A new paper published in “Frontiers in Allergy,” an international peer-reviewed research journal, explores the significant gap in clinical decision-making regarding which food allergy patients are most likely to benefit from specific allergy treatments and at what level of risk.
Heather Opseth, DMS, PA-C, assistant program director of the Master of Science in Physician Assistant Studies program at Des Moines University Medicine and Health Sciences, published “Bridging Innovation and Risk: The Missing Role of Validated Risk-Stratification in IgE-Mediated Food Allergy Management,” as a result of research conducted in collaboration with her mentor during her Doctor of Medical Science program.
“There has been a lot of innovation within food allergy treatment,” Opseth says. “There are biologic treatments now, a lot of research going into protocols and treatment approaches, but we don’t have a way to select who is the best patient for any of those specialized treatments.”
Opseth found a need for evidence-based guidelines to determine which patients should continue with allergen avoidance, which should undergo oral immunotherapy, which should receive biologics in addition to OIT and which may need a more specialized treatment approach.
“There are algorithms that exist, and I cited one of those in the article, but they don’t take individual patient risk into consideration to guide therapy selection,” Opseth explains. “They focus more on the risk of the therapy itself.”
Some of these innovative treatments require oral food challenges, which can be risky if providers do not know who should undergo them and who should not. This is especially important because Opseth found that some patients who experience anaphylaxis or death have had only mild reactions in the past. The severity of a previous reaction does not predict the severity of future reactions.
Opseth’s research is personal, as she has firsthand experience navigating the difficult balance between treatment innovation and patient safety. Her son has severe food allergies to both egg and peanut. When he underwent an oral food challenge with baked egg, it resulted in a three-night stay at the children’s hospital.
“That’s part of why this is so important to me,” she says. “Now you’re asking me if I want to try giving him small amounts of the allergen again as treatment, and I’m thinking, what do we need to be concerned about? It’s scary since we don’t have a way to systemically predict his outcome.”
Opseth hopes her published research sparks interest in addressing the knowledge gaps she identified, including developing standardized protocols for allergy treatments, determining which patients should receive them and understanding which treatments are most effective for specific allergies.
Opseth says her paper also challenges the misconception that research is only valuable if it solves a problem directly.
“Highlighting knowledge gaps, even if you don’t have the bandwidth to solve them, is still productive scholarship and research,” she says. “This project is an example of taking something you’ve seen in clinical practice or experienced in your own life and trying to make a difference.”