New food allergy guidelines aim to help prepare families for oral immunotherapy

New international guidelines published in the Journal of Allergy and Clinical Immunology this April aim to support healthcare professionals using oral immunotherapy to treat patients with food allergies. The guidelines were developed by a team of 36 international experts including Anaphylaxis UK’s Clinical and Scientific Panel member Dr Paul Turner. They are not mandatory but aim to standardise the process for families considering oral immunotherapy and improve outcomes for patients.

Oral immunotherapy is a treatment that aims to train the patient’s immune system to tolerate the food they are allergic to by eating or drinking very small amounts every day, so that the food no longer causes reactions. It can be used for common allergens such as eggs, milk and peanuts.

Before now, there was little evidence-based guidance available. Oral immunotherapy involves some risk because the food or drink needs to be given to children by their parents or caregivers at home, who need to observe reactions and make decisions about treatments.

Douglas Mack, study co-author and a clinical professor at McMaster University in Canada said: “These families must provide the therapy every single day. That’s why these guidelines are so important. Safety can be optimized to make sure that they understand what they’re taking on, while ensuring that they are aware of the kinds of side-effects that can be dangerous.”

The expert panel created a detailed and standardised consent form and topics for healthcare professionals to discuss with families. This includes explaining that oral immunotherapy is not a cure, that asthma should be controlled before starting the therapy, and stresses that all caregivers must understand how the process works. This should ensure that all parents and caregivers understand the risks and benefits, and the alternative treatment options available.

Douglas Mack said: “If they [families] decide they want to do it after following these guidelines, they’re prepared for what they’re getting into. They understand the risks and most importantly, it makes it safer because they can anticipate the challenges. This protocol sets the standard moving forward.”

The researchers included the following recommendations in the guidelines:
• A robust standardised education process for patients and caregivers through a detailed consent procedure
• Establishing adequate parental supervision for dosing before beginning treatment
• Identifying inadvisable risk factors including uncontrolled asthma, an unwillingness to use adrenaline, uncontrolled psychological concerns and pregnancy
• Clearly understanding the patient and caregiver goals
• Developing a structured universal consent form template

See the new guidelines in the Journal of Allergy and Clinical Immunology