Could Research Shift the Way You Feel About Food Allergy Treatments? with Dr. Lianne Soller

Transcript Disclaimer:
This transcript was generated using AI software from the original podcast audio and may contain errors, omissions, or minor inaccuracies. It has been lightly edited for readability. Please refer to the full podcast episode for the most accurate representation of the conversation.

0:00

Welcome back to Don't Feed the Fear. We are in the middle of our season exploring food allergy treatment options, not just the treatments themselves, but what it's actually like to make those decisions and then experience them. Before we move forward with more of the types of treatment that you might consider, I wanted to pause and do this episode about something that I find really exciting, but a lot of people find confusing or intimidating, which is research. And I wanted to do this by sharing with you one of the people whose research has really, over many years, shaped the care that many of us receive today. My hope is that this conversation will help you to understand the value of research and not think of it as something that's just for doctors and scientists. So I invited Dr. Lianne Soller to be with us here on the show. She is the allergy research manager at BC Children's Hospital, and she was recently appointed the board chair of Canada's Food Allergy Immunotherapy Program, or FAIT, F-A-I-T. I love the research of Dr. Soller and her team for a lot of reasons, both because they're not only focusing on the medical aspects, but the emotional and mental health as well. My hope is that you'll walk away with some curiosity and interest in the role of research in what actually makes its way to us as patients.

1:12

Welcome to the Don't Feed the Fear podcast, where we dive into the complex world of food allergy anxiety. I'm your host, Dr. Amanda Whitehouse, food allergy anxiety psychologist and food allergy mom. Whether you're dealing with allergies yourself or supporting someone who is, join us for an empathetic and informative journey toward food allergy calm and confidence.

Amanda Whitehouse, PhD 1:33

Dr. Soller, thank you so much for joining us here on Don't Feed the Fear today. I have so many questions I want to ask you.

Lianne Soller, PhD 1:39

I'm excited to get started. Thank you so much for having me.

Amanda Whitehouse, PhD 1:41

Of course. Would you just start by giving our listeners your background and how you got into food allergy research?

Lianne Soller, PhD 1:47

Sure. So it's been several years now. I started working in allergy in 2007 with the team at McGill University Health Centre in Montreal. And it was just a random job that I got as a recruiter for a peanut allergy study. At the time, I wanted to go into medical school, so I was looking for some research opportunities. And that sort of fast-forward to now, I completed a master's and PhD, with Dr. Clark at McGill as well, doing a peanut allergy study, a Canada-wide peanut allergy study where we looked at prevalence of food allergies. And I've had various opportunities with different teams over the years in Ireland, which is a paper we'll talk about today, and also working with Dr. Chan in Vancouver, British Columbia, since So I had met him at a conference years before that, and he said, "If you ever need a job, just give me a call." So I was looking for a change and moved from the east coast to the west coast of Canada, and I've been here in Vancouver ever since 2016. So it's been a long journey. Lots of changes and bumps along the road, but it's been a really great time, and I, I just-- I'm so passionate about the topic.

Amanda Whitehouse, PhD 2:59

Well, I'm glad you're there because you and your team are putting out so much great stuff. Would you tell everybody about your position there? Because it's a little different from a lot of the allergists that I have on the show.

Lianne Soller, PhD 3:05

Definitely. So I'm the research manager for the allergy department at Children's Hospital, in Vancouver, British Columbia. And I manage a team of research staff. So we have assistants, coordinators, as well as nurses. And we just do a variety of different research types, clinical trials as well as real world studies where we're looking at different food allergy treatments as well as prevention, anxiety, quality of life. We do a variety of work. But that's my role as a manager

Amanda Whitehouse, PhD 3:34

And I, I love that you do that because obviously when we talk about research, people are starting to understand that we, we want these big RCTs, clinical trials. But I think there's so much value in other forms of research too, and one of the first studies I wanted to ask you about was the one that you did with focus groups with parents of kids with food allergies. So would it be okay if we started with that one? And maybe people listening don't know what a focus group is, so maybe if you could explain that too.

