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Health care disparities refer to differences in health and health care between groups that are closely associated with governmental, social, economic, and/or environmental policies. To address this gap in knowledge, a forum to address health disparities in different regions of the world was developed as an American Academy of Allergy, Asthma & Immunology (AAAAI) presidential initiative (under Dr Jonathan Bernstein) in partnership with the World Allergy Organization to better understand political and socioeconomic issues within different countries and how they affect their health care systems. The first region selected was the Middle East. Representatives from Egypt, Israel, Lebanon, and Iran were invited to speak at this forum. Although we were not able to be inclusive of all countries in this region, it is apparent that the health care systems for those that participated are heterogeneous as a result of socioeconomic, educational, and governmental infrastructures. However, all regions noted health disparities that appeared to be linked to social determinants of health. Unfortunately, conflict in this region has had an additional adverse effect on these health care systems, making solutions even more challenging. However, recognition of the problems that loom large for allergy/immunology in particular can provide an opportunity for international collaboration that focuses on providing patient and physician education and identifying strategies to improve access to specialized health care.

Background: Oral immunotherapy containing peanut (Arachis hypogaea) allergen powder-dnfp (PTAH) (Palforzia [Aimmune Therapeutics, Brisbane, Calif]) for 9 to 12 months resulted in higher tolerated amounts of peanut protein in PTAH-treated individuals aged 4 to 17 years with peanut allergy than in placebo-treated participants. Objective: We aimed to describe additional long-term pooled safety data and changes in peanut sensitization markers from baseline through approximately 5 years of treatment. Methods: The results from 6 clinical trials of PTAH (3 controlled and 3 open-label extension studies [N = 1227]) were pooled, and analysis of safety outcomes and immunologic data was performed. The PTAH doses were administered sequentially as follows: initial dose escalation (dose increased to 6 mg over 2 days), updosing (dose increased every 2 weeks to 300 mg for a minimum of 6 months), and maintenance dosing (300 mg per day). Results: There was a trend toward decreased adverse events (AEs) at years 1 and 2 that was maintained up to 5 years, with 94% of patients experiencing mild or moderate AEs and only 13% discontinuing PTAH use because of AEs overall. Gastrointestinal symptoms were the most commonly reported treatment-related AEs. A downward trend in systemic allergic reactions was also reported. PTAH treatment resulted in reduced levels of peanut-specific IgE after the first year and increased levels of peanut-specific IgG4, with a lowered peanut-specific IgE:IgG4 ratio. A reduction in median peanut skin prick test wheal diameter was observed (11.50 mm at baseline vs 5.75 mm at year 5). Conclusion: Long-term immunomodulation without any new safety signals was reported with PTAH immunotherapy in the largest safety data set and longest treatment duration for oral immunotherapy published to date.