CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy
Top Cited Papers
Open Access
- 18 March 2020
- journal article
- review article
- Published by Springer Science and Business Media LLC in Allergy, Asthma & Clinical Immunology
- Vol. 16 (1), 1-45
- https://doi.org/10.1186/s13223-020-0413-7
Abstract
Background Oral immunotherapy (OIT) is an emerging approach to the treatment of patients with IgE-mediated food allergy and is in the process of transitioning to clinical practice. Objective To develop patient-oriented clinical practice guidelines on oral immunotherapy based on evidence and ethical imperatives for the provision of safe and efficient food allergy management. Materials and methods Recommendations were developed using a reflective patient-centered multicriteria approach including 22 criteria organized in five dimensions (clinical, populational, economic, organizational and sociopolitical). Data was obtained from: (1) a review of scientific and ethic literature; (2) consultations of allergists, other healthcare professionals (pediatricians, family physicians, nurses, registered dieticians, psychologists, peer supporters), patients and caregivers; and patient associations through structured consultative panels, interviews and on-line questionnaire; and (3) organizational and economic data from the milieu of care. All data was synthesized by criteria in a multicriteria deliberative guide that served as a platform for structured discussion and development of recommendations for each dimension, based on evidence, ethical imperatives and other considerations. Results The deliberative grid included 162 articles from the literature and media reviews and data from consultations involving 85 individuals. Thirty-eight (38) recommendations were made for the practice of oral immunotherapy for the treatment of IgE mediated food allergy, based on evidence and a diversity of ethical imperatives. All recommendations were aimed at fostering a context conducive to achieving objectives identified by patients and caregivers with food allergy. Notably, specific recommendations were developed to promote a culture of shared responsibility between patients and healthcare system, equity in access, patient empowerment, shared decision making and personalization of OIT protocols to reflect patients' needs. It also provides recommendations to optimize organization of care to generate capacity to meet demand according to patient choice, e.g. OIT or avoidance. These recommendations were made acknowledging the necessity of ensuring sustainability of the clinical offer in light of various economic considerations. Conclusions This innovative CPG methodology was guided by patients' perspectives, clinical evidence as well as ethical and other rationales. This allowed for the creation of a broad set of recommendations that chart optimal clinical practice and define the conditions required to bring about changes to food allergy care that will be sustainable, equitable and conducive to the well-being of all patients in need.Keywords
Funding Information
- Canadian Society of Allergy and Clinical Immunology
This publication has 154 references indexed in Scilit:
- Safety and feasibility of oral immunotherapy to multiple allergens for food allergyAllergy, Asthma & Clinical Immunology, 2014
- Duration of a cow-milk exclusion diet worsens parents’ perception of quality of life in children with food allergiesBMC Pediatrics, 2013
- Natural resolution of peanut allergy: A 12-year longitudinal follow-up studyThe Journal of Allergy and Clinical Immunology: In Practice, 2013
- Anaphylaxis treated in a Canadian pediatric hospital: Incidence, clinical characteristics, triggers, and managementJournal of Allergy and Clinical Immunology, 2013
- Growth Hormone Research Society Workshop Summary: Consensus Guidelines for Recombinant Human Growth Hormone Therapy in Prader-Willi SyndromeJournal of Clinical Endocrinology & Metabolism, 2013
- Oral Immunotherapy for Egg Allergy in ChildrenNew England Journal of Medicine, 2012
- Oral Immunotherapy for Treatment of Egg Allergy in ChildrenNew England Journal of Medicine, 2012
- Exploring the Determinants of the Perceived Risk of Food Allergies in CanadaHuman and Ecological Risk Assessment: An International Journal, 2012
- GRADE guidelines: 9. Rating up the quality of evidenceJournal of Clinical Epidemiology, 2011
- A randomized controlled study of peanut oral immunotherapy: Clinical desensitization and modulation of the allergic responseJournal of Allergy and Clinical Immunology, 2011