David Stukus, MD: Advancing Food Allergy Care

There are no head-to-head comparisons available for oral and epicutaneous immunotherapies being investigated for food allergy. But there’s enough clinical evidence for physicians to understand in what ways one may be favorable over the other in a particular patient.

In an interview with MD Magazine® while at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2019 Annual Meeting in San Francisco, CA, David Stukus, MD, of the Nationwide Children’s Hospital and the Ohio State University College of Medicine, shared comparative notes of the 2 forms of immunotherapy currently being investigated for peanut allergy desensitization.

He also shared perspective as to how the food allergy therapy field can feasibly advance in the coming year—and what the therapy market may look like in the next decade.

MD Mag: How do we compare epicutaneous and oral immunotherapies for food allergy?

Stukus: When we think about the epicutaneous immunotherapy for peanut allergy or food allergy, this is a very promising treatment option as well, and it's going to be very different. It's just a different regimen, we have much decreased risk of side effects, you put a patch on the skin and you wear it every day. It doesn't have the same efficacy and the ability to increase the amount that somebody could eat without having the reaction, but it seems like it's going to offer at least enough protection from cross-contamination and all those packaged products to say, “May contain a process in a facility that may have shared equipment with peanut or nuts,” or things like that.

So, I think when families think about the epicutaneous versus oral immunotherapy therapy, or ongoing avoidance, it really is going to be a consideration of how old is the child, what's their prior clinical history, what does the daily regimen look like with each treatment options, and what are the long-term sort of outcomes that they're going for.

So it'll be an interesting discussion. It certainly is not one-size-fits-all—nor should it be. But it's going to require a really thoughtful conversation with families to consider which path to pursue.

How will food allergy therapy development progress in the following year?

I think the conversations surrounding food allergy immunotherapy is going to continue to evolve into specific problems. One, we need to figure out what this looks like in real life. Just because products are available, it doesn't mean necessarily that we're going to implement these on a wide scale. So, we need to better study that and have those conversations to really help all the practicing allergies out there understand what this looks like on a daily practice setting.

And number 2, I think we're going to see this for other foods. So, in addition to peanut, there's going to be exploration at looking at treatment desensitization, egg desensitization, potentially cows’ milk—things along those lines. I think each year that passes, this meeting is going to have more and more sessions talking about the latest research in this. And I'm really excited for 5 to 10 years from now. It's going to be a very different conversation that we're having then than what we're having now.