2018 Section 5 - Rhinology and Allergic Disorders

II.

Allergic, Non-Allergic, and Immunologic A. Food

Du Toit G, Sayre PH, Roberts G, et al. Effect of avoidance on peanut allergy after early peanut consumption. N Engl J Med . 2016; 374(15):1435-1443. EBM level 2c.........................................................................141-149

Summary : This study indicates that prolonged consumption of peanut-containing foods may be protective, and 4 years of consuming peanut was sufficient to induce a state of tolerance. In this group, a 12-month period of peanut avoidance was not associated with increased prevalence of peanut allergy. Greenhawt M. The National Institutes of Allergy and Infectious Diseases sponsored guidelines on preventing peanut allergy: a new paradigm in food allergy prevention. Allergy Asthma Proc . 2017; 38(2):92-97. EBM level 1a........................................................................................................................................................150-155 Summary : Early introduction of appropriate peanut-containing food in infants ages 4 to 11 months with either moderate-to-severe eczema, egg allergy, or both was shown to help prevent the development of peanut allergy. Introduction to peanut-containing foods as early as 4 to 6 months of life is recommended for infants with severe eczema, egg allergy, or both after allergy specialist evaluation, at approximately 6 months for infants with mild-to-moderate eczema, and without restriction for infants without eczema or food allergy. B. Sublingual Immunotherapy (SLIT) Durham SR, Penagos M. Sublingual or subcutaneous immunotherapy for allergic rhinitis? J Allergy Clin Immunol . 2016; 137(2):339-349e.10. EBM level 1a................................................................................156-176 Summary : The evidence of the effectiveness of SCIT and SLIT are reviewed. Both strategies to treat allergic rhinitis appear to be effective. Head-to-head studies suggest that SCIT may be slightly more effective than SLIT, but SLIT is safer. C. Biologics Bachert C, Mannent L, Naclerio RM, et al. Effect of subcutaneous dupilumab on nasal polyp burden in patients with chronic sinusitis and nasal polyposis: a randomized clinical trial. JAMA . 2016; 315(5):469-479. EBM level 1b..............................................................................................................................................177-187 Summary : Dupilumab is an IL-4, IL-13 inhibitor which was shown in this randomized, double-blind, placebo- controlled trial to be effective in treating patients with chronic rhinosinusitis with nasal polyposis. Subcutaneous dupilumab therapy significantly improved subjective and objective outcome measures including SNOT-22, UPSIT, polyp, and Lund-Mackay scores.

Casale TB. Biologics and biomarkers for asthma, urticaria, and nasal polyposis. J Allergy Clin Immunol . 2017; 139(5):1411-1421. EBM level 1a....................................................................................................188-198

Summary : Biologics target specific immune pathways and have been shown to be effective in asthma, urticaria, and nasal polyps. Clinical trials are currently underway for agents that block IgE, IL-4, IL-13, and IL-5 for the treatment of nasal polyps.