Journal of Allergy and Clinical Immunology-In Practice最新文献

Background: Peanut oral immunotherapy (POIT) has promising potential of disease modification, but there are no studies to date evaluating high-dose POIT, leading to ad libitum (ad lib) consumption of peanut products, especially in children 6 months to 4 years of age.

Objective: To report real-world outcomes of high-dose POIT in children 6 months to 4 years of age, including adverse events, achievement of ad lib consumption, and the impact of age on these outcome measures.

Methods: Patients 6 months to 4 years of age with a diagnosis of peanut allergy were enrolled in a POIT protocol with a goal dose of 3000 mg. Demographics along with POIT and clinical outcomes 6 months after POIT are reported.

Results: Sixty children, with a median age of 16 months, started POIT. Three (5%) were lost to follow-up, and 6 (10%) discontinued POIT because of recurrent adverse events or the inability to consume daily peanut protein. Fifty-one (85%) children completed POIT in a median of 7 months and were consuming ad lib peanut products for a duration of 6 months after completion of the POIT protocol. Sixteen (26.7%) children experienced a total of 22 adverse reactions during POIT. Initiating POIT before 24 months of age increased the likelihood of ad lib peanut consumption by an odds ratio of 11.69 (1.19-114.31, P = .035).

Conclusions: Our study demonstrates that high-dose POIT in infants and toddlers is well tolerated and can lead to ad lib introduction of dietary peanut products into the diet, especially if initiated before 2 years of age.

Background: Atopic dermatitis is a common chronic skin disease that involves frequent physician visits and often complex care plans. Despite the expanding therapeutic options, there is no existing decision aid to guide patients, families, and clinicians through treatment options.

Objective: Our objective was to develop an evidence-based decision aid that would be widely accepted for shared decision-making in pediatric atopic dermatitis.

Methods: Per rigorous International Patient Decision Aid Standards, the following steps were taken: (1) literature review; (2) focus groups with patients and caregivers; (3) expert interviews; (4) prototype creation, revision, and pilot testing in the clinic; and (5) further in-clinic testing.

Results: Six focus groups provided insight into patient/parent preferences (n = 32) regarding treatment experiences and preferences. Nine expert interviews revealed implementation strategies for shared decision-making, eliciting themes of communication, patient education, challenges to and supports for treatment adherence, useful materials/resources, and other strategies for success. Using content from literature review, patient/parent focus groups, and expert interviews, a draft decision aid was systematically created. Cognitive interviews (n = 10) with patients/parents resulted in tool refinement. In-clinic testing demonstrated that the tool was helpful; an average ± standard deviation score was 7.8 ± 1.7 (0-10 scale, n = 18). A final decision aid was produced.

Conclusions: A decision aid for children with atopic dermatitis can be used for clinical encounters and has the potential to improve patient/family engagement in decision-making. In addition, we include a worksheet on patient/parent values and an eczema action plan for implementation. Efficacy of this tool will be tested across populations in future studies.