Oral Peanut Immunotherapy With Butyrate Adjuvant (OPIA) in Children: A Randomised, Controlled Trial.

Background: Sustained unresponsiveness (SU) remains a major challenge for peanut OIT. The short chain fatty acid (SCFA) butyrate has the potential to upregulate regulatory T cells (Tregs) to improve long term tolerance. We conducted a superiority randomised controlled trial to assess the efficacy and safety of the addition of daily oral butyrate to peanut OIT.

Inconsistences in Prescribing Epinephrine Autoinjectors.

A key strategy in supporting patients at risk of anaphylaxis is the provision of self-administered epinephrine ("self-epi"). However, there seems to be a lower threshold for prescribing self-epi in food allergy than in venom allergy. Self-epi is often recommended to someone with the relatively low risk of food anaphylaxis (under 5%), yet a similar level of risk in a venom-allergic patient is considered not to justify self-epi.

Risk of anaphylaxis on commercial flights.

Purpose Of Review: Air travel has now returned to prepandemic levels, with over 10.5 billion passengers in 2024. Many of these passengers have food allergies, and there is a perception that allergic reactions are common during commercial flights.

Re-evaluating treatment success in trials of peanut oral-immunotherapy: impact of different definitions on efficacy outcomes.

Purpose Of Review: Allergen immunotherapy (AIT) is increasingly popular as a treatment strategy for food allergy. Unfortunately, there is significant heterogeneity in reported outcomes, specifically in the dose-thresholds selected for evaluation and the symptoms used to define a "tolerated dose". These considerations are often investigator-driven and do not consider patient perspectives.

Efficacy and Safety of Epicutaneous Immunotherapy in Peanut-Allergic Toddlers: Open-Label Extension to EPITOPE.

Background: The pivotal phase 3 EPITOPE trial, a 12-month, double-blind, placebo-controlled study of epicutaneous immunotherapy with the VIASKIN patch containing 250 μg of peanut protein (VP250), previously reported significant treatment response versus placebo in peanut-allergic toddlers aged 1 through 3 years.

Objective: To assess the interim efficacy and safety of VP250 from the first year of the EPITOPE open-label extension (OLE) study.

Methods: Eligible participants enrolled in the OLE study for up to 3 years of total treatment with annual double-blind, placebo-controlled food challenges (DBPCFCs) and safety assessments; here we report the first-year OLE (year 2) results.

Anaphylaxis definition, overview, and clinical support tool: 2024 consensus report-a GALEN project.

Background: The 2006 National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network anaphylaxis criteria are widely used in clinical care and research. In 2020, the World Allergy Organization published modified criteria that have not been uniformly adopted. Different criteria contribute to inconsistent care and research outcomes.

AAAAI-EAACI PRACTALL: Standardizing oral food challenges-2024 Update.

This common statement of the American Academy of Allergy, Asthma and Immunology (AAAAI) and The European Academy of Allergy and Clinical Immunology (EAACI) provides an update of the 2012 published guidelines on food challenges. The guidelines equally address food challenges in the research and the clinical settings. They first address the diagnostic tests which can guide the decision to conduct a challenge.

Development of Cashew and Pistachio Ladders through a Food-Processing Approach.

Following successful oral immunotherapy (OIT) for peanut allergy using boiled peanuts (BOPI trial), this study investigated the potential of wet-thermal-processing-induced allergen modification, specifically soaking and boiling (1-4 h) to reduce the allergenicity of cashew and pistachio allergens. In addition, this study provides a foundation of understanding for developing safer forms of cashew/pistachio administration for application in OIT by gradual exposure to increasing doses of modified allergens with reduced potency as an "allergen ladder". An SDS-PAGE analysis and an intrinsic-fluorescence spectroscopy revealed altered tertiary structures of the allergens, leading to their denaturation and even degradation.

Time trends in the epidemiology of food allergy in England: an observational analysis of Clinical Practice Research Datalink data.

Background: Estimates for the prevalence of food allergy vary widely, with a paucity of data for adults. The aim of this analysis was to report trends in the incidence and prevalence of food allergy in England, using a national primary care dataset.

Methods: We analysed data from Clinical Practice Research Datalink between 1998 and 2018, with linked data to relevant hospital encounters in England.

BSACI guidance for the implementation of Palforzia® peanut oral immunotherapy in the United Kingdom: A Delphi consensus study.

Background: Palforzia® enables the safe and effective desensitisation of children with peanut allergy. The treatment pathway requires multiple visits for dose escalation, up-dosing, monitoring of patients taking maintenance therapy and conversion onto daily real-world peanut consumption. The demand for peanut immunotherapy outstrips current National Health Service (NHS) capacity and requires services to develop a national consensus on how best to offer Palforzia® in a safe and equitable manner.

Management of Refractory Anaphylaxis: An Overview of Current Guidelines.

In this review, we compare different refractory anaphylaxis (RA) management guidelines focusing on cardiovascular involvement and best practice recommendations, discuss postulated pathogenic mechanisms underlining RA and highlight knowledge gaps and research priorities. There is a paucity of data supporting existing management guidelines. Therapeutic recommendations include the need for the timely administration of appropriate doses of aggressive fluid resuscitation and intravenous (IV) adrenaline in RA.

Preparing Patients for Oral Immunotherapy (PPOINT): International Delphi consensus for procedural preparation and consent.

Background: Despite the promise of oral immunotherapy (OIT) to treat food allergies, this procedure is associated with potential risk. There is no current agreement about what elements should be included in the preparatory or consent process.

Objective: We developed consensus recommendations about the OIT process considerations and patient-specific factors that should be addressed before initiating OIT and developed a consensus OIT consent process and information form.

Flex-IT! Applying "Platform Trials" Methodology to Immunotherapy for Food Allergy in Research and Clinical Practice.

There is an increasing trend in the management of food allergy toward active treatment using allergen immunotherapy (AIT). Although AIT is efficacious, treatment-related adverse events are common, particularly with oral immunotherapy in those with high levels of allergen-specific IgE sensitization. In clinical practice, these adverse events inevitably create challenges: clinicians and patients routinely face decisions whether to alter the dose itself, the frequency of dosing, and the pace of escalation, or indeed discontinue AIT altogether.