Casey Cohen, PhD

HCPLive Five – Allergy Updates at AAAAI 2025

 2025 Academy of Allergy, Asthma, & Immunology (AAAAI) 

annual meeting in San Diego to connect with colleagues, explore late-breaking data, and attend hundreds of sessions.

 Allergy Team reported live from San Diego, conducting dozens of interviews and covering late-breaking research. In this iteration of the HCPLive Five, the team highlighted standout video interviews, covering topics such as insect allergy testing, chronic rhinosinusitis, omalizumab for food allergies, oral immunotherapy with autoclaved peanuts, and the WAYPOINT phase 3 trial assessing tezepelumab for nasal polyp management.

When to Test for Insect Sting Allergies, with David Golden, MD

David Golden, MD, from Johns Hopkins University, discussed the pitfalls of over-testing for insect sting allergies. He emphasized that a positive test does not confirm an allergy, as many people with positive results experience no reaction to stings.

Testing should be reserved for patients with anaphylactic reactions, as unnecessary testing can lead to undue worry and even disqualify individuals from opportunities like military service. Unlike peanut allergies, insect allergy tests do not predict reaction severity, making it crucial for clinicians to avoid misinterpreting strong test results as indicators of severe allergy risk.

When an Allergist Should Refer Endoscopic Sinus Surgery for Chronic Rhinosinusitis, with Kent Lam, MD

Kent Lam, MD, from Eastern Virginia Medical School at Old Dominion University, discussed when allergists should refer patients with chronic rhinosinusitis for endoscopic sinus surgery; surgery is recommended when symptoms persist despite treatment with topical steroids, saline irrigation, or antibiotics.

The procedure aims to improve sinus drainage and ventilation rather than remove tissue. Lam emphasized setting patient expectations regarding risks such as bleeding, scarring, and symptom persistence.

Omalizumab Performs Better Than Oral Immunotherapy for Food Allergy, with Robert Wood, MD

Robert Wood, MD, from Johns Hopkins Medicine, discussed the OUtMATCH trial comparing omalizumab and oral immunotherapy (OIT) for food allergies. The study found omalizumab superior in the intent-to-treat analysis (36% vs 19%;

 = .031), but per-protocol analysis—excluding dropouts—showed similar effectiveness (

OIT had a high dropout rate due to side effects, while omalizumab was well tolerated. Wood emphasized the need for individualized treatment, as OIT may offer long-term immune changes, but omalizumab provides a safer alternative with fewer side effects.

Patients Tolerate Oral Immunotherapy Better with Autoclaved vs Blanched Peanuts, with Casey Cohen, PhD

A study found that peanut-allergic patients tolerated oral immunotherapy better with autoclaved peanuts than with blanched peanuts. Casey Cohen, PhD, from McGill University, explained that autoclaving—using high temperature and pressure—reduces peanut-specific immunoglobulin binding, resulting in fewer severe reactions.

In a double-blind trial of 10 participants, the median tolerated dose was significantly higher for autoclaved peanuts (300 mg vs. 9 mg). No participants required epinephrine for autoclaved peanuts, whereas all were for blanched peanuts.

Tezepelumab Lowers Nasal Polyp Severity in CRSwNP During Phase 3 WAYPOINT, with Joseph Han, MD

The phase 3 WAYPOINT trial demonstrated that tezepelumab significantly reduced nasal polyp severity in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP), lowering the need for surgery by 92%. Tezepelumab significantly improved nasal congestion, sense of smell, and overall symptom scores at 52 weeks.

Investigator Joseph Han, MD, from Eastern Virginia Medical School, highlighted the near elimination of surgery in the treatment group. These findings support tezepelumab as a promising treatment option for CRSwNP, reducing reliance on systemic steroids and surgical intervention.

GlaxoSmithKline, Regeneron Pharmaceuticals, and AstraZeneca Pharmaceuticals for Lam, Genentech USA for Wood, none for Cohen, and GlaxoSmithKline, Genzyme Corporation, Regeneron Healthcare Solutions, Medtronic, Merck Sharp & Dohme, Optinose, AstraZeneca Pharmaceuticals, Aerin Medical, and PFIZER for Han.

Videos

Counting down the most impactful news at major medical meetings, it’s the HCPLive Five! This episode focuses on 5 key allergy updates from the 2025 American Academy of Allergy, Asthma, and Immunology (AAAAI) annual meeting.


A study discovered that patients tolerate peanut oral immunotherapy with autoclaved peanuts better than oral immunotherapy with raw, roasted, or blanched peanuts.

“We found that the allergic people could actually tolerate way higher doses of the autoclave peanut when compared to the blanched peanut, and we think this could be some very helpful first step into seeing if this could be used as a potential substrate for treatment,” Casey Cohen, PhD, from McGill University, told 

2025 American Academy of Allergy, Asthma, & Immunology (AAAAI) 

annual meeting taking place in San Diego from February 28 – March 3.

Cohen and colleagues’ research on autoclaved peanut oral immunotherapy was presented as a late-breaker during the meeting. Already, the team knew from earlier studies in their laboratory that autoclaving peanuts under a high temperature and pressure may reduce the binding of peanut-specific immunoglobulin. Investigators wanted to see whether individuals with peanut allergies experienced an 

The team recruited 10 peanut-allergic individuals from Montreal Children’s Hospital to participate in 2 double-blind oral food challenges using blanched or autoclaved peanuts. The sample had 3 females and a median age of 25 years old. Investigators collected data on tolerated doses, skin prick test wheal diameters, and allergic reactions.

The peanuts were autoclaved at 266 °F for 30 minutes. With autoclaved peanuts, participants could tolerate a maximum dose of 300 mg and a cumulative dose of 44 mg, compared with a 9 mg median tolerated dose of blanched peanuts.

No participants on autoclaved peanuts needed epinephrine, meanwhile all blanched peanut challenges required ≥ 1 dose of epinephrine. Participants had less severe reactions with autoclaved peanuts.

“We are very confident that not only is it this autoclaving—this process—diluting the peanut from its proceeds, but we think it's actually changing it in a different way, making this a very unique substrate,” Cohen said. “It's changing it in such a way that we might have all these new things in this peanut there's still some level of those allergens there, which is important to reduce tolerance, but way less of it intact. We get different pieces of all different lengths and sizes and shapes, and I think that is where really the money might be for this potential new treatment for peanut allergy.”

There are no relevant disclosures for Cohen.

Cohen, C, Rivero, D, Ali, A, et al. Peanut-Allergic Subjects Tolerate Higher Doses of Autoclaved Peanuts Compared to Blanched During Oral Food Challenges. Late-breaker presented at AAAAI 2025 in San Diego from February 28 – March 3.

Articles

A study found that peanut-allergic patients tolerate autoclaved peanuts better than blanched peanuts during oral immunotherapy. Autoclaving, which involves high temperature and pressure, reduces the binding of peanut-specific immunoglobulin, allowing higher doses to be tolerated. In a trial with 10 participants, autoclaved peanuts resulted in less severe allergic reactions and no need for epinephrine, unlike blanched peanuts. The process alters the peanut's structure, potentially offering a new treatment approach for peanut allergies by reducing intact allergens while maintaining some allergenic components to build tolerance.

HCPLive spoke with Cohen about how patients with a peanut allergy responded to oral immunotherapy with autoclaved peanuts.