Researchers share guidelines to help children “build tolerance” to food allergens

In a landmark first, academics from McMaster University have created guidelines to help prepare families who plan to build their child’s tolerance to common food allergens.

The international guidelines were published on 8 April in the Journal of Allergy and Clinical Immunology and disclose how to standardise the preparation process for families considering oral immunotherapy, a process that involves giving very small amounts of an allergen, such as peanuts, to patients before gradually increasing the amount to build up their tolerance.

The researchers claim that previously, clinicians had “little evidence-based guidance to provide parents administering this procedure to their child” and state that the new guidelines “fill an important gap as the therapy is not without its risks – it is administered daily at home to children by their parents, requiring caregivers to act like amateur medical professionals, observing reactions and deciding on necessary treatments”.

Commenting on the guidelines, Douglas Mack, lead author of the paper and Assistant Clinical Professor with McMaster’s Department of Pediatrics, said: “This is a landmark paper in our field because it has never been done before and this process has never been standardised.

 “We’re in dear need of having some kind of guidance on how to approach oral immunotherapy. We simply have not had this before.”

Included in the guidelines are various recommendations for families who are seeking to build their child’s tolerance to common food allergens, including:

• A robust standardised education process for patients and caregivers through a detailed consent procedure
• Establishing adequate parental supervision for dosing before beginning treatment
• Identifying inadvisable risk factors including uncontrolled asthma, an unwillingness to use epinephrine, uncontrolled psychological concerns and pregnancy
• Clearly understanding the patient and caregiver goals
• Developing a structured universal consent form template
• To develop the recommendations, the panel of 36 international oral immunotherapy experts identified more than 250 statements that met consensus as important considerations for clinicians in prescribing oral immunotherapy and 71 statements that were used to craft a consent form for families.

Using these findings, researchers have proposed a standardised protocol for clinicians to employ in preparing patients. Additionally, they have crafted a template consent form for clinicians to utilise, ensuring patients understand the risks, benefits, and alternatives associated with this therapy.

“These families must provide the therapy every single day. That’s why these guidelines are so important. Safety can be optimized to make sure that they understand what they’re taking on, while ensuring that they are aware of the kinds of side-effects that can be dangerous,” continued Mack.