This past weekend in Chicago, the AAAAI held our sold-out course: “Food Allergy: From Primary Prevention to Treatment and Intervention.” This educational program was one of the initiatives of Immediate Past President Robert A. Wood, MD, FAAAAI, and provided a unique setting to dive into the evidence concerning food allergy diagnosis, treatment, and prevention. Attendees were able to engage about the challenges related to food allergy treatment that we face in daily practice, while learning from experts in the field and each other via small group interactive discussions and hands-on training.
If you missed the opportunity to register for this course due to how quickly it sold out, all of the lectures were recorded and can be ordered from the AAAAI Continuing Education Center. We expect the recordings to be available by late October or early November.
It’s no coincidence that we offered this course at a time when a new era for our specialty is on the horizon—one where we will have treatment options for food allergy that are approved by the Food and Drug Administration (FDA).
Tomorrow, September 13, the FDA Allergenic Products Advisory Committee will meet from 8:30 am to 4:30 pm EDT to discuss and make recommendations on the safety and efficacy of the first such agent, which is an oral immunotherapy for peanut allergy. As you are aware, the intent of an Advisory Committee meeting is to provide recommendations to the FDA. The FDA will need to deliberate further in order to complete its review of the agent and announce a final decision.
You can find information about this meeting on the FDA website, including a link to view a live webcast while it’s in progress. You can also expect the AAAAI to inform you of the outcome of this meeting after it has concluded.
Most of us started our training at a time when we thought we’d never see the day where we’d have FDA approved food allergy treatments. In the fifth edition of Allergy: Principles and Practice (Middleton E, Reed C, Ellis E, Adkinson NF, Yuninger JW, Busse WW. Mosby, Inc. 1998), Hugh A. Sampson, MD, FAAAAI, who authored the “Adverse Reactions to Foods” chapter, wrote the following two sentences to conclude this chapter: “Current studies of allergen characterization and the rigorous scientific methods now being applied to this field by many investigators provide hope that new information regarding the pathogenesis of these disorders and new forms of therapy will soon become available. In the interim, allergists must carefully diagnose specific food sensitivities and educate patients in the rigorous elimination of the responsible allergen.”
So, over and over we educated our patients on the importance of assiduously avoiding culprit foods, being able to recognize the symptoms and signs of an allergic reaction, and carrying injectable epinephrine with them at all times. Management was limited to avoidance and anaphylaxis preparedness. Despite our best efforts and the diligence of our patients, in some cases inadvertent exposures that provoked serious reactions still occurred.
And now here we are, moving closer to a therapeutic intervention for peanut allergy becoming a reality. The ability to treat properly selected peanut-allergic patients with an intervention that can alter the allergic response, in order to safeguard against severe reactions with accidental exposure, is truly a groundbreaking development for us and for our patients.
An important point for all of us to consider is that while having a first generation of FDA approved food allergy treatments will bring a great deal of attention and excitement, it will also bring a number of challenges. For example, the enthusiasm surrounding this innovation could make it easy for patients to think there is a cure for food allergy. However, as you all know that’s not where we are yet. Patients and their families will need to be educated about the realities of these new therapies. As with other therapeutic interventions we prescribe, this is not a “one size fits all” situation. Moving from critical appraisal of the data published in clinical trials concerning efficacy and safety, which the FDA Allergenic Products Advisory Committee is doing (perhaps even as you read this), additional considerations in moving from evidence-based recommendations to caring for each of our individual patients will include considerations such as the severity of allergic reaction that was experienced, the likelihood the allergic state will be outgrown over time with continued avoidance, and the risk of inadvertent exposure. It will be important for each of us in managing our patients with peanut allergy to invest the time to explain the potential for benefit compared with the potential for harm/burden, and permit patients and families to express their values and preferences, participating in the medical decision making process to determine whether they desire to proceed with food oral immunotherapy.
Being on the threshold of this therapeutic advance in our specialty leads me to recall similar game changers in other areas—the introduction of novel agents for management of patients with C1 inhibitor deficiency syndromes, and biologic agents for patients with severe asthma, refractory chronic urticaria and atopic dermatitis. Each of us has had the memorable and gratifying experience of witnessing the substantial and meaningful improvement in quality of life that many of our patients with these conditions have experienced as a result of these revolutionary therapies.
And we are now on the verge of another momentous advance that will allow us to do more in improving the healthcare outcomes of our patients (and their families). The arrival of an FDA approved therapy for food allergy is the fulfillment of a dream. Perhaps in life the best dreams are those that happen while we’re still awake.
David M. Lang, MD, FAAAAI