You’ve mentioned Dr. Wesley Burks, who is a pioneer in OIT. What have you learned from him?
The initial project that drove my interest in food allergy was in mice. When Dr. Burks hired me to join the faculty at Duke, I had never done human research before, so he’s taught me almost everything I know about how to do good clinical research.
But as my primary mentor since hiring me for my first faculty job, he has taught me so much more than academic survival skills. He leads by example and with integrity, and shows every day that one can be highly successful in a competitive field while treating people the right way.
What do you see as the next steps in OIT research?
In the short-term I think it is important that we conduct multicenter trials involving hundreds of patients in which there is a group receiving placebo that is evaluated in just the same way as the active group. This is a relatively standard approach to definitive, or “pivotal,” phase III drug research, and yet it has not been done in OIT.
Typically the studies have not had a control group at all, and in those few that have had placebo controls, the placebo group is treated differently in the study. For example, they only receive placebo for one year and then cross over to receive active treatment. We need this type of study to know for certain that OIT can create tolerance. If the effect of OIT is ultimately temporary, then patients will have to take the allergen for the rest of their lives, which may not be a sustainable approach.
In the longer-term, we need to develop the next generation of immunotherapies. So far we just give patients the allergens – they are not modified. This seems to work reasonably well in some participants, but it can be toxic and ultimately may only be partially effective. I would expect the next generation of therapies to be fairly technologically advanced, such as using strategies to modify the allergens themselves, or to change the immune response with another medication while delivering OIT, or other approaches.
What else are you working on?
I am working hard to try to finish our early intervention trial and analyze the results. The other element in this trial was to compare two different doses head-to-head. I am excited to take a look at these data to determine what we have learned about how much allergen is necessary to achieve the desired effect.
I am also developing methods to measure patient-reported outcomes in immunotherapy. This will help us design products and trials that achieve the results that the patients themselves value.
How do you see being a food allergy specialist changing in the next few years?
If phase III studies are successful, it is likely that one if not more products will be submitted to FDA for formal approval. When that happens, the era of clinic-based immunotherapy will begin on a much larger scale. In the meantime, I expect to see continued improvements in the current standard of care with better diagnostics, an improved understanding of the risks posed by trace exposures and, importantly, the widespread implementation of early infant feeding as a preventative strategy.
Do you foresee patients regularly being desensitized to food allergies in allergist’s offices across the country?
This is a relatively time- and labor-intensive process, and it is neither necessary nor successful in every patient. At this point, it is really hard for me to predict exactly how clinic-based immunotherapy will be implemented.
For more on Dr. Vickery’s research, see: First Long-Term Study of Peanut Therapy Shows Lasting Protection
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