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1. First Real-World Effectiveness Analysis of Preschool Peanut Oral Immunotherapy

Author

Elissa M. Abrams, Stuart C. Carr, Lianne Soller, Kyla J. Hildebrand, Raymond H. Mak, Victoria E. Cook, Gregory Rex, Edmond S. Chan, Joanne Yeung, Mary McHenry, Sandeep Kapur, Tiffany Wong, Scott B. Cameron, Timothy K. Vander Leek, Sara Leo, and Thomas V. Gerstner

Subjects
medicine.medical_specialty, Arachis, Epinephrine, Oral immunotherapy, medicine.medical_treatment, Peanut allergy, Administration, Oral, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Immunology and Allergy, Peanut Hypersensitivity, 030212 general & internal medicine, Eosinophilic esophagitis, Desensitization (medicine), Oral food challenge, business.industry, Cumulative dose, Peanut specific IgE, Emergency department, Allergens, medicine.disease, 030228 respiratory system, Desensitization, Immunologic, Child, Preschool, business
Abstract

Background We previously described safety of preschool peanut oral immunotherapy (P-OIT) in a real-world setting; 0.4% of patients experienced a severe reaction, and 4.1% received epinephrine, during build-up. Objective To determine the effectiveness of preschool P-OIT after 1 year of maintenance. Methods Preschoolers (9-70 months) with at least 1 objective reaction to peanut (during baseline oral food challenge (OFC) or P-OIT build-up) received a follow-up OFC to cumulative 4000 mg protein after 1 year on 300 mg peanut daily maintenance. Effectiveness of desensitization was defined as proportion of patients with a negative follow-up OFC. Symptoms and treatment at follow-up OFC were recorded. Results Of the 117 patients who successfully completed 1 year of P-OIT and subsequently underwent a cumulative 4000-mg follow-up OFC, 92 (78.6%) had a negative OFC and 115 (98.3%) tolerated a cumulative dose of greater than or equal to 1000 mg. For the 25 (21.4%) who reacted, their threshold increased by 3376 mg (95% CI, 2884-3868) from baseline to follow-up; 17 (14.5%) patients experienced grade 1 reactions, 7 (6.00%) grade 2, and 1 (0.85%) grade 3. Two patients (1.71%) received epinephrine associated with P-OIT, and 1 (0.85%) went to the emergency department. Conclusions Our data demonstrate that real-world preschool P-OIT is effective after 1 year of maintenance for those who received a follow-up OFC. For those who reacted, their threshold increased sufficiently to protect against accidental exposures. P-OIT should be considered for preschoolers as an alternative to current recommendations to avoid peanut.

Published
2021
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2. Canadian Society of Allergy and Clinical Immunology annual scientific meeting 2016

