1. Your HostYael Kozar• Mother of 12 year old daughter with anaphylactic peanut allergy• Host & Producer of The Anaphylactic Allergy Podcast• President of Allergy Support & Anaphylaxis Prevention (South Bay)• Chairperson of the FAAN Walk for Food Allergy, Los Angeles
2. Agenda• Dr. Maeve O’Connor – The physician’s perspective• Dr. Rob Reinhardt – The science of molecular allergy testing• Question & Answer Session 3
3. Dr. Maeve O’Connor• Board‐Certified Allergist/Immunologist• Fellow of the American Academy of Asthma Allergy and Immunology and the American College of Asthma Allergy and Immunology• President of the Southeastern Allergy Society• Member of the Clinical Allergy Society• A food allergy expert, using the latest diagnostic tools to determine the severity of food allergies in adults and children 4
4. Dr. Rob Reinhardt• Medical Director, ImmunoDiagnostics business of Thermo Fisher Scientific• Associate Professor of Family Medicine at Michigan State University Medical School• Graduate of the Michigan State University College of Human Medicine and the Brown University Family Practice Residency.• Frequent speaker on healthcare‐related topics a featured medical expert in media outlets such as: USA Today, Sirius XM Doctor Radio, Woman’s Day, About.com, and Allergy and Asthma Today 5 4
5. Objectives• Raise awareness and knowledge of Molecular Allergy and advances in technology to better understand risk and severity of peanut allergy • Share the most current information about the availability of newly FDA‐cleared technology that is changing the way peanut allergy is diagnosed and managed• The Food Allergy Specialist’s perspective on diagnosing and managing food allergy with a focus on peanut• Case studies of the role peanut component testing has played in advancing patients’ knowledge about their peanut allergy 6
6. Dr. Maeve O’Connor The physician’s perspective 7
8. The Burden of Peanut Allergy • One of the ʺBig 8ʺ food allergies • Parents and children live with the uncertainty and fear of severe allergic reaction • More than 3 million people in the United States report being allergic to peanuts, tree nuts or both • Approximately 1% of the U.S. population has a peanut allergy • Less than 21% of patients with peanut allergy will outgrow it • Peanut allergy is the most common cause of food related deathʺPeanut Allergy Statistics.ʺ PeanutAllergy.com. Web. 31 May 2012. <http://www.peanutallergy.com/statistics‐and‐facts.html>. 9
9. Large Population of Patients with suspected peanut allergy have never received a diagnostic test• Testing is essential for making an accurate allergy diagnosis• Primary Care & Pediatrics: ~50% of patients are diagnosed by patient history and symptoms alone and no diagnostic test (either skin prick test or IgE blood test) 2• Allergists: 1 in 5 patients are diagnosed by history and symptoms1. Source: BASES Research 2010 10
10. Sensitization To Peanut Doesn’t Tell the Whole Story • Only 1 out of 4 children sensitized to whole 1 peanut have a high risk for severe reaction • Sensitization means the body had produced IgE antibodies due to exposure of peanut – Determined by blood testing 1 and /or skin testing 2 • Sensitization does not necessarily indicate a risk for severe symptoms1. Nicolaou et al. J Allergy Clin Immunol. 2010;125:191‐197 11
11. New Innovative Diagnostic Technology• Now, more advanced IgE blood testing is being used• A simple blood test can help predict the severity of peanut allergy – Down to the molecular level – Help families and physician decide how to best manage a child’s peanut allergy – Help to answer the question of “What is the risk of severe symptoms?”• Answers are found in the protein components within a peanut 12
12. Dr. Rob Reinhardt Molecular Allergy 13
15. Peanut components Risk for severe Risk for Risk for reactions mild severe reactions reactions Risk for mild reactions Risk for severe reactions 16
16. New developments in diagnostic testing – from allergen source to component proteins The risk of severe reactions can vary based on 5 different proteins found in peanuts Ara h 1 Ara h 8 Ara h 2 Ara h 9 Ara h 3References listed on slide 18 17
17. References For Slide 17• 1. Astier C, et al. J Allergy Clin Immunol. 2006;118:250‐256. • 2. Flinterman AE, et al. Clin Exp Allergy. 2007;37(8):1221‐1228.• 3. Peeters KABM, et al. Clin Exp Allergy. 2007;37(1):108‐115. • 4. Mittag D, et al. J Allergy Clin Immunol. 2004;114:1410‐1417.• 5. Asarnoj A, et al. Allergy. 2010;65:1189‐1195. • 6. Lauer I, et al. Clin Exp Allergy. 2009;39:1427‐1437. 7. Krause S, et al. J Allergy Clin Immunol. 2009;124:771‐778. 18
18. Protein Components Are Important Predictors of Clinical Allergy There are peanut components/proteins that are important predictors of clinical peanut allergy 1,2 Clinical Implications Measurement of IgE response to major peanut protein (Ara h 2) is more useful in predicting clinical allergy than whole peanut testing21. Nicolaou et al. J Allergy Clin Immunol. 2010;125:191‐197 2. Dang et al. J Allergy Clin Immunol. 2012;129:1056‐1063 19 540426.01
19. MAAS Peanut Study 1,085 born into Of the11.8 % of Patients With Positive Blood or Skin Test unselected population based cohort 22.4 % Ara h 2 1,029 attended 8‐year follow‐up 77.6 % Ara h 8 11.8% were peanut sensitizedNicolaou et al. J Allergy Clin Immunol. 2010;125:191‐197 20
20. Dr. Maeve O’Connor Case Study 21
21. Patient Case #1: Margaret, 6 years old • Seasonal allergy symptoms, grass, tree, weed • Oral itching to hazelnut ‐ was tested for peanut and tree nuts • Positive Peanut blood test • Positive skin prick test • Parents implemented strict nut‐free diet • Constant fear/ Never leave home without EpiPen • Parents think child may have recently had a granola bar that “may contain peanut” with no reaction • What do we do/ What are the options?Some tests available through 22the Phadia Immunology Reference Laboratory are laboratory‐developed tests. Interpretation of the results is the responsibility of the healthcare provider.
