Oral immunotherapy awareness lags

Immunotherapy offers a way to reduce the number of reactions due to food allergies. However, many people are unaware of what it is, what it does, and the overall safety of the therapy.

Despite advances in using oral immunotherapy (OIT) to help treat food allergies, many caregivers of people with food allergies know little to nothing about this therapy.

A new study, published in The Journal of Allergy and Clinical Immunology, sought to assess awareness and acceptance of OIT. What researchers found was that despite numerous studies backing the efficacy of OIT, few surveyed were aware of its benefits or comfortable with OIT as a treatment option for food allergies.1

According to the report, 72% of patients with food allergies—or caregivers of those with food allergies—had no idea what OIT was before the survey. Those who did were often from households with incomes greater than $100,000 or had college educations.

“The overall knowledge of OIT as a treatment is generally low in the United States and those who report awareness of OIT are disproportionately of higher socioeconomic status,” explained Ruchi Gupta, MD, MPH, director of the Center for Food Allergy & Asthma Research Institute for Public Health and Medicine at Northwestern University in Evanston, Illinois, and co-author of the report.

When participants did know what OIT was, about half believed the therapy would be used to simply protect them from accidental exposures to food allergens. A third of people who didn’t know what OIT was came to the same conclusion. On the other hand, 38% of the people who knew what OIT was and 35% who didn’t know believed that the therapy could completely cure their food allergy.

The truth is somewhere in between, according to Food Allergy Research & Education (FARE), a private food allergy research organization that helped to fund the study. The goal of OIT is to desensitize people with food allergies to the allergens that cause a reaction. Although this might not cure a food allergy completely, it can allow the person with the allergy to consume substantial amounts of the offending food item without reaction. This can reduce the need for emergency intervention when it comes to food allergies, but is not meant to be a cure.2

OIT works by offering small amounts of allergy-inducing foods over a period of time—typically under the supervision of a trained allergist. In time, reactions may be lessened, but the patient has to continue exposure to keep up the desensitization. Not everyone responds to OIT, either, FARE cautioned.

Education is just one hurdle that OIT efforts have to overcome, acceptance is another. The study found that more than half—55%—of people who had never heard of OIT wouldn’t be comfortable with the therapy, even under the supervision of a physician.

Gupta said part of the problem is that OIT hasn’t been a widely available therapy until recently.

“Access to OIT has been largely limited to patients willing to enroll in clinical trials and/or travel to receive care from a relatively small group of specialist OIT practitioners, who tend to be concentrated in select urban/suburban settings and payment is out of pocket,” Gupta said. “The first US Food and Drug Administration (FDA)-approved oral immunotherapy entered the US market last year, but uptake has been limited. As more treatment options gain FDA approval and are indicated for a greater variety of specific food allergens—besides peanut—we anticipate that buy-in for OIT will increase.”

As OIT is more widely adopted, there is more data clinicians can share with patients, too, Gupta said.

“We are learning a lot from ongoing studies regarding how to improve the safety profile of OIT and reduce the treatment burden of patients and families alike,” Gupta said “As these findings make their way into clinical practice and translate into better treatment outcomes with fewer treatment-related adverse events, this may increase buy-in as well.”

Although some clinicians may think this is an issue reserved for specialists, Gupta added that there is an increasing need for general practitioners to learn about this therapy, too.

“Among patients who report awareness of OIT, nearly as many—39%—reported consulting primary care providers about OIT as [the 49% that] reported consulting an allergist,” Gupta said. “Therefore, given that pediatricians are on the front lines of food allergy diagnosis and management, they should help educate all their patients about potential treatments and be aware to support underserved families in accessing such treatments.“

Moving forward, Gupta hopes that education and awareness increase to reduce the need for emergency treatments to food allergy reactions and to increase the quality of life for those who suffer from food allergies—especially among groups in lower-income or lower-education demographics.

“We hope that this report highlights the growing need for equitable access to safe, effective, emerging food allergy treatments. Our group's national epidemiological data indicate that food allergies disproportionately affect lower socioeconomic status communities of color in the United States,” Gupta said. “It is essential that the emergence of effective food allergy treatments, such as OIT, do not further entrench these disparities, but rather help to ameliorate them.”

References

1.Warren C, Roach A, Das R, et al. Oral immunotherapy–related awareness, attitudes, and experiences among a nationally representative sample of food allergy patients/caregivers. The Journal of Allergy and Clinical Immunology: In Practice. 2021. doi:10.1016/j.jaip.2021.07.020

2. Food Allergy Research & Education. Oral Immunotherapy in Practice. Accessed September 30, 2021. https://www.foodallergy.org/resources/oral-immunotherapy-oit-practice