems. Three children had a local reaction at the site of injection. Twelve additional children with atopic dermatitis and egg sensitivity were reviewed. Each child had a positive SPT and DBPCFC to egg. Ten of these children received the MMR vaccine prior to the time that their egg sensitivity was elucidated. Two other children were vaccinated elsewhere after they were documented egg sensitive. All 12 of these children tolerated the vaccine without incident. These results further substantiate the safety of MMR administration in egg-sensitive children and support routine vaccination of children who do not exhibit systemic allergic hypersensitivity to egg. It is suggested that SPT is an adequate screening method for children with anaphylactic egg sensitivity.

An evaluation of factors influencing response to epicutaneous immunotherapy for peanut allergy in the PEPITES trial

2020 ◽  
Vol 41 (5) ◽  
pp. 326-335 ◽  
Author(s):  
David M. Fleischer ◽  
Sharon Chinthrajah ◽  
Amy M. Scurlock ◽  
Dianne E. Campbell ◽  
Todd D. Green ◽  
...  
Keyword(s):  
Treatment Response ◽  
Peanut Allergy ◽  
Geometric Mean ◽  
Specific Ige ◽  
Double Blind ◽  
Treatment Benefit ◽  
Patch Application ◽  
Epicutaneous Immunotherapy ◽  
Lower Baseline ◽  
Baseline Characteristics

Background: Epicutaneous immunotherapy (EPIT) for peanut allergy is a potential novel immunotherapy that utilizes the unique cutaneous immunologic properties to induce desensitization. A randomized, double-blind, placebo-controlled Phase 3 trial (PEPITES) in peanut-allergic children 4‐11 years demonstrated an epicutaneous patch (DBV712) with 250 µg peanut protein was statistically superior to placebo in inducing desensitization following 12 months of daily treatment. Objective: To investigate what baseline and in-study factors influenced response to DBV712 250 µg, with a focus on patch adhesion, by posthoc analysis of PEPITES data. Methods: A posthoc multivariate model built with log-transformed Month 12 eliciting dose (ED) as the dependent variable was used to assess the influence of baseline characteristics and patch adhesion. Baseline characteristics and treatment response were also evaluated by stratifying subjects into decile subgroups by patch detachment rates over the 12-month study. Results: Multivariate analysis identified higher baseline ED and lower baseline peanut-specific IgE as the variables most predictive of higher Month 12 ED, followed by mean daily patch application duration, baseline SCORing Atopic Dermatitis (SCORAD) score, and age. By decile stratification, no association between patch detachment and treatment response was identified for 80% of DBV712-treated subjects. All DBV712-treated subjects, including those with the highest patch detachment rates, demonstrated treatment benefit measured by fold-changes in geometric mean ED. Conclusion: We identified subject baseline characteristics of higher baseline ED and lower baseline peanut-specific IgE as most predictive of higher Month 12 ED. For the majority of treated subjects, patch detachment did not impact treatment response. A minority of subjects, highly sensitive to peanut at baseline, had lower prespecified responder rates and higher patch detachment rates, yet still benefited from treatment based upon fold-changes in ED.

Hypertension (HTN) in National Cancer Institute of Canada Clinical Trials Group study BR.24: A randomized, double-blind phase II trial of carboplatin (C) and paclitaxel (P) with either daily oral cediranib (CED), an inhibitor of vascular endothelial growth factor receptors, or placebo, in patients with advanced non-small cell lung cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 3527-3527
Author(s):  
R. A. Goodwin ◽  
L. Seymour ◽  
K. Ding ◽  
I. Gauthier ◽  
A. Le Maitre ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Cox Regression ◽  
Treatment Algorithm ◽  
Progression Free Survival ◽  
Angiogenesis Inhibitors ◽  
Double Blind ◽  
Minimal Impact ◽  
Kaplan Meier ◽  
History Of ◽  
Baseline Characteristics

3527 Background: CED 30 mg/d with C+P increased response rate (RR: 38 vs 16% p < 0.0001) and median progression free survival (PFS: 5.6 vs 5 m, hazard ratio [HR] 0.77) over C+P alone. HTN is a known effect of angiogenesis inhibitors (AI). For BR.24, we describe the incidence of HTN, effects on drug delivery, predictors of its development/worsening, and assess the predictive effect of HTN on efficacy. Methods: Pts received C+P plus either placebo (n =146) or CED (n = 148). HTN as an adverse event (HTN AE: defined as either new onset HTN, or worsening grade HTN in a previously hypertensive pt), was managed with a protocol-defined algorithm. Exploratory analyses characterized the relationship between HTN AE and baseline characteristics and treatment arm. Kaplan Meier curves summarized time to event outcomes and Cox regression models with time dependent covariates correlated HTN AE to outcomes. Results: Rate of pts with a history of HTN were similar: CED 26 %, placebo 33 %. CED pts had significantly higher HTN AE (any: 38 vs 12%, p < 0.0001; grade 3 or 4: 19 vs 2 %). With the treatment algorithm, HTN AE had minimal impact on drug delivery (1 pt interrupted C+P, 11 pts [3.7%] reduced /discontinued CED / placebo). Headache was the only other AE that correlated with HTN AE. Predictors of HTN AE included: CED arm (p < 0.0001), good ECOG (p = 0.02), female (p = 0.006), history of HTN (p = 0.06). CED pts with HTN AE had significantly higher RR (51.8 vs 32.6%, p = 0.025) and PFS (8.5 vs 5.1 m; HR 0.45, 95% CI 0.29 to 0.72, p = 0.0007); similar but not significant findings were observed with placebo (RR 35.3 vs 17.2%, p= 0.098; PFS 5.6 vs 4.9 m; HR 0.84, 95 % CI 0.45–1.54); the interaction term by treatment arm was not significant. Conclusions: CED pts had greater HTN AE, but this did not impact drug delivery. Certain baseline characteristics predicted HTN AE in all pts. Unexpectedly, development of on-study HTN predicted improved outcome in all pts, although to a greater extent for those on CED. Additional evaluation of the role of HTN AE as a predictor of efficacy of both AI and cytotoxics is warranted. [Table: see text]

