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Food Allergen OIT for Shrimp and Cashew (MOTIF)

Primary Purpose

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

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Cashew or Shrimp Oral Immunotherapy
Sponsored by
Sayantani B. Sindher
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Allergy;Food focused on measuring OIT, Oral Immunotherapy, Cashew Allergy, Shrimp Allergy

Eligibility Criteria

7 Years - 55 Years (Child, Adult)All SexesDoes not accept healthy volunteers

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

Sites / Locations

  • Sean N Parker Center For Allergy and Asthma Research

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Cashew or Shrimp Oral Immunotherapy

Arm Description

Participants, ages 7 to 55 years, inclusive, with an allergy to Cashew or Shrimp.

Outcomes

Primary Outcome Measures

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.

Secondary Outcome Measures

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.
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

Full Information

First Posted
April 3, 2018
Last Updated
June 2, 2023
Sponsor
Sayantani B. Sindher
Collaborators
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT03504774
Brief Title
Food Allergen OIT for Shrimp and Cashew
Acronym
MOTIF
Official Title
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
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Terminated
Why Stopped
Study discontinued due to slow enrollment during COVID-19 pandemic
Study Start Date
July 9, 2019 (Actual)
Primary Completion Date
January 13, 2023 (Actual)
Study Completion Date
March 3, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Sayantani B. Sindher
Collaborators
National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
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
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.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Allergy;Food, Allergy to Shrimp, Allergy to Cashew Nut (Disorder)
Keywords
OIT, Oral Immunotherapy, Cashew Allergy, Shrimp Allergy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
Food allergy OIT in a single group design
Masking
None (Open Label)
Allocation
N/A
Enrollment
52 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cashew or Shrimp Oral Immunotherapy
Arm Type
Experimental
Arm Description
Participants, ages 7 to 55 years, inclusive, with an allergy to Cashew or Shrimp.
Intervention Type
Drug
Intervention Name(s)
Cashew or Shrimp Oral Immunotherapy
Other Intervention Name(s)
OIT
Intervention Description
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.
Primary Outcome Measure Information:
Title
Change in expression of CD28 in the CD4+ allergen specific (CD154+)
Description
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.
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Compare changes in expression of CD28+ allergen specific (CD154+)
Description
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.
Time Frame
64 weeks
Title
Compare changes in the following measures in CD4+CD28+ allergen specific (CD154+)
Description
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
Time Frame
58 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
7 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
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
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sayantani Sindher, MD
Organizational Affiliation
Stanford University, SNP Center for Food Allergy and Asthma Research
Official's Role
Study Director
Facility Information:
Facility Name
Sean N Parker Center For Allergy and Asthma Research
City
Palo Alto
State/Province
California
ZIP/Postal Code
94304
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Food Allergen OIT for Shrimp and Cashew

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