Lianne Soller, PhD 3:59

Sure. So a focus group is a group of people that you bring in, bring into a room or a virtual room if it's a virtual focus group. And what you're trying to do is, gather information from a variety of viewpoints on a specific topic, and it's usually open-ended. It allows people to share their views in a different way than, say, a questionnaire where you would say yes or no. And it really elicits a rich data set because people feed off each other's energy and they get immersed in the topic. They actually report that they, you know, make friends or they feel really comfortable. They enjoy being in that environment because they are finally meeting people that are going through something that's similar to them. So it's a very powerful way of collecting data for researchers, and I think it needs to be utilized more, especially in food allergy.

Amanda Whitehouse, PhD 4:47

I agree because I think people think of qualitative research as less than almost. But that's where we elicit the things that we don't know that we're not addressing until we give people the chance. So I totally agree with you. So tell me more about what you found.

Lianne Soller, PhD 5:01

Yeah. So, um, that study was done quite a, quite a number of years ago now, and I would, I would wonder whether some of the data would change, just given the different climate that we're living in now. But, what we found was we had seven focus groups. We had 40 parents. The vast majority, as you can imagine, were moms. So out of 40, we had 33 that were moms. And the main finding was that families wanted to have an in-person team of healthcare providers from a variety of backgrounds. So something like a dietician, a psychologist, an allergist, maybe, a nurse, just a variety of different, healthcare providers altogether that would allow for a more patient-centered care, service. And it was, I think, due to the fact that a lot of allergy families find that the care is really fragmented and that they're seeing their GP for the first time perhaps to get a referral, and then they're seeing an allergist. And then the allergist is giving them information, but it's not enough information or they want more.

They're always seeking more information. They don't have the skills to address their anxiety or their co-issues with coping. They're not experts in nutrition, so they're not really able to help out with ideas for new recipes or ways to cope with having a child with an allergy. And so that was another piece that we found from that study was that families are looking for more resources are vetted by experts, whether that's websites or, posters, pamphlets, videos, a variety of resources. Really, all we found was we just want more resources. It was very interesting. And one thing that I wonder is, since the pandemic, we've, we've really switched our offerings to being more virtual. And so, whereas the study found that families would, would like to have something in person, I do wonder if having something virtual would a similar way of delivering this healthcare team, but allow for people from across various geographies to attend those sessions, which would be even more powerful for families

Amanda Whitehouse, PhD 7:02

And so much more accessible and less expensive.

Lianne Soller, PhD 7:04

The goals I think were to help with reducing anxiety mainly. And that was one of the pieces that we found that came through, really all of the questions was that families were really struggling with anxiety. And though some of them didn't use the term because it was maybe stigmatizing it was really just felt that having an allergy or having a child with an allergy, there's just so much that is unknown from the perspective of the parent with a newly diagnosed child. And even years later, that anxiety still remains. It changes over time. They know a lot of information later, but then there's new things like going to university or sleepaway camp or jobs where their child isn't really under their wing anymore and is being released into the world, which then adds a whole other level of, of anxiety for the family the child, but also the parent who now has to give that, that control away to their, their child.

Amanda Whitehouse, PhD 8:04

I always say everything I've learned about parenting, but especially food allergy parenting, is just when you think you get the hang of things, it's going to change. And so you have to adjust ongoing. So that's a really important point. Similar but not quite the same concept is the study about quality of life, the one that you did with specifically looking at people with multiple allergies. So let's talk about that one next.

Lianne Soller, PhD 8:27

Sure. So, that one was done also several years ago now when I was still at McGill. And that one was looking at quality of life with different allergens, so different allergen types. And so far in the data, we've seen a lot of information on peanut allergy. As we know, most of the studies focus on peanut. But this was using family registry data that we had collected at McGill and across Canada where we had information on peanut, sesame, and seafood allergy. And I think we know very little about both sesame and seafood allergy in general, but in particular with quality of life. So what we found was that peanut and seafood allergy had a worse quality of life than sesame, kind of interesting. And that multi-food allergy children who were older and those with a history of anaphylaxis had worse quality of life.

