Trial registered on ANZCTR


Trial ID
ACTRN12616000322437
Ethics application status
Approved
Date submitted
23/02/2016
Date registered
11/03/2016
Date last updated
7/07/2016
Type of registration
Prospectively registered

Titles & IDs
Public title
A multicentre, randomized, controlled trial of Probiotic and Peanut Oral Immunotherapy (PPOIT) in inducing desensitisation or tolerance in children with peanut allergy compared with Oral Immunotherapy (OIT) alone and with placebo.
Scientific title
A phase 3, multicentre, randomized, controlled trial evaluating the effectiveness of Probiotic and Peanut Oral Immunotherapy (PPOIT) in inducing desensitisation or tolerance in children with peanut allergy compared with Oral Immunotherapy (OIT) alone and with placebo.
Secondary ID [1] 288591 0
NIL
Universal Trial Number (UTN)
Trial acronym
PPOIT-III
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Peanut Allergy 297734 0
Food Allergy 297735 0
Condition category
Condition code
Inflammatory and Immune System 297919 297919 0 0
Allergies

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
PEANUT FLOUR:
Peanut Flour (50% peanut protein) that is prepared under food manufacturing regulations.

PROBIOTIC (Lactobacillus rhamnosus GG)
The probiotic to be used is Lactobacillus rhamnosus GG (Health World Ltd).
Probiotic will be prepared under strict Food Manufacturing Regulations. Supply will be as dry powder pre-packaged in 350g bottles containing 160g of probiotic. The daily dose of 2x10^10 cfu will be measured using a standardised scoop. Participants will be instructed to mix one scoop of the probiotic in water at a temperature NOT exceeding 38 degrees Celsius. The probiotic must be stored at 4 degrees Celsius.

1. PPOIT- Probiotic and peanut OIT taken daily for 18 months.
2. OIT - Probiotic placebo and peanut OIT taken daily for 18 months.
3. Placebo - Probiotic placebo and OIT placebo taken daily for 18 months.

The study consists of:

- Screening visit occurs within three months before Day 1.

T0 - RUSH Induction - Day 1 phase is the start of treatment.
- On Rush Induction, participants receive increasing doses of peanut (or placebo) OIT every 20 minutes to reach a final dose of 12mg of peanut protein or placebo (cumulative dose 24mg peanut protein).
- There will be a maximum of 8 doses administered at a starting dose of 0.1mg.
- Nutritional services or an individual independent of the study will prepare the Rush doses.
- Peanut protein (or placebo) will be mixed with food (e.g. yoghurt).
- Subjects will receive a single dose of 2x10^10 cfu LGG (or placebo) (one level scoop mixed into 100 ml of water, at a temperature NOT exceeding 38 degrees Celsius) prior to initiation of the Rush Phase.

- Subjects will be monitored (including at least every 20 minutes vital signs and general nursing assessment of the skin and chest) for 2 hours after the last dose during the Rush Phase.
- The study doctor and study nurse will be present at all times during the Rush Phase.
- The rush phase will be performed in hospital.
- Spirometry will be performed on all participants aged 8 or older, and younger participants who are capable of doing spirometry reproducibly, before the participant receives their first dose of peanut oral immunotherapy (or placebo) and 2 hours after receiving the final dose of Day 1 Rush Induction.
- Subjects who complete the Rush protocol without reaction will commence the Buildup Phase at a daily dose of 25mg peanut protein (Dose 9) on the day after the Rush Induction day.
- If a subject reacts to one of the doses during rush induction, the Rush schedule will be ceased and they will commence the Buildup Phase at the dose immediately below the reaction-eliciting dose starting on the day after the Rush Induction day. The remaining Rush doses that were not completed on day 1 will be incorporated into the Buildup phase (modified Buildup schedule for that subject) and subsequent incremental dose increases will proceed through all remaining doses of the Rush schedule followed by the doses in the Buildup schedule. For example, if a reaction occurs following dose 6, the subject will commence the Buildup phase at the dose 5 amount and will be instructed to start this reduced dose on the following day).


BUILDUP Phase - Weeks 1 – 16 is the Buildup Phase.
- During Buildup, the daily dose of peanut OIT (or placebo OIT) is increased every 2 weeks until a maintenance dose of 2000mg is reached. This is expected to take 16 weeks.
- Each dose increase will be administered in hospital under medical supervision.
- Hospital visits for dose increases (Updose visits) will be scheduled every 2 weeks. Where indicated, dose adjustments will result in deferment of a dose increase to the next scheduled visit.
- Spirometry will be performed on all participants aged 8 or older, and younger participants who are capable of doing spirometry reproducibly, before the participant receives their first increased dose of peanut oral immunotherapy (or placebo)
- Peanut protein will be mixed into food (e.g. yoghurt).
- Subjects will also take a fixed daily dose of 2x10^10 cfu Lactobacillus rhamnosus GG (or placebo) (one level scoop mixed into water, at a temperature NOT exceeding 38°C) once daily prior to the OIT treatment.
- Subjects will be monitored for 2 hours after the treatment has been administered.

