The Health and Economic Outcomes of Peanut Allergy Management Practices.

Abstract

BACKGROUND:

Peanut allergy is managed with strict avoidance, epinephrine carriage, and promptly treating reactions.

OBJECTIVE:

The objective of this study was to assess the health and economic benefits of pre-emptively injecting epinephrine for peanut ingestion in the absence of any symptoms, and to avoid products with peanut precautionary allergen labeling (PAL).

METHODS:

We used Markov modeling and simulations, assuming a base-case 10-fold fatality risk increase for less conservative management, with sensitivity analysis investigating 100- to 1000-fold increased fatality risk, incorporating risks of accidental exposures, reactions, fatality, and family costs of food allergy. Low-dose threshold challenges were used to exclude subjects highly reactive to PAL items.

RESULTS:

Based on these assumptions, small reductions in per-patient fatality risk resulted from pre-emptive epinephrine injection without symptoms present (<1 × 10-4 fewer per-patient fatalities), with incremental costs of $1193 per patient, $11,681,501/life year saved, and $110,270,820/death prevented versus waiting for symptoms before use, but this was not cost-effective even assuming 1000-fold risk ($107, 971/quality of life adjusted year) or quality of life (QoL). There were small reductions in per-patient fatality risk (<1 × 10-4 fewer per-patient fatalities) for PAL avoidance versus universal PAL consumption, with incremental costs of $3342 per patient, $19,325,994/life year saved, and $182,434,277/death prevented versus allowing PAL consumption. PAL avoidance was not cost-effective when assuming 1000-fold risk or considering QoL. Incorporating a single, supervised low-dose challenge of 1.5 mg of peanut protein to exclude children reactive to PAL consumption was cost-effective.

CONCLUSIONS:

Commonly recommended practices of pre-emptive epinephrine injection in the absence of symptoms, or universal avoidance of PAL, were not cost-effective when compared with administering epinephrine on symptom development or allowing PAL consumption.

• Authors: Marcus Shaker, Matthew Greenhawt
• Journal: The journal of allergy and clinical immunology. In practice (J Allergy Clin Immunol Pract) 2018 Nov - Dec Vol. 6 Issue 6 Pg. 2073-2080 ISSN: 2213-2201 [Electronic] United States
• PMID: 29751153 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)
• Copyright: Copyright © 2018. Published by Elsevier Inc.

Chemical References

• Allergens
• Epinephrine

Topics

• Allergens (immunology)
• Anaphylaxis (prevention & control)
• Arachis (immunology)
• Child
• Cost-Benefit Analysis
• Epinephrine (therapeutic use)
• Female
• Humans
• Male
• Models, Econometric
• Peanut Hypersensitivity (drug therapy, economics)
• Practice Patterns, Physicians'
• Quality of Life
• Risk
• Treatment Outcome