That one is fairly self-explanatory. But interestingly, we also found that parents who had a university degree showed a higher or better quality of life than those without a university degree. And I think that one particularly was interesting to me to kind of try to understand why that might be the case. Of course, there could be a variety of reasons, but the one that I think is potentially plausible is that the families with a higher education, higher health literacy in general could be more likely to seek out extra supports. Perhaps they have the financial means to allow them to pay out of pocket for things like a psychologist or counselor or a dietician. So those are just some reasons we might have found this quality of life difference. But I'm sure there are others out there as well.

Amanda Whitehouse, PhD 10:03

I think back to myself when I was that new allergy mom, and luckily, obviously I have a little bit of education and understand research, and some people just don't know the difference between or feel comfortable reading a peer-reviewed research article versus something else that they might find that seems legitimate and obviously is presented as science, but it might not be science. So part of me wonders if that could be a little bit of it too, knowing how to consume and find good information.

Lianne Soller, PhD 10:27

That's definitely a skill set that I think is really under-recognized. And exactly what you said, if you don't know where to look for the right, the credible information, then you're probably going to come across a lot of information that is not credible. And that's the case with our daily life. We find things that are not credible all the time, and it's knowing how to differentiate those things from the credible information, and that's, that's not something that we are taught in high school, unfortunately.

Amanda Whitehouse, PhD 10:54

No. No, and it's not just that it's hard. In a world where people are getting their health information online, there are people intentionally trying to sell us things by presenting themselves and misrepresenting what they're doing or what they're selling.

Lianne Soller, PhD 11:06

Yeah. Yes. Yes, I agree. Yeah

Amanda Whitehouse, PhD 11:08

It seems clear or self-explanatory why certain people would struggle more with the multiple allergies or the history of anaphylaxis, but I think it's validating, even if it's a little bit more obvious. I think that's, again, another benefit of being a consumer of the research is just knowing like, "Yes, I, I knew that. We've known that for so long," and now the doctors all confirm it with the research, too. But I would love it if you would say more about that just because I do think it's an important topic.

Lianne Soller, PhD 11:35

Oh, yes, definitely. So I do think that the families who have multiple allergies, You find out you have one, and then there's testing for more, and then you go home and you're like, "Hey, we have this under control," and then there's another one that pops up. It just adds so many layers of, of complexity to your life. And we know that a lot of schools, in Canada, I don't know about other countries, but there's peanut-free schools. But there's not cashew-free schools or sesame-free schools or cow's milk-free schools. Certainly the, the multi-food allergy is really tricky. And, and the history of anaphylaxis, right? Like anybody who's had a reaction, or had a bad health outcome knows, like when something happens and symptoms come up they're just fearful of it. It's a trauma. It's really a trauma. So it, there's PTSD that comes up. Probably a, a lot of it is mostly undiagnosed, and so just living day to day, and a lot of the time your child isn't with you, so it's, there's also that, the lack of control of all the situations.

Amanda Whitehouse, PhD 12:32

Yes. Thank you for saying all that. I love all the conversation about anxiety and I wanted to move next to something I'm very excited about, the IMPAACT tool that your team is working on developing. So tell us about that, please.

Lianne Soller, PhD 12:44

Yes. So we realized many years ago, this was actually a question from the qualitative focus group study, and we, we wanted to include questions on anxiety, and we just included the STAI, which is a generic anxiety tool. And so the ethics committee was like, "Why aren't you asking about allergy anxiety?" I'm like, "Well, there, isn't a tool." Why don't you, like, make

Amanda Whitehouse, PhD 13:08

Yeah.

Lianne Soller, PhD 13:09

So, so we're like,

Amanda Whitehouse, PhD 13:10

Simple

Lianne Soller, PhD 13:11

uh, okay, okay. I guess we could do that." Uh, so we spent a, a few years looking for someone who was an expert in anxiety, so psychology-related person, and also interested in research because the vast majority of people that are psychologists have no time, zero time for research. They're too busy clinically. There's massive wait lists, and they don't have time for any academic work. We found someone who was a fellow, so she worked with us for, I think, three years and she developed the, the IMPAACT tool. And so it's kind of a funny acronym, but it's basically Impairment Measure for Parent-Associated Anxiety coping tool. Yes. And, uh, so it's got the double A going on, so it's IMPAACT, IMPAACT. So it started off with I think close to 50 or 60 questions, and we sent the questionnaire around to members of Food Allergy Canada, which is our large advocacy group here in Canada, as well as some local patients who were at BC Children's Hospital, and they just validated the questions. And then ended up with a 28-item tool which measures four subscales. and it's interesting because what we wanted to do was have a really, a short tool that would allow us to measure anxiety. But what we quickly realized was that there's a lot of different facets. And so doing something like a 10-item or a 5-item tool, it just... It didn't feel like it was going to capture really what we thought would be important constructs when it comes to anxiety.

