McMaster University researchers have developed the first-ever guidelines to assist families in preparing to build their child’s tolerance to common food allergens. These international guidelines aim to standardize the preparation process for families considering oral immunotherapy, which involves gradually increasing the amount of allergen given to patients to build up their tolerance. This process is designed to help families who are planning to undergo oral immunotherapy for their children with food allergies.An article published on April 8, 2024 in the Journal of Allergy and Clinical Immunology aimed to standardize the preparation process for families considering oral immunotherapy. This process involves giving small amounts of an allergen, such as peanuts, to patients and gradually increasing the amount to build up their tolerance.
Previously, clinicians had little evidence-based guidance to offer parents who were administering this procedure to their child. The new guidelines aim to fill this important gap, as the therapy carries risks and is administered daily at home to children by their parents, requiring caregivers to act like amateur medical professionals.Healthcare professionals are responsible for observing reactions and determining necessary treatments.
“This paper is groundbreaking in our field because it is unprecedented and the process has not been standardized,” explains Douglas Mack, the paper’s lead author and assistant clinical professor with McMaster’s Department of Pediatrics. “We really need some sort of guidance on how to handle oral immunotherapy. We have never had this before.”
The researchers outlined several recommendations, including:
- A comprehensive standardized education process for patients and caregivers through a detailed consent procedure.
- Ensuring that parents provide adequate supervision for dosing before starting treatment
- Recognizing risk factors that are not advisable, such as uncontrolled asthma, reluctance to use epinephrine, uncontrolled psychological issues, and pregnancy
- Understanding the goals of the patient and caregiver clearly
- Creating a standardized universal consent form template
In order to create the recommendations, a group of 36 international experts in oral immunotherapy identified over 250 statements that were unanimously considered important for clinicians to consider when prescribing oral immunotherapy, as well as 71 statements that were agreed upon.The researchers utilized the statements to create a consent form for families. This standardized protocol can be used by clinicians to prepare patients and a template consent form has been developed to ensure that patients comprehend the risks, benefits, and alternatives to the therapy. “Families must administer the therapy on a daily basis, making these guidelines crucial. Safety measures can be optimized to ensure their understanding of the commitment, as well as their awareness of potentially dangerous side effects.”
Before these guidelines, up to 33% of patients did not receive appropriate consent or preparation before starting treatment. The study found that when adequate counseling was provided, the average time spent was 30-60 minutes.
“If families are not ready for oral immunotherapy, they are likely to fail or it could become unsafe,” he explains.
“If they decide to proceed with treatment after following these guidelines, they are well-prepared for the process. They understand the risks and, most importantly, it makes the treatment safer because they can anticipate the challenges. This protocol establishes the standard.”The study found that introducing peanuts to infants as early as 4 months could help prevent peanut allergies from developing later in life. This research was funded by the National Institute of Health.
