Ep. 225: Updates from the AAAAI/WAO Joint Congress

Learn more about the ground-breaking news from the recent American Academy of Allergy, Asthma, and Immunology (AAAAI)/World Allergy Organization (WAO) Joint Congress from FAACT Medical Advisory Board Chair, Dr. Shahzad Mustafa. Topics include the most recent research in anaphylaxis, food allergy therapies, and other conditions in allergy and immunology.

Resources to keep you in the know:

• AAAAI

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Transcript

Caroline: Welcome to FAACT's Roundtable, a podcast dedicated to navigating life with food allergies across the lifespan. Presented in a welcoming format with interviews and open discussions, each episode will explore a specific topic, leaving you with the facts to know or use.

Information presented via this podcast is educational and not intended to provide individual medical advice. Please consult with your personal board certified allergist or healthcare providers for advice specific to your situation.

Hi everyone, I'm Caroline Moassessi and I am your host for the FAACT's Roundtable podcast. I am a food allergy parent and advocate and the founder of the Gratefulfoodie blog.

And I am FAACT's Vice President of Community relations.

Before we start today's podcast, we would like to take a moment to thank Genentech for being a kind sponsor of FAACT's roundtable podcast. Also, please note that today's guest was not paid by or sponsored by Genentech to participate in this specific podcast.

Today is unique since we will hear about a variety of topics presented at the annual American Academy of Allergy, Asthma and Immunology meeting, also known as Quad A I,

which is a global gathering of doctors, researchers and experts presenting and hosting discussions about food allergy, asthma and immunology related topics. Joining us today is FAACT's Medical Advisory Board Chair, Dr.

Shahzad Mustafa, who in his signature warm and welcoming style, will update us in easy to understand terms and language.

Welcome back, Dr. Mustafa to FAACT's Roundtable podcast. You are one of the favorites here because you explain these really complicated medical terms and conditions and issues and treatments and all this great stuff down into lay terms that we can understand.

So we really appreciate you being here today. So thank you and welcome.

Dr. Shahzad Mustafa: Thanks so much for having me. I look forward to the conversation.

Caroline: Wonderful. So now we're just gonna jump right in because it was a pretty exciting and busy meeting and you've been updating us over the years actually with your time and expertise.

So let's just jump right into the conversation. What are the hottest topics that you heard at the Quite AI meeting this year?

Dr. Shahzad Mustafa: Yeah, it's a really fun time to be practicing allergy immunology with a lot of new therapeutics. So I think we can start with, you know, something that is always kind of top of mind.

Food allergy. Um, so there's certainly food allergy therapies. A year ago,

A year ago, in a couple weeks, omalizumab or Zolair was FDA approved for food allergy. Right. And that came out of this big study, this big study called Outmatch. And the first part of that was putting people on placebo or omalizumab and seeing if they could tolerate more of a food allergen than before.

Right. So now that study,

the data from stage two of that study was presented which compared omalizumab in treating food allergy compared to oral immunotherapy. Pretty interesting trial design. Complicated trial design with lots of food challenges.

These individuals are mostly children, almost all children. The mean age was about 7. They had a peanut allergy and another food allergy, and they underwent multiple food challenges. And stage two, kind of the highlight is that omalizumab was more effective than oral immunotherapy in achieving goals of desensitization, where individuals with a food allergen could tolerate certain doses of the food.

So highly efficacious and very importantly, it was better tolerated. There were less side effects, with the exception of injection site side effects, There was less side effects in the omalizumab or zolair group than in the oral immunotherapy group.

And I think that's an important point. So not only was it effective and probably more effective, it was probably well tolerated, which is very important when you're taking care of people with food allergies.

Right. You don't want the treatment to be worse than the condition.

Caroline: Very true. And then on that study, so then one group was taking just Xolair and the other one was doing just oit, or was it a combination of OIT with Xolair?

Dr. Shahzad Mustafa: It was Xolair and placebo versus OIT and placebo. So they did not combine Xolair and oit, which gets done in clinical practice sometimes. But this was really comparing Xolair to oit and, you know, to many of us, I think we think Xolair is a highly efficacious medication intervention for food allergy.