And so we ended up with 28 items, which is still in itself a little bit long, but the questions are all on the same scale, so it kind of is easy to get through. So we, we developed that tool and we published on it, quite a number of years ago now before the pandemic. And then we were trying to work over the course of the last several years now on finding someone who could help us validate it against a diagnosis of anxiety from a healthcare provider. And that, with the pandemic and just all the things we just hadn't had the time to do that or the person to do that. And so, we now have somebody who's been working with us over the last one and a half years. And she's, she's administering that IMPAACT questionnaire to her patients and then also blinded so she doesn't look at the scores. And then she's also looking at their anxiety when she sees them virtually, and then she's giving them kind of a score on her own as well. So, that'll be a great paper to see, what those differences are. I'm really excited

Amanda Whitehouse, PhD 15:36

Yeah. The categories, would you say more about what they are? I think people will be curious

Lianne Soller, PhD 15:41

The four subscales are called cognitive, behavioral, impact, and child coping, and they measure different aspects of anxiety. The impact one goes over things like physical symptoms worries related to the child's food allergy in terms of distress, having issues relaxing, becoming sad about the child's food allergy, impact on activities and stress. There's the child coping one that talks about the parent's ability to cope with their child's allergy, and also talks about the child and his ability to cope. So it's, there's a variety of questions. They're all somewhat different, and they all measure somewhat different things, and I think that's why we were wanting to do these different subscales to see which, which of the areas, in particular, when you're thinking of treatment, or focusing CBT or cognitive behavioral therapy, or talk therapy on your patients, which area should we focus on? Are all these four areas important for that specific family? So it allows the provider to somewhat tailor their approach to the individual family based on where they scored the highest, or if they scored high on all of them

Amanda Whitehouse, PhD 16:56

I can see that as a provider being so helpful in terms of all the conversation that it might take to get there versus a quick scale to know for each individual, this one is a challenge, but you're actually doing pretty okay in this area. So what are your thoughts though on how that might IMPAACT clinical use with those of us working with families?

Lianne Soller, PhD 17:15

So the idea behind the, the tool is to act as a screen. So what we're trying to do is understand what the total score is and which area has the highest score. And that will allow the provider to understand kind of at a quick glance, is this family really having a hard time with their anxiety or is it not an issue? For the allergist in particular, I think that's important because then they can say, "Okay, this family is doing great. I don't need to give them resources." Of course, it's great to have resources, but they don't-- maybe they don't need to push a psychologist on the family. But for those who have a higher degree of anxiety, it could perhaps allow the allergist to advocate for the patient to be seen faster, or they could refer the patient to a community psychologist who might be able to see them faster. So they, it would just allow the allergist to know a bit better, when they see the patient, what are they really getting themselves into and, and how much support is the patient going to need. And then also just with the provider, the psychologist, um, allowing them to tailor their, their treatment path and, and see which areas the family might need the most help in. And that will just allow them to have easier conversations with the family. Hopefully the family have an easier buy-in into this process of treatment or, or help

Amanda Whitehouse, PhD 18:31

Right, right. Because that concrete number on a scale for some people will impact them differently than someone just saying, "I'm concerned." "As you said, we do this routine screening with everyone, and here's where you fell in relation to other people," the buy-in might be

Lianne Soller, PhD 18:43

That's right.

Amanda Whitehouse, PhD 18:44

And one of the treatments that you're, as you're mentioning that's very common and helpful is cognitive behavioral therapy, and that's one of the last things that I want to talk about is how you're looking at integrating that into the Thriving Families program. I would just love you to talk all about that please.

