Before writing your Letter, Annals editors suggest you consider including as much of the following information regarding your experience with peanut OIT (within the space limitations of a Letter – you may want to include some of this information as a table):
- When did your practice start offering PN OIT?
- How many patients have you enrolled into the treatment program to date?
- How much office space and time do you dedicate to OIT?
- Estimate the volume of after hours/weekend calls from patients with questions regarding dosing, e.g., calls per week.
- At what age do you start treating with OIT, do you have a lower and upper age limit?
- Do you use any exclusion criteria (e.g., diagnosis of EoE, chronic GI symptoms, uncontrolled asthma, history of anaphylaxis, high peanut-specific IgE)?
- Do you perform threshold food challenge before initiating OIT?
- Do you use office-based peanut SLIT as the initial treatment prior to initiating OIT?
- What is your typical starting dose (mg peanut protein)?
- How frequently do you updose, e.g., every 1-2 weeks or other time interval?
- Approach to premedicating with oral antihistamines (H1 and H2 blockers), do you recommend it for all patients or only those who report symptoms?
- Do you use probiotics to mitigate gastrointestinal side effects?
- How long do you observe patients following in office updose?
- What is the usual target daily maintenance dose and over how many office visits has it been achieved?
- What is your advice to patients regarding limiting exercise or other physical activity following the dose during up-dosing and maintenance, when, if ever, do you eliminate the need for physical activity restrictions after dosing?
- What is your approach to dosing interruption due to intercurrent illness, e.g., how do you restart following the given number of missed doses?
- Number (%) of patients who discontinued OIT due to adverse events versus other reasons (e.g., taste aversion, schedule change, anxiety).
- Were any patients treated with epinephrine for dose increases in the office or during home dosing?
- What milestones do you use before you: a) allow ingestion of trace amounts/products with precautionary allergen labels (PAL); b) allow unrestricted eating while still avoiding large amounts of concentrated peanut?
- Do you perform oral food challenges to evaluate the outcome of OIT, if yes, at what time point(s) and do you base your decision on changes in biomarkers such as SPT, peanut sIgE, Ara h2-sIgE, basophil activation test?
- How many of the patients treated in your practice are able to tolerate full servings of peanut and continue to eat freely without any restrictions?
- How many of the patients treated in your practice are able to tolerate full servings of peanut and continue to eat freely without any restrictions after stopping daily dosing?
- Do you decrease frequency of dosing from daily to less frequent and at what time point or certain milestone (biomarker, food challenge)?