22. Patient Case #1: Margaret, 6 years old Peanut Component Test Results Interpretation • Positive for whole peanut • Positive for Ara h 8 proteins components associated with birch pollen cross‐ reactivity • Negative for nut storage proteins associated with severe reactionsSome tests available through 23the Phadia Immunology Reference Laboratory are laboratory‐developed tests. Interpretation of the results is the responsibility of the healthcare provider.
23. Patient Case #1: Margaret, 6 years old Peanut Component Test Results Recommendations • Risk of Mild Reactions • Good Candidate for an oral food challenge • Passed oral food challenge address parents’ worry over “hidden peanuts” in snack foods • Without a history of systemic reactions to peanuts there is no need to sit at the peanut free table in the school cafeteria • Significant improvement in family’s quality of lifeSome tests available through 24the Phadia Immunology Reference Laboratory are laboratory‐developed tests. Interpretation of the results is the responsibility of the healthcare provider.
24. Patient Case #2: Thomas, 16 years old • As a toddler, developed flushing and rhinorrhea followed hours later by vomiting and hives after a bite of a peanut butter sandwich. • Anaphylaxis event at age 4 after ingesting peanut butter • Both skin tests and blood tests were positive to peanut • Parents implemented strict nut‐free diet • Patient not as careful when his parents aren’t around and rarely carries his epinephrine auto‐injector. • What do we do/ What are the options?Some tests available through 25the Phadia Immunology Reference Laboratory are laboratory‐developed tests. Interpretation of the results is the responsibility of the healthcare provider.
25. Patient Case #2: Thomas, 16 years old Peanut Component Test Results Interpretation • Positive for whole peanut • Positive for Ara h 2, nut storage protein components associated with severe reactions • Positive for Ara h 8 component associated with mild reactionsSome tests available through 26the Phadia Immunology Reference Laboratory are laboratory‐developed tests. Interpretation of the results is the responsibility of the healthcare provider.
26. Patient Case #2: Thomas, 16 years old Peanut Component Test Results Recommendations • High risk for severe reactions • Thomas needs to respect the severity of his peanut allergy and continue strict avoidance of peanuts • It is important that he carries his epinephrine auto‐injector and always tells his coaches and friends about the serious risks associated with his allergy.Some tests available through 27the Phadia Immunology Reference Laboratory are laboratory‐developed tests. Interpretation of the results is the responsibility of the healthcare provider.
27. Indications for Molecular Allergy Testing• Patient history is unclear – Mild reactions: “He developed a couple small hives after eating..” – Oral Allergy Syndrome‐like reactions: “He complained of tingling and itchy mouth” – Single system reactions: “He vomited 30 min after eating peanut” – History of ingestion is unclear: “I think he ate a peanut”• Considering a food challenge – Need to limit in‐office reactions• Whole extract is not conclusive• Parents/caregivers request documentation of peanut allergy 28
28. Accuracy Down To The Molecule• Quantify primary, species‐specific allergen sensitization• Assess risk for severe allergic reactions• Differentiate between clinical peanut allergy and cross‐reactivity• Ensure relevant dietary advice and avoid unnecessary modifications• Address parent anxiety with clear answers 29
29. There’s More to Know• Help ease the anxiety of guessing about a child’s peanut sensitivity with clear answers. • uKnow Peanut component testing helps families and physicians decide how to best manage a child’s peanut allergy – helps answer the question of “What is the risk of severe symptoms?” • Component testing as described in this presentation is available through the Phadia Immunology Reference Laboratory (PiRL)• For the information you need to speak with your physician about peanut component testing and to learn more, visit us at uKnowPeanut.com 30
30. Question and Answer Session 31
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32. With follow up questions, or for an exclusive interview with Dr. O’Connor or Dr. Reinhardt, please contact: Michelle Larkin GREGORY|FCA 610‐228‐2117 Michelle@GregoryFCA.com