The natural history of peanut allergy in young children and its association with serum peanut-specific IgE

2000 ◽  
Vol 137 (6) ◽  
pp. 749-755 ◽  
Author(s):  
Timothy K. Vander Leek ◽  
Andrew H. Liu ◽  
Kay Stefanski ◽  
Betty Blacker ◽  
S.Allan Bock
Keyword(s):  
Natural History ◽  
Young Children ◽  
Peanut Allergy ◽  
Specific Ige ◽  
History Of

scholarly journals Case Report: Allergic Reactivity to Mahaleb (Prunus mahaleb) Spice in a Subject With Almond and Other Tree Nut Allergies

2020 ◽  
Vol 11 ◽  
pp. 215265672095908
Author(s):  
Lora Benoit ◽  
Jongkit Masiri ◽  
Harish Janagama ◽  
Steven M. Gendel ◽  
Mansour Samadpour
Keyword(s):  
Skin Prick Testing ◽  
Middle Eastern ◽  
Specific Ige ◽  
Cross Reactivity ◽  
Enzyme Linked Immunosorbent Assay ◽  
Tree Nut ◽  
Polyclonal Igg ◽  
History Of ◽  
Specific Igg ◽  
Food Recalls

Background Mahaleb is an aromatic spice prepared from the fruit stone of the St. Lucie Cherry that is used as a flavoring agent in traditional Turkish and Middle Eastern baking. Immunodiagnostic kits for almond, which are based on polyclonal almond-specific IgG antibodies, have been shown to demonstrate considerable cross-reactivity with mahaleb as was incidentally discovered during a cluster of allergen-related food recalls in 2015. Objective Though acute allergy to almond is somewhat common, allergies to mahaleb have not been previously documented. However, based on antigenic similarity observed with almond-specific IgG, it is predicted that mahaleb nut proteins would exhibit some level of cross-reactivity with almond-specific IgE and may therefore potentiate acute allergic symptoms in individuals with food allergy to almond. Case Presentation: Herein, we report on a 40-year old Caucasian female with longitudinal history of multiple tree nut allergies including allergy to almond, presenting with moderate pruritus and oropharyngeal swelling shortly following ingestion of mahaleb seed kernels. Methods and Results Skin-prick testing using extracts compounded from pistachio, almond, and mahaleb revealed positive wheals measuring 8, 3, and 7 mm respectfully. Indirect enzyme-linked immunosorbent assay (ELISA) using plate-bound antigens prepared from pistachio, almond, and mahaleb revealed IgG positive responses to all three targets. ELISA and Western blot analysis performed using goat anti-almond polyclonal IgG demonstrated significant cross-reactivity between almond and mahaleb, but not to pistachio. Conclusion This is the first documented case of acute allergy to mahaleb, co-occurring in the context of plural tree nut allergies, providing novel evidence that mahaleb may pose a risk to nut-allergic individuals and indicating a need for awareness of spice contamination with nut and mahaleb residues.

scholarly journals White paper peanut allergy—part 2: Diagnosis of peanut allergy with special emphasis on molecular component diagnostics

2021 ◽  
Author(s):  
Lea Alexandra Blum ◽  
Birgit Ahrens ◽  
Ludger Klimek ◽  
Kirsten Beyer ◽  
Michael Gerstlauer ◽  
...  
Keyword(s):  
Gold Standard ◽  
Peanut Allergy ◽  
Immunoglobulin E ◽  
Skin Prick Testing ◽  
Systemic Reaction ◽  
Food Challenge ◽  
Clinical History ◽  
Double Blind ◽  
Skin Reactions ◽  
Diagnostic Algorithms