Lianne Soller, PhD 19:01

We have been working for about two years now on a new program offering. So it's interesting because part of the work that we do is we do a lot of nonprofit work and fundraising as part of our research. And, we met this mom, who at our, one of our fundraising events who's a GP, and she's also has training in cognitive behavioral therapy and had been working for quite a number of years at a psychology clinic offering CBT and DBT to her patients, not specifically with food allergy, but just in general. And her son happens to have multiple food allergies. And so she introduced herself to me and to, Dr. Chan at this event. And, and so we started talking with her about potentially offering a program. And so we had been really lucky to get extra physician time in our clinic, and so we invited her to join us three days a week.

So she's been seeing families as part of this new program, which we've called Thriving Families Program or TFP. We try to steer away from any word that said anxiety or stress or quality of life because we wanted to make sure that it was inclusive and that it wasn't stigmatizing, which is why we called it Thriving Families, because what the goal is, is to allow families to thrive with their diagnosis and throughout their journey of food allergy. So, this program is offered virtually with some in-person sessions, depending on needs. And it's for a variety of types of patients, anywhere from a newly diagnosed family who might have a fear of blood testing to a patient who is 17 or 18 years old, who's struggling with food allergy treatment. So there's a wide variety of opportunities.

She also does this in the context of like individual, youth only, parent only, family, or group. So there's a variety of different offerings as well, and it really just depends on the needs of the family at the time. And she works with each family for as long as they need. It's unlimited because it's a free healthcare system here. And so being part of the clinic, it allows a direct relationship with the allergist and that GP, where they can discuss the cases together, and she can see all the notes from the past. It's really allows in seamless integration into our allergy program, which I think is quite unique, in Canada at least.

Amanda Whitehouse, PhD 21:18

Yeah. That's amazing. I hope that will happen more obviously with a different structure here. So let's move into, another thing that can hopefully help people with allergy anxiety and their quality of life as well, which is immunotherapy options that we have now. Let's start with oral immunotherapy and talk about what we're seeing with that on quality of life and anxiety.

Lianne Soller, PhD 21:40

We've kind of hit a really good groove now in that the OIT in preschoolers is like the best option for that age group, and it has a massive IMPAACT on quality of life and anxiety. And so I think it's the combination of the treatment and the age you can intervene early enough that the child isn't growing up with an allergy and the fears that become ingrained in that child, as well as preventing the long-term, impact of quality of life, and anxiety on the family.

We've been doing immunotherapy real world OIT since 2017, and what we found is that if you intervene early that the child really doesn't even grow up knowing that they had an allergy. Like they, they don't even realize it. They don't have that aversion to the food, so they're less likely to refuse to eat the food which they need to keep doing in order to maintain their desensitization. And the parents, don't have to worry about all these life transitions, which we already talked about where they're having to hand their kid off to summer camp or a job or a university, and they're worried their child's going to have anaphylaxis, outside of their protective bubble. It's really life-changing. And I think that the data perhaps were mixed in the past because the OIT was being done in older kids and adults, and it was not being done in this age group because there's this fear of not being able to recognize anaphylaxis in small children, which I, I believe you had two episodes

about, um, on your podcast recently, and those were wonderful.

Amanda Whitehouse, PhD 23:11

Yes, the amazing Dr. Pistiner. Yeah

Lianne Soller, PhD 23:14

Those were great episodes. But yes, I think the quality of life issue and anxiety issue is something that we can really address early and we can prevent all these long-term consequences if we just intervene as early as possible with OIT.

Amanda Whitehouse, PhD 23:29

So then of course that leads all of us who don't have preschoolers to go, "Oh, what about..." You know,

Lianne Soller, PhD 23:35

Yeah. So we've been collecting data on that for quite some time. We haven't published it yet, so that will be something that we'll be doing hopefully in the next year or two. We're just waiting to gather enough sample size to be able to show something that might be helpful to families. But yes, I anticipate it'll be similar that really any treatment, as long as it's safe, and the child is not reacting all the time, that there will be an impact on quality of life and

Amanda Whitehouse, PhD 24:03

Yeah. I always think and just suspect from my experience and my clients that the initial investment of time and energy and stress is high, higher when the kids are older, as you described. But I think over time that really is worth it in the long haul.

