David Stukus, MD: Communication Throughout Food Allergy Care

Before investigative peanut allergy immunotherapies AR-101 and Viaskin Peanut have even received US Food and Drug Administration (FDA) approval, discussion at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2019 Annual Meeting in San Francisco, CA, has focused on means to improve on the potential first-generation food allergy drugs.

But before those improvements can even reach clinical discussion, it’s on allergists and physicians to manage navigation around food allergy care. In an interview with MD Magazine®, David Stukus, MD, of the Nationwide Children’s Hospital and the Ohio State University College of Medicine, discussed how care providers need to manage current and future therapy options in a treatment decision-making model that includes the patients’ best interests.

MD Mag: How important is communication between physicians and patients when treating food allergy?

Stukus: Part of the role of being an expert—any specialist or any physician really is an expert in field—is to take complicated medical information and parse it down in a way that patients can understand, and then to help them with the ability to approach it through shared decision-making.

What are your thoughts on the potential real-world application of AR-101, from Aimmune?

So, when we think about the immunotherapy options that are going to be available for food allergy in the near future, we have the oral immunotherapy AR-101, which shows very promising results and the ability to increase the threshold dose that would cause a reaction among children who have peanut allergy. When we think about the implementation of this, I really think that it needs to be thought through on multiple levels—including what this looks like in the practice setting.

We're going to have to have allergist trained on what the product does and does not do, the regimen involved—including the initial dose escalation, and then increasing the doses every 2 weeks and then reaching the therapeutic dose—and what type of follow-up is involved. This is really going to entail a lot of support staff because there’s going to be questions along the way.

We know that there are side effects that are quite common, and thankfully most of them are mild, but children can't have anaphylaxis while receiving this product—even when you're on therapeutic dosing. So, staffs need to be ready to go and answer the calls that come in, and be able to answer them and adjust doses if necessary, and provide support to families.

Lastly, I think it's really going to come down to: Do allergists have the ability to approach this through a medical shared decision-making model, where they can walk through the different options that are available to families, including the option of doing nothing? Ongoing avoidance is a perfectly suitable option for a lot of families, especially if they haven't had a reaction for quite some time, they don't have smoothing and restrictions, they don't have significant restrictions on their social encounters or going to school, things like that.

But then, if they do want to approach AR-101 immunotherapy, it's understanding what is the regimen detail, what are the potential side effects or the potential benefits, and then what are the goals of therapy. This is not a cure for peanut allergy, and I think it's really important that families understand that this is a desensitization procedure, where they need to continue to be exposed to a therapeutic dose every day. But this will offer protection from small or trace amounts causing severe allergic reactions.