Summary Background Peanut allergy is an immunoglobulin E (IgE)-mediated immune response that usually manifests in childhood and can range from mild skin reactions to anaphylaxis. Since quality of life maybe greatly reduced by the diagnosis of peanut allergy, an accurate diagnosis should always be made. Methods A selective literature search was performed in PubMed and consensus diagnostic algorithms are presented. Results Important diagnostic elements include a detailed clinical history, detection of peanut-specific sensitization by skin prick testing and/or in vitro measurement of peanut (extract)-specific IgE and/or molecular components, and double-blind, placebo-controlled food challenge as the gold standard. Using these tools, including published cut-off values, diagnostic algorithms were established for the following constellations: 1) Suspicion of primary peanut allergy with a history of immediate systemic reaction, 2) Suspicion of primary peanut allergy with questionable symptoms, 3) Incidental findings on sensitization testing and peanut ingestion so far or 4) Suspicion of pollen-associated peanut allergy with solely oropharyngeal symptoms. Conclusion The most important diagnostic measures in determining the diagnosis of peanut allergy are clinical history and detection of sensitizations, also via component-based diagnostics. However, in case of unclear results, the gold standard—an oral food challenge—should always be used.

Natural Course and Prognostic Factors of Immediate-Type Peanut Allergy in Children

2021 ◽  
pp. 1-5
Author(s):  
Minyoung Jung ◽  
Hye-In Jeong ◽  
Yechan Kyung ◽  
Su Kyung Kim ◽  
Ju Suk Lee ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Peanut Allergy ◽  
Challenge Test ◽  
Food Challenge ◽  
Specific Ige ◽  
Natural Course ◽  
Cox Proportional Hazard ◽  
Sige Level ◽  
Tertiary Hospitals ◽  
History Of

<b><i>Background:</i></b> Predicting food allergy resolution is essential to minimize the number of restricted foods in children. However, there have been no studies on the natural history of peanut allergy (PA) in Korea. <b><i>Objective:</i></b> This study aimed to evaluate the natural course and prognostic factors of immediate-type PA in children till the age of 10 years. <b><i>Methods:</i></b> We retrospectively collected data of 122 children who developed PA before 60 months of age from 3 tertiary hospitals in Korea. Diagnosis and resolution of PA was defined as an oral food challenge test or a convincing history of symptoms within 2 h after peanut ingestion. The prognostic factors for resolution of PA were identified using the Cox proportional hazard model. <b><i>Results:</i></b> The median (interquartile range) age at diagnosis was 2.0 (1.3–3.0) years. Among the 122 children, PA resolved in 18 (14.8%) children. The level of peanut-specific IgE (sIgE) at diagnosis in the persistence group was significantly higher than that in the resolution group (<i>p</i> = 0.026). The probabilities of resolution of PA were 10.3% and 32.8% at the ages of 6 and 10 years, respectively. A peanut-sIgE level ≥1 kU/L at diagnosis was significantly associated with persistent PA (hazard ratio, 5.99; 95% confidence interval, 1.89–18.87). <b><i>Conclusions:</i></b> Only 10.3% of our patients had a probability of developing spontaneous resolution of PA by 6 years of age. Peanut-sIgE levels ≥1 kU/L at diagnosis were associated with the persistence of PA.

scholarly journals Randomized, Double-Blind, Multicenter Study of Caspofungin versus Amphotericin B for Treatment of Oropharyngeal and Esophageal Candidiases

2002 ◽  
Vol 46 (2) ◽  
pp. 451-457 ◽  
Author(s):  
Eduardo G. Arathoon ◽  
Eduardo Gotuzzo ◽  
L. Miguel Noriega ◽  
Rayanne S. Berman ◽  
Mark J. DiNubile ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Therapeutic Option ◽  
Study Drug ◽  
Drug Efficacy ◽  
Double Blind ◽  
Esophageal Candidiasis ◽  
Esophageal Involvement ◽  
History Of ◽  
Dose Ranging ◽  
Intent To Treat

ABSTRACT Caspofungin is an antifungal agent of the novel echinocandin class. We investigated its efficacy, safety, and tolerability as therapy for oropharyngeal and/or esophageal candidiasis in a phase II dose-ranging study. Patients were randomized in a double-blind manner to receive either caspofungin acetate (35, 50, or 70 mg) or amphotericin B (0.5 mg/kg of body weight) intravenously once daily for 7 to 14 days. A favorable response required both complete resolution of symptoms and quantifiable improvement of mucosal lesions 3 to 4 days after discontinuation of study drug. Efficacy was assessed using a modified intent-to-treat analysis. No hypothesis testing of efficacy was planned or performed. Of 140 enrolled patients, 63% had esophageal involvement and 98% were infected with the human immunodeficiency virus (HIV) (median CD4 count, 30/mm3). A modestly higher proportion of patients in each of the caspofungin groups (74 to 91%) achieved favorable responses compared to amphotericin B recipients (63%), but there was considerable overlap in the 95% confidence intervals surrounding these point estimates. Similar trends were found in the subgroups with esophageal involvement, a history of fluconazole failure, and CD4 counts of ≤50/mm3. A smaller proportion of patients receiving any dose of caspofungin experienced drug-related adverse events compared to patients given standard doses of conventional amphotericin B (P < 0.01). Caspofungin provided a generally well-tolerated parenteral therapeutic option for HIV-infected patients with oropharyngeal and/or esophageal candidiasis in this study.

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