Lianne Soller, PhD 24:19

Yes, I agree. And the dropout rates for OIT in preschool are quite low. We are not seeing a representative sample of whole population with allergy. But all, every patient in our clinic is offered some sort of treatment. So it's not like we're cherry-picking those who we think are going to benefit the most so that our data looks good. Everybody is being offered. And so we're finding over time that maybe initially the doctors were choosing patients who it would be easier to do treatment on because they were motivated. But over the years, it's been a more come one, come all to the program. And so we've definitely seen some changes in terms of the data and, and what we're, what we're finding with patient dropouts and with adherence. And it, it's changing over time.

Amanda Whitehouse, PhD 25:06

Yeah. I'm going to jump out of order because that makes me think of something else I wanted to ask you about is your other role working across Canada with providers. And I, I know here in the States we don't have enough people offering this. People are really struggling to find them. So I was just wondering if you could comment on that piece of your work and what the status of things are in Canada for finding immunotherapy providers.

Lianne Soller, PhD 25:28

Sure. Yeah, definitely. So, um, I am the scientific director for a foundation called the Canadian Food Allergy Immunotherapy Foundation. And part of that is, um, well, funding, but also research and advocacy to increase access to food allergy treatment across the country. And we're starting with doing that locally in Vancouver, in British Columbia. But the goal, and we're starting to now go national. We have a committee of allergists and healthcare providers across Canada who are doing this great work with us collecting information on their patients who are receiving treatment. But as part of this foundation, one of the programs that we delivered for the first time in 2025 was a symposium where we actually brought together allergists from our local Vancouver area to learn about immunotherapy and learn about how to do immunotherapy. We had local speakers from Vancouver, from our BC Children's site. And we spent the whole day going through various topics on immunotherapy, anywhere from how to set up your office to how to mix peanut powder and draw up in a syringe. And it was a really wonderful day. There were about 50 guests that attended, and so it just shows like the interest. In BC, I think there's maybe 80 allergists, and like 50 of them came to the day. I think that what is perhaps unique to Canada... I know there's a group in the US doing similar, but, is the real world aspect and using grocery store products to do immunotherapy as opposed to waiting for clinical trials to be approved or new drugs to be approved. It allows for families from variety of different backgrounds to access treatment. It is very inexpensive. And for the Canadian context where everything is, you know, quote unquote "free," people don't want to pay thousands of dollars for drops from a pharmacy. They really want to be able to get something free. So if we can allow them to do their treatment, their entire peanut treatment with a bottle of PB2 from Costco for $20, that's quite inexpensive. And so I think that that's maybe that's why it's been so successful here in Canada, because it's really following the model of, of trying to be as free as possible or as close to free as possible and just allowing that access for everybody.

Amanda Whitehouse, PhD 27:50

One last thing I want to touch on, SLIT, which is sublingual immunotherapy, just for the audience before we dive in, I want to clarify in case they don't remember, can be done with pharmacy mixed drops and extracts, and maybe not always, but generally speaking, food-based drops are another option. So let's talk about your research on SLIT. This is my favorite article of yours because I'm so on board with this mindset and helping people with the anxiety aspect of treatment.

Lianne Soller, PhD 28:16

So I think SLIT is I, I'm biased, but I think it's the best.

Amanda Whitehouse, PhD 28:22

I agree. I totally agree. This is really awesome. Thank you

Lianne Soller, PhD 28:24

Yeah, because it's super safe, like nobody has reactions or their reactions are very minimal. It can be done in any age, and it can be done very easily and cheaply, which we've already talked about. When we first started our program for OIT in 2016, we were looking at the Vickery study on early peanut OIT, and it was not a lot of patients. There were like 40 patients in the study, but it showed great safety and great effectiveness of a low dose OIT of 300 milligrams. And that kind of got us going into that foray of peanut OIT for preschoolers. And then over the years we kind of, "Oh, maybe the cashew, like we have to do something about the cashew allergy." So we started to offer OIT to other foods. And then when Ed Kim's paper on SLIT was published, that showed better than we thought effectiveness, we were like, "Oh, what if we did SLIT for older kids?"