MAINTENANCE Phase - Weeks 16 – 78
- During Maintenance, participants take a daily dose of 2g of peanut protein (or placebo) and a daily dose of 2x10^10 cfu Lactobacillus rhamnosus GG (or placebo) at home and continue until a total of 18 months treatment is completed. If the subject has not completed a minimum of 6 months on maintenance dosing at 18 months, the total duration of treatment will be extended to ensure a minimum of 6 months maintenance dosing.

T1 - Week 78 - One Day after final day of maintenance treatment

T2 - Week 90 - 12 weeks after final day of maintenance treatment

T3 - Week 130 - One year after final day of treatment

All groups will be followed up for 1 year after the treatment period. During this time, at 6 months, a telephone interview will be conducted with the participant to collect information on exposure to peanut/amount of peanut being eaten and allergic reactions.

STRATEGIES TO MONITOR ADHERENCE
We will monitor adherence by daily dosing diary and weighing / counting contents of returned treatment packages.
Intervention code [1] 293987 0
Treatment: Other
Comparator / control treatment
PEANUT PLACEBO:
Peanut Placebo is maltodextrin powder with food colouring and peanut essence that has similar appearance, taste and smell to the active product.

PROBIOTIC PLACEBO:
Probiotic Placebo is maltodextrin. The daily dose will be measured using a standardised scoop. Participants will be instructed to mix one scoop of the placebo in water at a temperature NOT exceeding 38 degrees Celsius. The Probiotic Placebo must be stored at 4 degrees Celsius.
Control group
Placebo

Outcomes
Primary outcome [1] 297435 0
Proportion of participants with long-term sustained unresponsiveness (passed T2 challenge- determined by performing a double bling placebo controlled food challenge (DBPCFC)) in PPOIT vs placebo

Timepoint [1] 297435 0
T2 - Week 90 - 12 weeks after final day of maintenance treatment
Primary outcome [2] 297453 0
Proportion of participants with long-term sustained unresponsiveness (passed T2 challenge- determined by performing a double bling placebo controlled food challenge (DBPCFC)) in PPOIT vs OIT
Timepoint [2] 297453 0
T2 - Week 90 - 12 weeks after final day of maintenance treatment
Secondary outcome [1] 321047 0
Proportion of participants who achieve full desensitization (passed T1 challenge-determined by performing a double bling placebo controlled food challenge (DBPCFC)) in: (i) PPOIT vs placebo; (ii) PPOIT vs OIT; and (iii) OIT vs placebo.
Timepoint [1] 321047 0
T1 - Week 78 - One Day after final day of maintenance treatment
Secondary outcome [2] 321081 0
The cumulative dose tolerated during the T1 challenge- determined by performing a double blind placebo controlled food challenge (DBPCFC)- (cumulative doses below the reaction-eliciting dose if there is a reaction; or total cumulative challenge dose if there is no reaction) in: (i) PPOIT vs placebo; (ii) PPOIT vs OIT; and (iii) OIT vs placebo.
Timepoint [2] 321081 0
T1 - Week 78 - One Day after final day of maintenance treatment
Secondary outcome [3] 321082 0
Proportion of participants who are eating peanut in their diet without reactions at 12 months after cessation of treatment in: (i) PPOIT vs placebo; (ii) PPOIT vs OIT; and (iii) OIT vs placebo. This will be assessed by parent-report during the T3 visit.
Timepoint [3] 321082 0
T3 - Week 130 - One year after final day of treatment
Secondary outcome [4] 321083 0
Change in peanut skin prick test wheal size at end of treatment, and at 12 weeks and 12 months after end of treatment) in: (i) PPOIT vs placebo; (ii) PPOIT vs OIT; and (iii) OIT vs placebo. This outcome is assessed by a skin prick test.
Timepoint [4] 321083 0
T1 - Week 78 - One Day after final day of maintenance treatment

T2 - Week 90 - 12 weeks after final day of maintenance treatment

T3 - Week 130 - One year after final day of treatment
Secondary outcome [5] 321084 0
Quality of life score (at end of treatment(T1) and at 12 months after end of treatment (T3) in: (i) PPOIT vs placebo; (ii) PPOIT vs OIT; and (iii) OIT vs placebo. The quality of life score to be used will be calculated from a validated Food Allergy Quality of Life-Parent Form (FAQL-PF) completed by the parents on behalf of the children.
Timepoint [5] 321084 0
T1 - Week 78 - One Day after final day of maintenance treatment

T3 - Week 130 - One year after final day of treatment
Secondary outcome [6] 321396 0
Change in immunological measures (sIgE and sIgG4) at end of treatment, and at 12 weeks and 12 months after end of treatment) in: (i) PPOIT vs placebo; (ii) PPOIT vs OIT; and (iii) OIT vs placebo. This will be determined from blood samples.
Timepoint [6] 321396 0
T1 - Week 78 - One Day after final day of maintenance treatment