Author

Duncan Lejtenyi, Vincent Stagg, Michael N. Fein, Young Woong Kim, Mark W. Tenn, Peter Vadas, Marylin Desjardins, David Dai, Allan B. Becker, Charlotte Miller, David Holt, Elissa M. Abrams, Jaclyn Quirt, Brenda Reid, Leman Yel, Roxane Labrosse, Daniel Suez, Dhaifallah Alotaibi, Helen Neighbour, Alex Simidchiev, Eiman Al-Selahi, Thomas V. Gerstner, Mary Messieh, Sanju Mishra, Edward M. Conway, Lucy Duan, Xichun Sun, Amin S. Kanani, Chaim M. Roifman, Mark Stein, Delia Heroux, ChenXi Yang, Chrystyna Kalicinsky, Chun T. Che, Barbara McCoy, Louis Paradis, Herman Tam, Martine Lemire, Donna Martin, Philippe Bégin, Linda Pedder, Jeffrey S. Zaltzman, Timothy Teoh, Greg J. Evans, Preeti Zimmer, Lucy Chen, Christopher Mill, Kateryna Vostretsova, Scott J. Tebbutt, Casey P. Shannon, Gillian Bartlett, Nikita Raje, Evelyn Gunawan, Bruce Mazer, Kevin E. Renahan, Stephane Barakat, Charles S. Barnes, Sudhir Gupta, Salaheddin M. Mahmud, Elli Rosenberg, Alexander Ho, Michael Trus, Meghan B. Azad, Harley Eisman, Ricardo Jimenez, Savannah Grodecki, Jean-Phillipe Drolet, Christelle Bourgeois, Lisa W. Fu, Gail M. Gauvreau, Cristina Longo, Shiyuan Zhang, Andrea E. Burke, Frank Albers, Heinz Leibl, Victoria E. Cook, Christopher Carlsten, Elinor Simons, Jenny Thiele, Amber Oberle, Padmaja Subbarao, Matthew C. Tunis, Ahmed A. Darwish Hassan, R. Robert Schellenberg, Alexander Singer, Jennifer A. Sullivan, Paul K. Keith, Isaac Melamed, Meredith D. Chiasson, Andrew Moses, Amin Kanani, Bassel Dawod, Danay Maestre-Batlle, Diana L. Lefebvre, Rishma Chooniedass, Jeffrey R. Brook, Gina Lacuesta, Adelle Atkinson, Lorena Vehling, Sofianne Gabrielli, Tracie A. Barnett, Judy Morris, Iftikhar Hussain, Tibor Schuster, Edson Castilho, Edmond S. Chan, Colin Barber, Mihaela Paina, Brooke I. Polk, Amrit Singh, Keely Loewen, Brenda MacGibbon, Lisa M. Steacy, Michelle L. North, Yasmin Othman, Gordon L. Sussman, Elodie Portales-Casamar, Yahya Fiteih, Joel Liem, Diana Quint, Sandor Fritsch, Yann Amistani, Hanan Alshamali, Kenneth Paris, Francisco J.D. Noya, Vanessa Omana, Jacques Hébert, Harissios Vliagoftis, Vishal Avinashi, Moshe Ben-Shoshan, Olga M. Pena, Lori A. Connors, Annika Klopp, Andrew Wakeman, Desmond Leddin, François Graham, Ori Scott, Lori Connors, Amanda Ciccolini, Hans Pasterkamp, Eyal Grunebaum, Stephen Couban, Sebastien LaVieille, Geert W. ‘t Jong, Claire Tacon, Kavisha Jayasundara, Anne K. Ellis, S.E. Turvey, Beverley Temple, Fernando Aleman, Jean S. Marshall, Malcolm R. Sears, Peter Menikefs, Kevin Woodward, Roberta L. Woodgate, Piushkumar J. Mandhane, Martin Noel, Marianne Beland, Necdet B Gunsoy, John-Paul Oliveria, Saiful Huq, Adrienne Roos, Josiane Cognet-Sicé, Lawrence Joseph, Mark Larché, Anne Des Roches, Katia Charland, Michelle Bolner, Anette Kocbach Bølling, Gordon Sussman, Teresa Pun, Olivier Chambenoi, Nikhil Joshi, Mark FitzGerald, Francine M. Ducharme, M.R. Sears, Vy Hong-Diep Kim, Raphael Hanna, Leah T. Stiemsma, Piushkumar Mandhane, Brad Millson, Donald Stark, Persia Pourshahnazari, Laurie Lee, Mohammad A. Alsayegh, Joseph Shuster, Hani Hadi, Thomas B. Issekutz, Anna Cvetkovic, Barret A. Monchka, Christos M. Tsoukas, Jonathan Lacombe-Barrios, Douglas P. Mack, Elizabeth A. Lee, Susan Waserman, Sebastien K. Gerega, Scott Sawyer, Parameswaran Nair, Shairaz Baksh, Miriam Diamond, Judah A. Denburg, Wade Watson, Ann E. Clarke, Christopher F. Rider, Christopher Mills, Kara Robertson, Jay M. Portnoy, Sima Chiva-Razavi, Lindsay Douglas, Kathy Abiteboul, Damian Tworek, Babar Haroon, F. Estelle R. Simons, Hana Müllerová, Pascale Dupuis, Sara F. Johnson, Gilbert Nadeau, William Powley, Lana Rosenfield, Stuart E. Turvey, Reza Alizadehfar, Greg Plunkett, Steven G. Smith, Chris Olesovsky, Christine McCusker, and Mousa Khadada

Subjects
Allergic Rhinitis, lcsh:Immunologic diseases. Allergy, Allergy, medicine.medical_specialty, Clinical immunology, business.industry, Alternative medicine, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, Meeting Abstracts, Food Allergy, Chronic Granulomatous Disease, Asthma, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Family medicine, Immunology, Medicine, lcsh:RC581-607, business
Published
2017
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3. First Real-World Safety Analysis of Preschool Peanut Oral Immunotherapy