We weren't totally surprised by the results, but doing it in such a rigorous way is, I think, incredibly helpful to have this information going forward. And we know oit, it works, it desensitizes individuals.

But I think we're learning more and more that the age of initiation of OIT is very important. I'm going to take a minute to plug a study we just published.

It was not presented at the QUAD A I, but we just presented peanut OIT in children. And if you start before age two,

it's incredibly well tolerated and more likely to facilitate ad lib peanut consumption. So this was a study that was published in Journal of Allergy, Clinical Immunology. I encourage the listeners to track it down we know oit is effective, but starting before age 2 may be the biggest bang for your buck.

And then it decreases in effectiveness and side effects probably creep up as individuals get older.

Caroline: That's really good information to know and hear. That's a big deal.

Dr. Shahzad Mustafa: Yeah, it's exciting. And I mean, we want to think about goals of food allergy therapy. Right. Is the goal to be protected from an accidental exposure? Where is the goal to consume the food?

That's the question.

And those are different goals. And different people have different goals. Different people have different goals for different foods. Many times people who are peanut or tree nut allergic may not want to consume the food, but they want to be protected or want to feel safer.

But older individuals with milk and egg allergy often want to consume the food. Right. Think about pizza and ice cream. So it's really nuanced. It's not a one size fits all.

Age matters, food matters. All sorts of things matter in deciding the right therapy. But the data that's coming out of Outmatch is really a treasure trove of information that complements our knowledge of food allergy therapy.

So it's really exciting times. I encourage individuals to look at it, look this up. It's certainly in the mainstream media if you have access to these studies. Take a look.

It's really fun.

Caroline: Excellent. Well, it is very exciting times. And so now, what else were hot topics at the meeting?

Dr. Shahzad Mustafa: Yeah. Talking about food allergy therapies. I'll touch upon one more. There was multiple abstracts and presentations on epicutaneous immunotherapy for peanut allergy or the peanut patch.

It's moving along in development. Excellent data that shows it goes slower than other forms of therapies like zolair or oral immunotherapy. It's a slower onset, but highly efficacious and desensitization to peanut allergy.

So I know the company is looking for approval here in the coming year or so, down to a young age. I don't know what that age will be, but it could be as low as one year of age.

And it's really exciting. It's another option of immunotherapy affecting someone's peanut allergy with a different approach. And with a peanut patch, it's incredibly well tolerated. Right. Side effects are minimal.

And it is. It is shown to be immune modulatory and helps your immune system. It increases tolerance of peanuts. So another exciting therapy coming down the pike.

Caroline: And anything else on hot topics before we move on to some specifics on treatments.

Dr. Shahzad Mustafa: These are kind of treating food allergies. Right. These are hopefully decreasing exposures or needing treatment for accidental ingestions with epinephrine, potentially even facilitating introduction of foods into the diet. But if you do have accidental exposures, if you do need epinephrine, we've had intramuscular or epinephrine auto injectors.

Right. Needles available for years and there's different brands of those.

In the fall, intranasal epinephrine was FDA approved. Right. The brand name is Nephi. This is an intranasal epinephrine spray, single spray in the setting of severe allergic reaction, shown to be similarly effective with blood levels and kinetics as intramuscular.

And this is exciting. We might be the first to report here.

A little birdie told me, I hope this isn't like some confidential information that's going to get me in trouble, but I don't think it is. Neffy is currently approved for the full strength dose, 2 milligrams or above 60 pounds, 30 kilograms.

Um, the junior dose, below 60 pounds was just approved today.

Hot off the press.

Caroline: Wow, that is hot off the press.

Dr. Shahzad Mustafa: Should be seeing news releases and things like that in the next literally 24 hours or so. And I expect it to be commercially available later this month.

So neffy had always had the higher dose 2 milligrams, which correlates with the full strength epinephrine auto injector.