We were just about to start offering OIT to older kids, and this was before COVID, right before the pandemic hit. And so we were planning out a clinic in person, and we were going to hire a nurse. We were going to have OIT for older kids. But, Dr. Chang came back from the American college meeting, and he was like, "I talked to Ed Kim, and Ed Kim said that we should do SLIT in older kids." I was like, "Okay, here we go. Another crazy idea that now I have to implement." But I think it was a blessing in disguise because from that point onwards, really we just rolled with that idea. And so anyone who's six and up, it's very easy in our clinic. It's zero to five, or s- right under six, they get OIT, and then six and up is SLIT. So it makes it super easy for everyone to explain. It's not like you're being treated unfairly. Your age is this.

And so we've been offering SLIT to as many foods as possible really. There's certain foods that you can't use, do SLIT for because they clump together, like chia seeds, for example. But almost any other food you can do SLIT to. and so we, we were just offering it to a few people initially. We started off with the highly motivated patients who had failed OIT and were older. then like, "Oh, just like, this is so easy. Let's just offer it to everybody." And the kicker is every single visit of ours was virtual. Every single one.

So all the visits, even the first one, virtual. Yeah. And the only anaphylactic reactions we ever had were because of dosing errors where, sorry to say, dad gave double the dose and the kid had anaphylaxis. And then the other one was an asthma exacerbation, which the parent thought was anaphylaxis. But otherwise, we've had itchy mouth, you the typical mouth symptoms. Some GI as well, but mild to, at the very most, moderate symptoms from dosing. And so patients are doing their doses at home. We have a massive province, BC, if people don't know the geography. We've got patients coming from perhaps 12, 15 hours away to come to Children's Hospital. Imagine them having to come in every two to four weeks to get their treatment. It's not accessible. So now it's, now it's from home.

Amanda Whitehouse, PhD 31:54

what's the accessibility outside of your clinic as far as how easy it is to find a SLIT provider in Canada versus OIT? Here in the US it is harder.

Lianne Soller, PhD 32:03

Honestly, it hasn't taken

Amanda Whitehouse, PhD 32:04

Okay. Same.

Lianne Soller, PhD 32:06

So it, it's very difficult. I think, uh, I think it'll change hopefully soon. It does take quite a long time for the research to be ingrained in clinical practice. If we can imagine 2017 was when we started doing OIT and it really didn't-- OIT really didn't take off till probably the early 2020s. So it's, it's taking a long time. Um, but I do think that it, it's starting to shift, and especially with the symposium that we offered in the fall as part of the foundation. That really opened people's eyes to how easy SLIT is, and that perhaps if they don't want to do OIT, they, they should still probably do SLIT. because I think they thought they had to do both or that they should do OIT and not SLIT. If a provider is worried about the safety issues and the resource utilization, and just how many patient questions they're going t be getting, the SLIT is way easier. So that would be kind of my recommendation of if you want to start, start with SLIT.

Amanda Whitehouse, PhD 33:08

Yeah, I agree, and I wish it was more accessible because I want to tell all of the families that I'm struggling with, with the anxiety, it's the perfect, it's the Goldilocks of you don't have to have the scary part of OIT, but you get the relief from that anxiety that you have about the allergen, and then you have multiple pathways from there if you want to move forward or stick with it. It's, it's hopefully going to catch on here too.

Lianne Soller, PhD 33:29

Initially when we started SLIT, families were asking, "Oh, I'm going to have to be on SLIT for so long. This is going to take forever. Am I ever going to be able to eat the food?" so we decided that, we were going to do two years of SLIT, and then we were going to just see if they could tolerate the OIT maintenance dose of 300 milligrams. We'll do it in clinic as a food challenge. So if there's a reaction, it can be controlled and there's a co-team or ED if needed." And that actually went extremely well.

