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Faculty & Disclosures

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    Faculty & Disclosures
    Dr Antonella Cianferoni

    Children’s Hospital of Philadelphia, PA, USA

    Dr Cianferoni is an associate professor in paediatrics at the Perelman School of Medicine, University of Pennsylvania and the Medical Director of the Food Allergy Immunotherapy Program at the Children’s Hospital of Philadelphia (CHOP), PA, USA. She is board-certified by the American Board of Allergy and Immunology and is a practising paediatric allergist with a special clinical and research interest in food allergy, both IgE- and non-IgE-mediated. read more

    Dr Cianferoni obtained her MD, PhD, at the University of Florence, Italy; she then completed a research fellowship at Johns Hopkins Allergy Center, Baltimore, MD, followed by a residency in paediatrics at CHOP and an allergy and immunology fellowship at Boston Children’s Hospital, MA, before finally joining the faculty of the Allergy and Immunology Division in the Department of Pediatrics at CHOP.

    She was the first person to describe how iNKT and T cells contribute to food allergy pathogenesis, including EoE and IgE-mediated food allergies. Dr Cianferoni also contributed to the identification of TSLP, EMSY and CAPN14 as genetic risk factors for EoE. She was the primary investigator in the first ever study aimed at modifying the course of EoE by inducing tolerance to milk allergen with epicutaneous immunotherapy, and is the co-investigator in many other clinical trials.

    Based on her work at CHOP, Dr Cianferoni has developed the multifood immunology protocol to treat patients with complex food allergies, and she is currently studying the safety and efficacy of such protocols and how they influence the development of EoE.

    Dr Cianferoni is the past chair of the BCI Section at the American Academy of Allergy, Asthma & Immunology, a member of the Eosinophilic Esophagitis Working Group at the European Academy of Allergy & Clinical Immunology, and a member of the medical board in the International FPIES Association.

    Dr Antonella Cianferoni discloses: Advisory board or panel fees from Sanofi (relationship terminated). Consultancy fees from AstraZeneca and Sanofi (all relationships terminated).
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    Focus Questions
    How has the shift from restrictive avoidance to early introduction of allergic food impacted the prevention of food allergies?
    How has the shift from restrictive avoidance to early introduction of allergic food impacted the prevention of food allergies?
    What are the latest advances in the diagnosis of IgE and non-IgE-mediated food allergy?
    What are the latest advances in the diagnosis of IgE and non-IgE-mediated food allergy?
    What role can allergen component testing play in optimizing diagnosis and management of food allergies?
    What role can allergen component testing play in optimizing diagnosis and management of food allergies?
    Does a positive diagnostic test result mean a patient has an allergy, or are further considerations needed?
    Does a positive diagnostic test result mean a patient has an allergy, or are further considerations needed?
    How may novel diagnostic tools be best incorporated into the care pathway?
    How may novel diagnostic tools be best incorporated into the care pathway?
    What medications are available for the treatment of IgE and non-IgE-mediated food allergies?
    What emerging biologic treatments are in development for food allergy?
    What emerging biologic treatments are in development for food allergy?
    What is the role of shared decision making in patients with food allergy?
    What is the role of shared decision making in patients with food allergy?
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    Expert insights in food allergy: Considerations for diagnosis and management in primary care and beyond

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    Dr Cianferoni is an associate professor in paediatrics at the Perelman School of Medicine, University of Pennsylvania and the Medical Director of the Food Allergy Immunotherapy Program at the Children’s Hospital of Philadelphia (CHOP), PA, USA. She is board-certified by the American Board of Allergy and Immunology and a practising paediatric allergist with a special clinical and research interest in food allergy, both IgE- and non-IgE-mediated. read more

    Dr Cianferoni obtained her MD, PhD, at the University of Florence, Italy; she then completed a research fellowship at Johns Hopkins Allergy Center, Baltimore, MD, followed by a residency in paediatrics at CHOP and an allergy and immunology fellowship at Boston Children’s Hospital, MA, before finally joining the faculty of the Allergy and Immunology Division in the Department of Pediatrics at CHOP.

