So, Danielle, I know you want to give a little bit of a background about really what this question is all about.

Yeah.

So the clinical question that we were trying to answer were in children with peanut allergy, does oral immunotherapy increase peanut tolerance and what are the adverse effects? But I think it's important just to preface this by saying that when we say oral immunotherapy and when we talk about the intervention here, we're not talking about initial exposure to peanuts.

So we actually did a previous tools for practice that looked at peanut introduction.

So talking about, you know, having that initial exposure with your infant and introducing them to allergens.

Right.

So when we looked at early peanut introduction, so essentially introducing peanuts somewhere between the ages of three and 10 months, that early introduction was associated with lower peanut allergy risk.

right yeah and that's useful because in you know most people are going to be okay with the skin reaction it's that ultimately requiring epinephrine that's the scariest part but there is some evidence for that and we'll get into that just a bit right

Yeah.

I think it's these kids have a higher pain tolerance.

It must be.

Yeah, it's tricky, right? Once you get into this age category, it's like, what are the important things that we're measuring and how are we measuring it? So obviously, you know, it's like a caregiver type scale that we're measuring with, not finding a difference.

But again, it's like something to consider.

We're seeing it with other populations.

No.

And also, sorry, just relaying it back to the outcome.

So, Danielle, I know you want to give a little bit of a background about really what this question is all about.

Yeah.

So the clinical question that we were trying to answer were in children with peanut allergy, does oral immunotherapy increase peanut tolerance and what are the adverse effects? But I think it's important just to preface this by saying that when we say oral immunotherapy and when we talk about the intervention here, we're not talking about initial exposure to peanuts.

So we actually did a previous tools for practice that looked at peanut introduction.

So talking about, you know, having that initial exposure with your infant and introducing them to allergens.

Right.

So when we looked at early peanut introduction, so essentially introducing peanuts somewhere between the ages of three and 10 months, that early introduction was associated with lower peanut allergy risk.

right yeah and that's useful because in you know most people are going to be okay with the skin reaction it's that ultimately requiring epinephrine that's the scariest part but there is some evidence for that and we'll get into that just a bit right

And your co-writer on this tool was Danielle Perry, and she's also on the line.

[laughs] Thanks, James.

I'm Danielle.

I'm a clinical evidence expert with the College of Family Physicians of Canada.

Yeah, no. Yeah, and, and-

But yeah, it's, it's tricky, right? Once you get into this age category, it's like, what are the important things that we're measuring and how are we measuring it? So obviously, you know, it's like a caregiver-type scale that we're measuring with, um, not finding a difference, but again, it's like something to consider.

We're seeing it with other populations.

There was also some stuff on arm position, which actually did make an, have an impact to some degree that would almost clinically relevant.

Yeah, for sure.

So arm position is another interesting one because I just think like it's changed over time, but I'm assuming like, you know, in some clinical practice, it's still, you know, you bring your patient in and maybe they're sitting on the exam table and you're measuring the blood pressure from there.

So this study, it was a trial of 133 patients and it was looking at a few different positioning.

So it was the gold standard or the comparator was the arm supported at heart level.

So it was like supported up there at the heart, compared that to having their arm resting on their lap or their arm hanging at their side.

And what they found was when they compared that supported arm to having your arm at your lap, the lap overestimated it by about four millimeters of mercury for both systolic and diastolic.

So what was the main context that you guys came up with? Daniel, do you want to do a couple of them and then Tony end it up? Sure.

There was also some stuff on arm position, which actually did make an, have an impact to some degree that would almost clinically relevant.

Yeah, for sure.

So arm position is another interesting one because I just think like it's changed over time, but I'm assuming like, you know, in some clinical practice, it's still, you know, you bring your patient in and maybe they're sitting on the exam table and you're measuring the blood pressure from there.

So this study, it was a trial of 133 patients and it was looking at a few different positioning.

So it was the gold standard or the comparator was the arm supported at heart level.

So it was like supported up there at the heart, compared that to having their arm resting on their lap or their arm hanging at their side.

And what they found was when they compared that supported arm to having your arm at your lap, the lap overestimated it by about four millimeters of mercury for both systolic and diastolic.

So what was the main context that you guys came up with? Daniel, do you want to do a couple of them and then Tony end it up? Sure.