Patients Prioritize Efficacy in Food Allergy Treatment Over Method, Frequency

In a discrete choice experiment, US patients tended to prefer more efficacious, safer, and convenient (oral, at-home, less frequent) food allergy treatments.¹

“Treatment efficacy was the most highly ranked treatment feature, followed by risk of gastrointestinal symptoms and method of treatment administration,” wrote study investigator Alexis T. Mickle, MSc, director at Broadstreet Health Economics & Outcomes Research, and colleagues. “It was notable as well that when there was a history of OIT use (vs. those without), concern over the risk of gastrointestinal symptoms was stronger.”

FDA-approved therapies for food allergy have similar efficacy profiles but differ in several key features, including method of administration, adverse events, frequency, setting, and the need to limit activities following treatment. Treatments on the market include peanut (Arachis hypogaea) allergen powder-Dnfp (an oral immunotherapy), sublingual immunotherapy, omalizumab (a biologic), and epinephrine for anaphylaxis.² Until now, few studies have assessed food allergy treatment preferences.

Investigators aimed to examine food allergy treatment preferences among adolescents and caregivers of children, as well as how these preferences varied by clinical and demographic factors.¹ A discrete choice experiment, conducted between May and June 2024, included adolescents aged 13 – 17 years (n = 73; mean age, 15.9 years) or caregivers of a child under 12 years old (n = 228; mean age, 37.1 years) with a self-reported, physician-diagnosed food allergy. The sample included 55% males, 52% White, and 91.4% from urban, town, or suburban areas.

In this experiment, respondents had to choose between several hypothetical treatments defined by key attributes, allowing respondents to select their preferences without being directly asked about the attributes. In the survey, each treatment attribute had ≥ 2 variations. For instance, for administration frequency, it asked about daily vs weekly administration.

The survey collected treatment-attribute data, with questions related to demographics, the Intolerance of Uncertainty-12 Scale (IUS-12), and the Food Allergy Independent Measure (FAIM). Investigators conducted conditional logistic regression analyses to assess the association between treatment attributes and the odds of preferring a treatment.

The analysis found that patients were significantly more likely to prefer treatments that offered a 95% relative reduction in the risk of moderate-to-severe allergic reactions compared with no reduction (P < .001). Participants preferred oral administration over subcutaneous (P < .001), at-home administration over a clinical setting (P < .05), less frequent (every 2 or 4 weeks) over daily administration (both P < .001).¹

“It is notable that for patients with a history of OIT use, dosing frequency had less of an impact on preferences than among those with no/unsure use, potentially because these patients were accustomed to the treatment regimen and the true impact of these burdens was less impactful in real life than as perceived by those who had not experienced them,” investigators wrote.¹

Participants were less likely to prefer treatments when they had a 10% increased risk of gastrointestinal symptoms (4% drop; OR, 0.96; 95% confidence interval [CI], 0.95 – 0.97; P < .001) or a 5% increased risk of anaphylaxis (6% drop; OR, 0.94; 95% CI, 0.91 – 0.96; P < .001). Overall, the experiment identified efficacy, at least a 75% decrease in the relative risk of a moderate-to-severe allergic reaction, as the top-ranked attribute (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.49 – 1.75). Caregivers had an even stronger preference for efficacious treatment than adolescents, and investigators speculated this may be due to parents having a greater level of concern about their children than adolescents have about themselves.¹

The team also noted a trend among caregivers of children with less severe allergies, indicated by lower FAIM scores and a single food allergy. These caregivers had a significantly greater preference for efficacy as a treatment attribute compared to caregivers of children with more severe allergies.

“This might be explained by individuals with less severe allergies having less experience with managing reactions, potentially leading to greater anxiety about reactions and making treatment efficacy a higher priority for them,” investigators wrote.¹

References

1. Mickle AT, Warren CM, Seetasith A, et al. Patient preferences for food allergy treatments in the United States: a discrete choice experiment. Curr Med Res Opin. Published online August 18, 2025. doi:10.1080/03007995.2025.2544596

2. Food Allergy Treatment & Management. Allergy & Asthma Network. https://allergyasthmanetwork.org/food-allergies/food-allergy-treatment-and-management/. Accessed August 20, 2025.