The Health and Economic Outcomes of Peanut Allergy Management Practices

The Journal of Allergy and Clinical Immunology. in Practice
Marcus S Shaker, Matthew J Greenhawt

Abstract

Peanut allergy is managed with strict avoidance, epinephrine carriage, and promptly treating reactions. 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). 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. 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-pat...Continue Reading

Citations

Apr 3, 2019·Current Opinion in Pediatrics·Dana ToyMarcus Shaker
May 16, 2019·Current Opinion in Pediatrics·Dana ToyMarcus Shaker
Jan 25, 2021·The Journal of Allergy and Clinical Immunology. in Practice·Marcus ShakerMatthew Greenhawt
Jan 23, 2021·Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology·Philippe A EigenmannRobert A Wood
May 10, 2021·The Journal of Allergy and Clinical Immunology·Susan WasermanJan L Brozek
Jun 8, 2021·The Journal of Allergy and Clinical Immunology. in Practice·Scott H SichererJonathan O'B Hourihane
Jun 21, 2021·The Journal of Allergy and Clinical Immunology. in Practice·Elissa M AbramsMarcus Shaker
Jun 16, 2019·The Journal of Allergy and Clinical Immunology. in Practice·Marcus Shaker, Matthew Greenhawt

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