    She was the first person to describe how iNKT and T cells contribute to food allergy pathogenesis, including EoE and IgE-mediated food allergies. Dr Cianferoni also contributed to the identification of TSLP, EMSY and CAPN14 as genetic risk factors for EoE. She was the primary investigator in the first ever study aimed at modifying the course of EoE by inducing tolerance to milk allergen with epicutaneous immunotherapy, and is the co-investigator in many other clinical trials.

    Based on her work at CHOP, Dr Cianferoni has developed the multifood immunology protocol to treat patients with complex food allergies, and she is currently studying the safety and efficacy of such protocols and how they influence the development of EoE.

    Dr Cianferoni is the past chair of the BCI Section at the American Academy of Allergy, Asthma & Immunology, a member of the Eosinophilic Esophagitis Working Group at the European Academy of Allergy & Clinical Immunology, and a member of the medical board in the International FPIES Association.

    Dr Antonella Cianferoni discloses: Advisory board or panel fees from Sanofi (relationship terminated). Consultancy fees from AstraZeneca and Sanofi (all relationships terminated).

    Learning Objectives

    After watching this activity, participants should be better able to:

    • Discuss evolving guidance in the prevention and diagnosis of food allergies
    • Summarize interdisciplinary strategies for personalizing the management of patients with food allergies
    Overview

    In this interview, Dr Antonella Cianferoni answers a series of questions focused on the diagnosis and management of food allergies, including the role of allergen component testing, current and emerging therapies, and the importance of shared decision making. read more

    Target Audience

    Allergists, immunologists, paediatricians, primary care physicians and nurse practitioners with an interest in pet allergy.

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Dr Antonella Cianferoni discloses: Advisory board or panel fees from Sanofi (relationship terminated). Consultancy fees from AstraZeneca and Sanofi (all relationships terminated).

    Content Reviewer

    Danielle Walker, DNP, APRN, AGNP-C has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Contributors

    Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu.

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 0.5 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 0.5 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Date of original release: 22 February 2024. Date credits expire: 22 February 2025.

    If you have any questions regarding credit please contact cpdsupport@usf.edu.

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    Topics covered in this activity

    Allergy
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    This activity is funded by:

    An independent medical education grant from Thermo Fisher Scientific.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty has been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 22 February 2024. Date credits expire: 22 February 2025.

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    Expert insights in food allergy: Considerations for diagnosis and management in primary care and beyond
    0.5 CE/CME credit
    Question 1/5
    Which of the following statements best reflects the current status of diagnostic approaches to food allergy?

    EoE, eosinophilic esophagitis; FPIES, food protein-induced enterocolitis syndrome; IgE, immunoglobulin E.

    Although molecular diagnostics are gaining traction in allergology, guidelines recommend beginning diagnostic workup with a comprehensive allergy-focused clinical history, followed by sensitization tests and optional challenge tests.1,2 Molecular component allergens for IgE testing can provide an individualized sensitization profile to aid differential diagnosis and guide allergy management.1 There are currently no biomarkers or in vitro tests available for the diagnosis of FPIES as the underlying pathophysiological mechanisms are not yet understood.3 Similarly, there are currently no available biomarkers that can replace upper endoscopy for the diagnosis and monitoring of EoE.3

    Abbreviations

    EoE, eosinophilic oesophagitis; FPIES, food protein-induced enterocolitis syndrome; IgE, immunoglobulin E.

    References

    1. Dramberg C, et al. Pediatr Allergy Immunol. 2023;34:e13854.
    2. Muraro A, et al. World Allergy Org J. 2022;15:100687.
    3. Cianferoni A, et al. Curr Pediatr Rev. 2020;16:95–105.
    Question 2/5
    You have been managing a 4-year-old child with confirmed peanut allergy for the past 12 months. The parents have recently had a second child, who is now 5 months old and has mild eczema. At a follow-up appointment for their 4-year-old child, the parents ask you if their new baby is also at risk of peanut allergy and if there is anything they should do regarding allergy risks for their second child. What would you consider next in the management of this family affected by peanut allergy?

