Is It Allergy? Peanut Allergy Summit

Your Host

Yael 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

Agenda

• Dr. Maeve O’Connor– The physician’s perspective

• Dr. Rob Reinhardt – The science of molecular allergy testing

• Question & Answer Session

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Dr. Maeve O’Connor

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• 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

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

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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

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The physician’s perspective

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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 death

ʺPeanut Allergy Statistics.ʺ PeanutAllergy.com. Web. 31 May 2012. <http://www.peanutallergy.com/statistics‐and‐facts.html>. 9

• 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)

• Allergists: 1 in 5 patients are diagnosed by history and symptoms

Large Population of Patients with suspected peanut allergy have never received a diagnostic test

1. Source: BASES Research 2010 10

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Sensitization To Peanut Doesn’t Tell the Whole Story

1. Nicolaou et al. J Allergy Clin Immunol. 2010;125:191‐197 11

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1

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• Only 1 out of 4 children sensitized to whole peanut have a high risk for severe reaction

• Sensitization means the body had produced IgEantibodies due to exposure of peanut

– Determined by blood testing and /or skin testing

• Sensitization does not necessarily indicate a risk for severe symptoms

• 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

New Innovative Diagnostic Technology

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Dr. Rob Reinhardt

Molecular Allergy

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Peanut components

Risk for severe reactions

Risk for mild

reactions



Risk for mild

reactions

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The risk of severe reactions can vary based on 5 different proteins found in peanuts

New developments in diagnostic testing –from allergen source to component proteins

Ara h 1

Ara h 2

Ara h 3

Ara h 8

Ara h 9

17References listed on slide 18

• 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.

References For Slide 17

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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 testing2

Protein Components Are Important Predictors of Clinical Allergy

540426.01

191. Nicolaou et al. J Allergy Clin Immunol. 2010;125:191‐197 2. Dang et al. J Allergy Clin Immunol. 2012;129:1056‐1063

Nicolaou et al. J Allergy Clin Immunol. 2010;125:191‐197

MAAS Peanut Study

11.8% were peanut sensitized

1,029 attended 8‐year follow‐up

1,085 born into unselected population

based cohort

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22.4 %Ara h 2

77.6 %Ara h 8

Of the11.8 % of Patients With Positive Blood or Skin Test


Case Study

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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 the Phadia Immunology Reference Laboratory are laboratory‐developed tests. Interpretation of the results is the responsibility of the healthcare provider.

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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 reactions


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Patient Case #1: Margaret, 6 years oldPeanut 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 life


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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?


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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 reactions


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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.


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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 allergy28

• 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

Accuracy Down To The Molecule

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• 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

There’s More to Know

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Question and Answer Session

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With follow up questions, or for an exclusive interview with Dr. O’Connor or Dr. Reinhardt, please contact:

Michelle LarkinGREGORY|FCA610‐228‐2117

[email protected]

Is It Allergy? Peanut Allergy Summit

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