It will soon have the quote, unquote, junior dose here very soon. Exciting.

Caroline: That's very exciting.

Dr. Shahzad Mustafa: And if that's not enough excitement with different forms of epinephrine, a needleless form. Another company is studying sublingual epinephrine, a film that goes under the tongue almost like a Listerine film.

Those studies are ongoing. They've been completed in adults and they're just completing enrollment in children pediatrics. So in the next, you know, one to two to three years, we should have another form of epinephrine sublingual in it, kind of like a Listerine film that dissolves under the tongue.

Pretty exciting.

Caroline: Oh, yeah. We've seen all those little packets where you just pull it off and it's just this little tiny drip.

Wow. That. That is. That is. You're just giving epinephrine.

Dr. Shahzad Mustafa: Yeah.

Caroline: You're just laying all this great stuff on us.

Dr. Shahzad Mustafa: So I think that's kind of the food allergy space with therapies and then treatment of, you know, reactions, which certainly.

Caroline: And now how about outside of that food allergy direct realm?

Dr. Shahzad Mustafa: I think there's a lot of information going on in other disease states as well. Chronic urticaria. Chronic hives is something we take care of. Most individuals get better with antihistamines. Omalizumab or Xolair is FDA approved for this as well.

Other medications are coming down the pike. People have heard of dupilumab or dupixent. There's data on that in Urticaria that's continuing to be investigated. It's not yet FDA approved, but I think that's coming pretty soon.

Very exciting.

And then there's a type of medicine called a BTK inhibitor. So these are pills that decrease degranulation of mast cells or spilling of allergic chemicals like histamine. And BTK inhibitors will soon be FDA approved for chronic hives as well.

These can have immune impact on the immune system. But in the setting of urticaria, the doses we're using, they're incredibly well tolerated where they don't appear to be immunosuppressive with any significant side effects.

So, again, these are all choices. It's nice to have needleless therapies, whether they're oral pills or nose sprays. And I think we're making that progress in hives as well.

Caroline: That is very. Again, this is amazing. And actually just taking a little sidestep here. I mean, think of when you were just learning and just getting out there in the field to now, what do you see, what do you feel?

It's a lot happening.

Dr. Shahzad Mustafa: The explosion of therapeutics is fantastic. We can do things for patients today that we simply couldn't do two, three, four, five years ago. That's not even going back to my training, which was a long time ago.

I'll be honest, I don't want to be a Debbie Downer, but I actually think some of our therapies are outpacing our ability to deliver them. Right. We have all these amazing medications, right,

these injectables for asthma. There is a study published, presented at Quad A I, a medication called tazepilumab, Carolyn, which is test fire. It's FDA approved for asthma, has excellent, excellent, really impressive, promising data.

And chronic sinusitis and nasal polyposis. So individuals with lots of nasal congestion, sinus disease, they have trouble smelling, they have trouble tasting their food.

Tesupilumab test buyer has really promising data in that space. So we have all these amazing therapies, but we know how hard it is sometimes to prescribe them or for our patients to get them.

So incredible advancement in our therapeutics. So exciting. I really think we need to get better and we need to look in the mirror as a healthcare industry of how can we get these incredible therapeutics to our patients?

Because the drugs are only good if you get to use them. And there's so many challenges right now. And anyone who's in healthcare in any level, whether you're working in it or you're interfacing with it, it's a challenge right now.

So we have to do better and we have to find ways to make it more of a user friendly experience.

Caroline: Well, I think with all the different organizations and passionate physicians like you, we're on a good path. I'm that half full glass person, you know, at least we have something to even talk about.

I mean, what a problem to have.

Dr. Shahzad Mustafa: Absolutely. No, there's been great advancements recently.

Caroline: So now turning a little selfish for my own family and for our listeners, you know, who are listening to you talk about all these new advancements. How do we take this information now and translate it to our next physician appointment or even just a family conversation?

Right. Like Xolair Oit first step is awareness.

