Food Allergen OIT for Shrimp and Cashew

Study Overview
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Brief Summary
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A prospective Phase 2, single-center, single-allergen OIT of cashew or shrimp in participants with proven allergies to either cashew or shrimp, respectively. We intend to treat 72 participants, ages 7 to 55 years with an allergy to either cashew, or shrimp determined by Double Blind-Placebo Controlled-Food Challenge (DBPCFC), allergy history, clinical symptoms, food-allergen (FA)-specific IgE levels, and skin prick test (SPT).

Detailed Description
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A prospective Phase 2, single-center, single-allergen OIT of cashew or shrimp in participants with proven allergies to either cashew or shrimp, respectively. We intend to treat 72 participants, ages 7 to 55 years with an allergy to either cashew or shrimp determined by Double Blind-Placebo Controlled-Food Challenge (DBPCFC), allergy history, clinical symptoms, food-allergen (FA)-specific IgE levels, and skin prick test (SPT). Enrolled participants must be positive at or before the 300 mg (443 mg cumulative) dosing level of FA protein. OIT treatment groups will be cashew or shrimp. All cohorts will undergo an updosing regimen starting at 5 mg allergen, with dose escalation every 2 weeks to reach a 1000 mg dose at week 28, after which they will be maintained at that dose for 24 weeks. At the conclusion of the maintenance phase (Week 52), participants will undergo DBPCFC. Participants that pass their food challenge with no or mild objective reactions to up to a cumulative 2043 mg of the FA allergen in their OIT at the end of this phase (primary outcome) will be considered desensitized and have successfully met the primary endpoint. All participants then will continue in the study by undergoing withdrawal from OIT for 6 weeks to examine mechanisms underlying sustained responsiveness (SU) which will be defined as a participant's passing a DBPCFC with no or mild objective reaction to up to a cumulative 2043 mg of the FA allergen in their DBPCFC at week 58. Those participants who pass the Week 58 challenge up to a cumulative of 2043 mg will be given the option to continue the withdrawal phase up to Week 64 which will be end of study. Week 58 will be end of study for those who do not opt for this continuation of withdrawal.

Official Title
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T Cell Reagent Research for Monitoring T Cells in Food Allergy (MOTIF) Phase 2 Study Using Food Allergen Oral Immunotherapy for Shrimp or Cashew Allergies

Conditions
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Allergy;Food, Allergy to Shrimp, Allergy to Cashew Nut (Disorder)

Intervention / Treatment
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* Drug: Cashew or Shrimp Oral Immunotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subject and/or parent guardian must be able to understand and provide informed consent Age 7 through 55 years (inclusive) Clinical history of allergy to cashew or shrimp-containing foods Serum IgE to cashew or shrimp of ≥0.35 kUA/L [determined by UniCAPTM within the past 12 months] and/or a SPT to cashew or shrimp ≥3 mm compared to control Experience dose-limiting symptoms at or before the 300 mg challenge dose of FA protein on Screening DBPCFC conducted in accordance with PRACTALL guidelines Written informed consent from adult participants Written informed consent from parent/guardian for minor participants Written assent from minor participants as appropriate (e.g., above the age of 7 years or the applicable age per local regulatory requirements) All female subjects of child-bearing potential will be required to provide a blood or urine sample for pregnancy testing that must be negative one week before being allowed to participate in the study. Use of effective birth control by female participants of child-bearing potential. Exclusion Criteria: Inability or unwillingness of a participant to give written informed consent or comply with study protocol History of uncontrolled cardiovascular disease, including uncontrolled hypertension History of other chronic disease (other than asthma, atopic dermatitis, or allergic rhinitis) requiring therapy (e.g., heart disease, diabetes) that is, or is at significant risk of becoming unstable or requiring a change in chronic therapeutic regimen and, in the opinion of the Principal Investigator, would represent a risk to the subject's health or safety in this study or the subject's ability to comply with the study protocol. History of eosinophilic esophagitis (EoE), other eosinophilic gastrointestinal disease, chronic, recurrent, or severe gastroesophageal reflux disease (GERD) grade 3 according to CTCAE version 5.0, symptoms of dysphagia (e.g., difficulty swallowing, food getting stuck), or recurrent gastrointestinal symptoms of undiagnosed etiology Current participation in any other interventional study Subject is currently in the build-up phase of immunotherapy to another allergen and is on maintenance immunotherapy dose for any allergen related to cashew or shrimp Severe asthma (NAEPP EPR-3 Medication Criteria Steps 5 or 6) Mild or moderate asthma (NAEPP EPR-3 Medication Criteria Steps 1-4), if not controlled as indicated by an ACT<19 A hospitalization for asthma in the past 6 months ER visit for asthma within the past 6 months Burst or steroid course for asthma in the past 6 months Use of omalizumab or biologic therapy (e.g., infliximab, rituximab, etc.) within the past 6 months Use of complementary and alternative medicine (CAM) treatment modalities (e.g., herbal remedies) for atopic and /or non-atopic disease within 90 days preceding Initial Dose Escalation Day (IDED) or at any time after the IDED Use of beta-blockers (oral) Pregnancy or lactation Allergy to oat History of severe anaphylaxis to cashew or shrimp with symptoms including hypotension requiring fluid resuscitation and/or the need for mechanical ventilation within the last year Use of investigational drugs within 12 weeks of participation Past or current medical problems or findings from physical assessment or laboratory testing that are not listed above, which, in the opinion of the investigator, may pose additional risks from participation in the study, may interfere with the participant's ability to comply with study requirements or that may impact the quality or interpretation of the data obtained from the study

Ages Eligible for Study
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Minimum Age: 7 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Food allergy OIT in a single group design
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cashew or Shrimp Oral Immunotherapy<br>Participants, ages 7 to 55 years, inclusive, with an allergy to Cashew or Shrimp. | Drug: Cashew or Shrimp Oral Immunotherapy<br>* All cohorts will undergo an updosing regimen starting at 5 mg allergen, with dose escalation every 2 weeks to reach a 1000 mg dose at week 28, after which they will be maintained at that dose for 24 weeks. At the conclusion of the maintenance phase (Week 52), participants will undergo DBPCFC.<br>* Other names: OIT;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in expression of CD28 in the CD4+ allergen specific (CD154+) | Change in expression of CD28 in the CD4+ allergen specific (CD154+) T-cells at 52 weeks relative to baseline values between those who do and do not tolerate a cumulative of 2043 mg in the DBPCFC at week 52. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compare changes in expression of CD28+ allergen specific (CD154+) | Compare changes in expression of CD28+ allergen specific (CD154+) T-cells over multiple time points from baseline to week 58 and week 64 between those with sustained unresponsiveness (SU) vs those desensitized but SU failures vs those who did not pass DBPCFC. | 64 weeks | 
| Compare changes in the following measures in CD4+CD28+ allergen specific (CD154+) | Compare changes in the following measures in CD4+CD28+ allergen specific (CD154+) T-cells at week 52 and week 58 between those who achieved sustained unresponsiveness (SU) vs those desensitized but SU failures vs those who did not pass the desensitization DBPCFC at week 52 Levels of IFN-gamma Levels of IL-4 Receptor diversity in allergen specific T cell CDR3b as compared to non-specific T cells Levels of IL-10 Levels of TGF beta Levels of GPR15 Levels of CCR4+ Levels of CRTh2 | 58 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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OIT, Oral Immunotherapy, Cashew Allergy, Shrimp Allergy