Dr. Kim's paper was three to five years on SLIT before they did the 5,000 milligram challenge. So he didn't do a low-dose challenge, but we wanted to get these kids onto the real food so that especially those who are in high school or going to university can just take a peanut a day, or they don't have to do their mixture. So we wanted to make it easier for families. And, so we did find about 80% of the kids were able to switch from SLIT to OIT without reacting. And those who did react, reacted at the last dose, and typically with mild symptoms. So what we would do instead of reverting back to SLIT was we would just start them on OIT at a lower dose and then tell them to build up to maintenance. So it really just allowed for much smoother sailing through the protocol. They did SLIT, they didn't react, and then they had their OIT low-dose challenge and saved a lot of time as well for the physician. So it was a really interesting way of doing it.

Amanda Whitehouse, PhD 34:58

Absolutely. Hopefully it'll keep growing because I think that's going to be really, really helpful for the community. Let's wrap up by just talking about what else should we keep an eye out for?

Lianne Soller, PhD 35:09

Yeah. So, um, one of the things that we really are excited about right now is the looking at long-term adherence data and long-term anxiety data. So we know that, uh, with preschoolers that, you know, OIT is pretty good, it's safe, it's effective, most patients are not dropping off. But what happens when they finish their OIT? When they've done their exit challenge and they're not being followed regularly anymore, are they still adherent to their food? Are they eating it regularly? So we're starting to look at that data.

I'm actually quite excited to see that because I anticipate that the long-term data isn't as good as we think it's going to be, and that, that will then bring up another, another area of research where we need to figure out how are we going to keep these kids on long term. So that's, that's one area that I think is going to be really important. And then the other one is the data that we're collecting. So we've been collecting data from across Canada for many years now, and our database is quite large, like in the thousands. So we're really excited to publish on larger dataset looking at different age groups, looking at different treatments, virtual versus in-person, to really see and be able to understand what are the differences with the different protocol options that are offered across the country. So that's a really exciting project as well that I'm excited

Amanda Whitehouse, PhD 36:27

Thank you so much. What's the best way for people to follow the work that you're doing? I mean, it's hard for some of us who don't have journal access and so forth to, to keep up to date

Lianne Soller, PhD 36:35

So we have a website. It is F-A-I-Tprogram.org. We also have Facebook and Instagram, although I'm the administrator, and I have very little time to update Facebook and Instagram, so that one is really just when we publish papers occasionally we'll publish those on, on those sites. But the website is really where we have our most up-to-date research. We've got our publications. We have current research, people-- how, how people can get involved. Um, so yeah, and things about our team. Yeah.

Amanda Whitehouse, PhD 37:06

Wonderful.

Lianne Soller, PhD 37:07

to find

Amanda Whitehouse, PhD 37:07

Thank you. I appreciate you being here there's so much more we could have covered, but thank you for taking the time to do all of those with us

Lianne Soller, PhD 37:13

I appreciate that. Thank you so much.

Amanda Whitehouse, PhD 37:15

I hope today's conversation has helped you see that research can be really interesting and has helped you to expand your thinking beyond just what treatment options might be available to me or what might we be eligible for, and think about the bigger picture of treatment and how it impacts people. After today's conversation, here are three action steps that you can take if you want to follow up. First, take a moment to follow FAIT, canadianfaitfoundation.org, the group that is funding research, training, and access to oral immunotherapy and sublingual immunotherapy in Canada. If you're in the area and you're curious about BC Children's Hospital's allergy programs, you can find them at bchildrens.ca And finally, if you're looking for a resource that will support you through all of these emotional and practical aspects of treatment decisions, I would invite you to check out my new book, From Fear to Freedom: A Workbook for Navigating Allergy Immunotherapy. It brings together expert medical perspectives, patient stories, psychological point of view, and practical activities and exercises to help the whole family navigate treatment decisions and then follow through with greater confidence and self-compassion. Thank you so much to my guest, Dr. Soller. Thank you to those of you listening, helping the show continue to grow by sharing episodes and leaving ratings or reviews for the show wherever you listen. Until we talk again, remember, don't feed the fear

Speaker 2 38:37

The content of this podcast is for informational and educational purposes only, and is not a substitute for professional medical or mental health advice, diagnosis, or treatment. If you have any questions about your own medical experience or mental health needs, please consult a professional. I'm Dr. Amanda Whitehouse. Thanks for joining me. And until we chat again, remember don't feed the fear.