    In response to the Learning Early About Peanut Allergy (LEAP) study, there has been a paradigm shift in food allergy management, most notably updates to the guidelines recommending early introduction of peanut protein in children with eczema or egg allergy who may be at risk of developing a peanut allergy.1–3 The LEAP study showed that at 60 months of age, 13.7% of the peanut-avoidance group and 1.9% of the peanut-consumption group were allergic to peanuts; this equates to an 11.8 percentage point difference in risk (95% confidence interval 3.4–20.3; p<0.001), representing an 86.1% relative reduction in the prevalence of peanut allergy.3 

    References

    1. Perkin MR. Lancet. 2022;399:2329.
    2. Halken S, et al. Pediatr Allergy Immunol. 2021:32;843–58.
    3. Du Toit G, et al. N Engl J Med. 2015;372:803–13.
    Question 3/5
    You are reviewing the component-resolved diagnostic test results for your patient with suspected peanut allergy. The molecular allergen test results show your patient is monosensitized to the peanut allergen Ara h 8. How might you explain these results to your patient and their family?

    Pollen-related pathogenesis-related class 10 (PR-10) proteins such as Ara h 8 are labile and are associated with mild-to-moderate (usually oropharyngeal) symptoms.1 Studies have shown that Ara h 8 monosensitization in children is associated with fewer and less severe symptoms compared with children polysensitized to the Ara h 1, Ara h 2 and Ara h 3 peanut allergens.2 Follow-up studies, which included an oral allergen provocation test, suggested that isolated (mono) Ara h 8 sensitization appears to indicate peanut tolerance.3

    References

    1. Dramberg C, et al. Pediatr Allergy Immunol. 2023;34:e13854.
    2. Asarnoj A, et al. Allergy. 2010;65:1189–95.
    3. Asarnoj A, et al. J Allergy Clin Immunol. 2012;130:468–72.
    Question 4/5
    Your 15-year old patient has a severe peanut allergy with a history of anaphylaxis on accidental allergen exposure. During a follow-up appointment your patient expresses their anxieties around remembering their epinephrine auto-injector all the time and the constant fear of having a severe reaction somewhere in public. They tell you they feel fed up as it is affecting their academic work, but they enjoy being at school with their friends. How might you advise this patient?

    IgE, immunoglobulin E.

    Food allergy is best managed by a multidisciplinary team.1 The team should encompass clinicians, dietitians, gastroenterologists, and also psychologists to support people that are experiencing anxiety and/or negative impacts on quality of life.1 Anti-IgE biological therapy for the management of IgE-mediated food allergies are in clinical trials but are not yet approved for the treatment of food allergies.2*

    *Addendum: Following the recording of this interview, omalizumab received FDA approval on 16 February 2024 in a new indication for IgE-mediated food allergies.3 Omalizumab is now approved in IgE-mediated food allergy in adult and paediatric patients aged ≥1 year for the reduction of Type I allergic reactions, including reducing the risk of anaphylaxis that may occur with accidental exposure to one or more foods; omalizumab is to be used in conjunction with food allergen avoidance.4

    Abbreviation

    IgE, immunoglobulin E.

    References

    1. Muraro A, et al. World Allergy Org J.2022;15:100687.
    2. Sindher S, et al. J Allergy Immunol Pract. 2023;doi: 10.1016/j.jaip.2023.11.032.
    3. FDA. Available at https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-help-reduce-allergic-reactions-multiple-foods-after-accidental (accessed 28 February 2024).
    4. FDA. Prescribing information: omalizumab. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/103976s5245lbl.pdf (accessed 28 February 2024).
    Question 5/5
    Your patient is an 18-month-old baby with a confirmed peanut allergy. Which of the following treatment options would you consider discussing with the parents to manage their child’s allergy?

    Studies have shown that peanut oral immunotherapy is safe for children aged 1–3 years, with 71% becoming desensitized and tolerating peanut protein following treatment.1,2 Although antihistamines may have value for treatment of acute non-life-threatening symptoms, prophylactic use is not recommended in case symptoms of anaphylaxis are masked.3 

    References

    1. Brasal-Prieto M, et al. Nutrients. 2023;15:3744.
    2. Jones SM, et al. Lancet. 2022;399:359–71.
    3. Muraro A, et al. Allergy. 2014;69:1008–25.
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    This activity is funded by:

    An independent medical education grant from Thermo Fisher Scientific.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty has been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 22 February 2024. Date credits expire: 22 February 2025.

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