Author

Edmond S. Chan, Elissa M. Abrams, Kyla J. Hildebrand, Lianne Soller, Scott B. Cameron, Timothy K. Vander Leek, Sara Leo, Gregory Rex, Joanne Yeung, Per G. Lidman, Victoria E. Cook, Nicole J. Lee, Mary McHenry, Sandeep Kapur, Raymond H. Mak, Stuart C. Carr, Thomas V. Gerstner, and Tiffany Wong

Subjects
Male, Canada, medicine.medical_specialty, Allergy, Arachis, Peanut allergy, Administration, Oral, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, medicine, Humans, Immunology and Allergy, Peanut Hypersensitivity, 030212 general & internal medicine, Eosinophilic esophagitis, Adverse effect, Skin Tests, Oral food challenge, business.industry, Maintenance dose, Infant, Allergens, Immunoglobulin E, medicine.disease, Clinical trial, 030228 respiratory system, Desensitization, Immunologic, Child, Preschool, Female, business
Abstract

Background In 2017, a clinical trial of 37 subjects demonstrated that preschool peanut oral immunotherapy (P-OIT) was safe, with predominantly mild symptoms reported and only 1 moderate reaction requiring epinephrine. Objectives We sought to examine whether these findings would be applicable in a real-world setting. Methods As part of a Canada-wide quality improvement project, community and academic allergists administered P-OIT to preschool-age children who had (1) skin prick test wheal diameter greater than or equal to 3 mm or specific IgE level greater than or equal to 0.35 kU/L and history of reaction and/or positive baseline oral food challenge, or (2) no ingestion history and specific IgE level greater than or equal to 5 kU/L. Over 16 to 22 weeks, patients had biweekly clinic visits for updosing, and consumed the dose daily at home between visits. Target maintenance dose was 300 mg peanut protein. Symptoms were classified using a modified World Allergy Organization Subcutaneous Immunotherapy Reaction Grading System (1 mildest, 5 fatal). Results Of 270 patients who started P-OIT in the period 2017 to 2018, 243 reached maintenance, and 27 dropped out (10.0%); 67.8% of patients experienced reactions during buildup: 36.3% grade 1, 31.1% grade 2, and 0.40% grade 4. Eleven patients (4.10%) received epinephrine (10 patients received 1 dose, 1 patient received epinephrine on 2 separate days), representing 2.23% of reactions (12 of 538) and 0.029% of doses (12 of 41,020). Conclusions We are the first group to describe preschool P-OIT in a real-world multicenter setting. The treatment appears to be safe for the vast majority of patients because symptoms were generally mild and very few reactions received epinephrine; however, life-threatening reactions in a minority of patients (0.4%) can still occur.

Published
2019
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5. Allergy to cooked, but not raw, peas: a case series and review

Author

Thomas V. Gerstner and Elissa M. Abrams

Subjects
Pulmonary and Respiratory Medicine, Veterinary medicine, Allergy, business.industry, Pea, technology, industry, and agriculture, food and beverages, Context (language use), Case Report, General Medicine, medicine.disease, Legume, Food allergy, medicine, otorhinolaryngologic diseases, Immunology and Allergy, Food science, business
Abstract

Allergic reactions to legumes are common.Food allergy to cooked, but not raw, pea has been rarely reported in the literature. This case series describes five children who had various IgE-mediated symptoms upon consumption of cooked pea, but tolerated raw pea. Skin testing then confirmed positive responses to cooked, but not raw, peas. It is important to consider allergy to cooked legumes, even in the context of raw legume tolerance.

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6. Anaphylaxis related to avocado ingestion: a case and review

Author

Elissa M. Abrams, Allan B. Becker, and Thomas V. Gerstner

Subjects
lcsh:Immunologic diseases. Allergy, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Allergy, food allergy, business.industry, MEDLINE, food and beverages, Case Report, General Medicine, medicine.disease, Dermatology, avocado, Food allergy, Immunology, anaphylaxis, Medicine, Ingestion, Immunology and Allergy, In patient, lcsh:RC581-607, business, Anaphylaxis, Latex sensitization
Abstract

Anaphylaxis to avocado, independent of latex sensitization, has been rarely reported in the literature. This case report describes a 15 year old male who experienced anaphylaxis within half an hour after eating avocado-containing food. Avocado consumption is common in both North America and South America. It is important to consider avocado as a cause of anaphylaxis, even in patients not sensitized to latex.

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