Sakura Sato1, Chizuko Sugizaki1, Noriyuki Yanagida1, Komei Ito2, Yusei Ohshima3, Naoki Shimojo4, Takao Fujisawa5, Motohiro Ebisawa6. 1. Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan. 2. Study Group on the "Establishment of New Management Method of Food Allergy in Children" in the Practical Research Project for Allergic Disease and Immunology of Japan Agency for Medical Research and Development, AMED, Tokyo, Japan; Department of Allergy, Aichi Children's Health and Medical Center, Obu, Japan. 3. Study Group on the "Establishment of New Management Method of Food Allergy in Children" in the Practical Research Project for Allergic Disease and Immunology of Japan Agency for Medical Research and Development, AMED, Tokyo, Japan; Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan. 4. Study Group on the "Establishment of New Management Method of Food Allergy in Children" in the Practical Research Project for Allergic Disease and Immunology of Japan Agency for Medical Research and Development, AMED, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan. 5. Study Group on the "Establishment of New Management Method of Food Allergy in Children" in the Practical Research Project for Allergic Disease and Immunology of Japan Agency for Medical Research and Development, AMED, Tokyo, Japan; Allergy Center, Mie National Hospital, Mie, Japan. 6. Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan; Study Group on the "Establishment of New Management Method of Food Allergy in Children" in the Practical Research Project for Allergic Disease and Immunology of Japan Agency for Medical Research and Development, AMED, Tokyo, Japan. Electronic address: m-ebisawa@sagamihara-hosp.gr.jp.
Abstract
BACKGROUND: Clinical trials on oral immunotherapy (OIT) have been increasing for nearly a decade; however, several national guidelines do not recommend OIT as a standardized procedure. The aim of this study was to obtain insights into the current use and practice of OIT in Japan. METHODS: A first questionnaire was mailed to 524 training and teaching facilities of the Japan Pediatric Society. The first survey requested information on the implementation of OIT, whereas the second survey aimed to gather more detailed information on OIT, such as its safety. RESULTS: In total, 360 facilities (69%) responded to the survey; among them, 102 (28%) provided OIT to 7973 patients [1544 received OIT while hospitalized (inpatient OIT), whereas 6429 received OIT without hospitalization (outpatient OIT)]. Approval for OIT was obtained from an ethics committee or institutional review board in 89% and 31% of facilities for inpatient and outpatient OIT, respectively. In inpatient OIT, immediate allergic reactions requiring treatment occurred in 68% of patients while hospitalized, and in another 56%, following discharge. In contrast, 11% of patients developed immediate allergic reactions in outpatient OIT. Adrenaline injections at home were required in 2%. Sixteen patients developed adverse reactions other than immediate allergic reactions, among which eosinophilic gastroenteritis was most common. CONCLUSIONS: OIT is widely provided not only as clinical research but also as general practice in Japan. However, because there is a high risk of developing anaphylaxis at home, OIT should be conducted carefully as in a clinical research setting taking safety into consideration.
BACKGROUND: Clinical trials on oral immunotherapy (OIT) have been increasing for nearly a decade; however, several national guidelines do not recommend OIT as a standardized procedure. The aim of this study was to obtain insights into the current use and practice of OIT in Japan. METHODS: A first questionnaire was mailed to 524 training and teaching facilities of the Japan Pediatric Society. The first survey requested information on the implementation of OIT, whereas the second survey aimed to gather more detailed information on OIT, such as its safety. RESULTS: In total, 360 facilities (69%) responded to the survey; among them, 102 (28%) provided OIT to 7973 patients [1544 received OIT while hospitalized (inpatient OIT), whereas 6429 received OIT without hospitalization (outpatient OIT)]. Approval for OIT was obtained from an ethics committee or institutional review board in 89% and 31% of facilities for inpatient and outpatient OIT, respectively. In inpatient OIT, immediate allergic reactions requiring treatment occurred in 68% of patients while hospitalized, and in another 56%, following discharge. In contrast, 11% of patients developed immediate allergic reactions in outpatient OIT. Adrenaline injections at home were required in 2%. Sixteen patients developed adverse reactions other than immediate allergic reactions, among which eosinophilic gastroenteritis was most common. CONCLUSIONS: OIT is widely provided not only as clinical research but also as general practice in Japan. However, because there is a high risk of developing anaphylaxis at home, OIT should be conducted carefully as in a clinical research setting taking safety into consideration.
Authors: P Bégin; E S Chan; H Kim; M Wagner; M S Cellier; C Favron-Godbout; E M Abrams; M Ben-Shoshan; S B Cameron; S Carr; D Fischer; A Haynes; S Kapur; M N Primeau; J Upton; T K Vander Leek; M M Goetghebeur Journal: Allergy Asthma Clin Immunol Date: 2020-03-18 Impact factor: 3.406