ATTITUDES AMONG U.S.-BASED ALLERGISTS AND IMMUNOLOGISTS ABOUT IMMUNOTHERAPY, PEANUT EXPOSURE AND TREATMENT

Introduction Recent findings suggest that prevalence and severity of childhood food allergy is greater than previously reported. No approved therapy exists for peanut allergy (PA), suggesting substantial unmet need. A survey was conducted to assess allergist/immunologist attitudes toward PA and oral immunotherapy (OIT). Methods An online self-administered survey was fielded to allergists and/or immunologists in the U.S. between December 28, 2017-January 27, 2018. Participants were included if they completed training >5 years ago, spent >20% of their time in direct patient care, and annually managed ≥50 patients with food allergy. Results Of 101 participating allergists/immunologists from 28 cities, 46% practiced in/were affiliated with an academic medical center, 47% had practiced for 11-20 years, and 78% spent 81-100% of their time in direct patient care. Approximately half of respondents (48%) treated patients with OIT in the past year. Clinical/behavioral factors cited as “extremely” or “very” important to initiating immunotherapy included caregiver/patient motivation (94%) and no compliance concerns/challenges (85%). 81% of allergists/immunologists agreed that the dose tolerated in OIT was the most clinically meaningful for a patient to know. Of those respondents not implementing OIT, the most important reason for not doing so was lack of FDA approval (73%). Most allergists/immunologists (66%) recommended restricting activities of their patients to practice avoidance (Figure). Conclusions Patients with PA are subject to significant lifestyle restrictions to avoid accidental exposure. “Tolerated dose” was felt by physicians to be the most clinically relevant term for patients following OIT.  Most allergists/immunologists would initiate OIT following FDA approval.