All Publications


  • Changing Patient Mindsets About Non-Life-Threatening Symptoms During Oral Immunotherapy: A Randomized Clinical Trial. The journal of allergy and clinical immunology. In practice Howe, L. C., Leibowitz, K. A., Perry, M. A., Bitler, J. M., Block, W., Kaptchuk, T. J., Nadeau, K. C., Crum, A. J. 2019

    Abstract

    BACKGROUND: Oral immunotherapy (OIT) can lead to desensitization to food allergens, but patients can experience treatment-related symptoms of allergic reactions that cause anxiety and treatment dropout. Interventions to improve OIT for patients are needed.OBJECTIVE: To determine whether fostering the mindset that non-life-threatening symptoms during OIT can signal desensitization improves treatment experience and outcomes.METHODS: In a randomized, blinded, controlled phase II study, 50 children/adolescents (28% girls, aged 7-17, M=10.82, SD=3.01) completed six-month OIT for peanut allergies. Patients and their parent(s) had monthly clinic visits at the Sean N. Parker Center for Allergy & Asthma Research between 1/5/2017-8/3/2017. All families received identical symptom management training. In a 1:1 approach, 24 patients and their families were informed that non-life-threatening symptoms during OIT were unfortunate side effects of treatment, and 26 patients and their families were informed that non-life-threatening symptoms could signal desensitization. Families participated in activities to reinforce these symptom mindsets.RESULTS: Compared to families informed that symptoms are side effects, families informed that symptoms can signal desensitization were less anxious (B=-0.46, 95% CI (-0.76 to -0.16), p=0.003), less likely to contact staff about symptoms (5/24[9.4%] vs. 27/154[17.5%] instances, p=0.036), experienced fewer non-life-threatening symptoms as doses increased (BInteraction=-0.54(-0.83 to -0.27), p<0.001), less likely to skip/reduce doses (1/26[4%] vs. 5/24[21%] patients, p=0.065), and showed greater increase in patient peanut-specific blood IgG4 levels (BInteraction=0.76(0.36 to 1.17), p<0.001).CONCLUSION: Fostering the mindset that symptoms can signal desensitization improves OIT experience and outcomes. Changing how providers inform patients about non-life-threatening symptoms is a promising avenue for improving treatment.

    View details for DOI 10.1016/j.jaip.2019.01.022

    View details for PubMedID 30682576

  • Providers' Demeanor Impacts Patient Perceptions of Visit Length. Journal of general internal medicine Howe, L. C., Hardebeck, E. J., Leibowitz, K. A., Crum, A. J. 2018

    View details for DOI 10.1007/s11606-018-4665-6

    View details for PubMedID 30215175

  • Physician Assurance Reduces Patient Symptoms in US Adults: an Experimental Study. Journal of general internal medicine Leibowitz, K. A., Hardebeck, E. J., Goyer, J. P., Crum, A. J. 2018

    View details for DOI 10.1007/s11606-018-4627-z

    View details for PubMedID 30128787

  • Making mindset matter. BMJ (Clinical research ed.) Crum, A. J., Leibowitz, K. A., Verghese, A. 2017; 356: j674-?

    View details for DOI 10.1136/bmj.j674

    View details for PubMedID 28202443