Dr. Shahzad Mustafa: So be aware that these therapies are available. There are absolutely therapies available for any individual with food allergies, especially over the age of one. So starting that conversation with your healthcare provider, your primary care physician, a board certified allergist, if you have food allergies or if you're at risk for anaphylaxis with bee stings or any other reasons,

knowing that there's multiple forms of epinephrine available to you if you have asthma or nasal polyps, I mean, so many people have asthma and nasal polyps. Asthma is 10% of the population know that there's all these advanced therapeutics, there's all these advanced injection medications, FDA approved, that are incredibly safe.

What I want to take away, I want everyone to take away is if you're being treated with oral steroids, prednisone, Medrol, these things are bad for you. And if you're being treated with oral steroids for hives or nasal stuffiness and congestion or asthma or anything,

you should be talking to your healthcare team about treatments that are safer and more effective than oral steroids with oral steroids are bad for you. And most of the things we take care of will get better with oral steroids.

But the side effects are so undesirable and so many that we really want to treat things without that. So that's a big part of what we do. And I encourage everyone to advocate for themselves.

Bring this stuff up with your healthcare team.

Caroline: Really good advice and I appreciate you sharing that with our listeners. And so, just to give our listeners a little peek into the Quade eye meeting itself. Why, what is it like?

Like, why is it so important for our doctors to be at this event and researchers?

Dr. Shahzad Mustafa: Yeah, I think it's twofold. It is one of the bigger meetings of allergy in the world. I think I might be wrong. Don't hold me to it. It's about 4 to 5,000 attendees, which is pretty big.

There's an incredible wealth of scientific information that's shared there. So I think it's cutting edge. It's a way to keep up. Information's always changing. Right. All these new therapies, all these things I mentioned, we're presented to Quad AI, so you want to be the first to hear about it and then take it back to your practice.

And there's an incredible secondary benefit.

Colleagues get to interact with colleagues, we get to see old friends. That is incredibly important. We get to chat, we get to have a drink or dinner together. Ideas come up, brainstorming happens, research happens.

I usually come back with a host of exciting ideas that I want to implement at the office or research study just by talking to colleagues, seeing other people present, research, all sorts of stuff.

So there's direct learning that happens, but there's so much indirect conversation and benefit and wellness and just brainstorming that occurs too. It's incredible that it all happens in one place.

Caroline: This is true. And I remember attending my first meeting and actually watching people like you interface with others and your eyes are lighting up and the talk is going and it's exciting and everyone's exchanging ideas and you can see the collaboration is leading to the next thing.

It's amazing.

Dr. Shahzad Mustafa: Yeah, no, it's a, it's a really great opportunity. And I think going to these medical conferences has incredible amounts of benefit in so many ways.

Caroline: This has been really informative and we're so grateful again for your time and you just, you just giving us those snippets that are so important for our lives as listeners and patients and caregivers.

But before we wrap up today, is there anything else that you would like our listeners to hear from you?

Dr. Shahzad Mustafa: Yeah, I think this is an exciting time in allergy and I think if you work with a board certified allergist who keeps up, who goes to the Quad AI, that's great.

But many of us have to really advocate for some of these therapies. So kudos to you. Kudos for platforms like this of raising awareness and be advocates for yourself, for your family.

Members, for your loved ones, for your friends. It's a lot of therapies and I think it's an incredible time in the world of allergy and immunology,

and that it is.

Caroline: So thank you once again for your time and we look forward to having you back on FAACT's Roundtable Podcast.

Dr. Shahzad Mustafa: Thanks so much for having me.

Caroline: Before we say goodbye today, I just want to take one more moment to say thank you to Genentech for their kind sponsorship of Facts Roundtable Podcast. Also, I want to note that today's guest was not paid by or sponsored by Genentech to participate in this specific podcast.

Thank you for listening to FAACT's Roundtable Podcast. Stay tuned for future episodes coming soon. Please subscribe, leave a review, and listen to our podcast on Pandora, Apple Podcasts, Spotify, Google Podcasts, iHeartRadio and Stitcher.

Have a great day and always be kind to one another.