T2 - Week 90 - 12 weeks after final day of maintenance treatment

T3 - Week 130 - One year after final day of treatment
Secondary outcome [7] 321633 0
Correlation between change in peanut skin prick test wheal size and sustained unresponsiveness at end of treatment, and at 12 weeks and 12 months after end of treatment) in: (i) PPOIT vs placebo; (ii) PPOIT vs OIT; and (iii) OIT vs placebo. Sustained unresponsiveness is assessed by a Double Blind Placebo Controlled Food Challenge.
Timepoint [7] 321633 0
T1 - Week 78 - One Day after final day of maintenance treatment

T2 - Week 90 - 12 weeks after final day of maintenance treatment

T3 - Week 130 - One year after final day of treatment
Secondary outcome [8] 321634 0
Correlation between change in immunological measures (sIgE and sIgG4) and sustained unresponsiveness at end of treatment, and at 12 weeks and 12 months after end of treatment) in: (i) PPOIT vs placebo; (ii) PPOIT vs OIT; and (iii) OIT vs placebo. Sustained unresponsiveness will be determined by a Double Blind Placebo Controlled Food Challenge.
Timepoint [8] 321634 0
T1 - Week 78 - One Day after final day of maintenance treatment

T2 - Week 90 - 12 weeks after final day of maintenance treatment

T3 - Week 130 - One year after final day of treatment
Secondary outcome [9] 325494 0
Proportion of participants with long-term sustained unresponsiveness (passed T2 challenge- determined by performing a double bling placebo controlled food challenge (DBPCFC)) in OIT vs placebo.
Timepoint [9] 325494 0
T2 - Week 90 - 12 weeks after final day of maintenance treatment

Eligibility
Key inclusion criteria
Children are eligible for the study if they meet all of these criteria:
- Children aged between 1 year and 10 years of age
- greater than 7kg (the weight considered safe for the administration of an Epipen/EpiPen Jr)
- Confirmed diagnosis of peanut allergy as defined by a failed Double-Blind, Placebo-Controlled Food Challenge (CBPCFC) with peanut and a positive SPT or SIgE to peanut at screening.
Minimum age
1 Years
Maximum age
10 Years
Gender
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
Children are not eligible for the study if they meet any of these criteria:
- History of severe anaphylaxis (as defined by persistent hypotension, collapse, loss of consciousness, persistent hypoxia or ever needing more than three doses of intramuscular adrenaline or an intravenous adrenaline infusion for management of an allergic reaction)
- Severe anaphylaxis during the study entry DBPCFC (defined as persistent hypotension, collapse, loss of consciousness, persistent hypoxia, or requiring three or more doses of intramuscular adrenaline or an intravenous adrenaline infusion for management of an allergic reaction)
- FEV1 less than 85% at rest and FEV1/FVC is less than or equal to 85% at rest or ongoing chronic persistent asthma (as per Australian Asthma Foundation guidelines)
- Underlying medical conditions (e.g. cardiac disease) that increase the risks associated with anaphylaxis
- Use of beta-blockers, ACE inhibitors, proton pump inhibitors
- Inflammatory intestinal conditions, indwelling catheters, gastrostomies, immune-compromised states, post-cardiac and/or gastrointestinal tract surgery, critically-ill and those requiring prolonged hospitalisation or other conditions that may increase the risks of probiotic associated sepsis
- Already taking probiotic supplements within the past 6 months (does not include formula)
- Reacting to the placebo component during the study entry DBPCFC
- Have received other food immunotherapy treatment in the preceding 12 months
- Currently taking immunomodulatory therapy (including allergen immunotherapy)
- Past or current major illness that in the opinion of the Site Investigator may affect the subject’s ability to participate in the study e.g. increased risk to the participant
- Subjects who in the opinion of the Site Investigator are unable to follow the protocol
- Another family member already enrolled in the trial (to maintain safety and blinding)

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Participants will be enrolled and randomized up to one week prior to Rush Induction. Enrolled participants will be randomized to PPOIT, OIT or placebo groups with an allocation ratio of 2:2:1. Randomization will be stratified by study site (RCH, PCH, WCH), and also by age (1-5yr; 6-10yr) and peanut SPT wheal size (less than and equal to 10mm; greater than 10mm).
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Each study site will have their own randomization list stratified by age and peanut SPT wheal size. Randomization will be in randomly permuted blocks of variable length. An independent statistician in the Clinical Epidemiology and Biostatistics Unit (CEBU) at Murdoch Childrens Research Institute (MCRI) will provide the randomization schedules to hospital pharmacies at each site. The study pharmacist at each hospital will assign the next available unique Randomisation Number for the participant's appropriate stratum using the randomisation list and notify the trial personnel of that number.
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Parallel
Other design features
Participants will be randomized to one of three groups
1. PPOIT- Probiotic and peanut OIT taken daily for 18 months.
2. OIT- Probiotic placebo and peanut OIT taken daily for 18 months.
3. Placebo- Probiotic placebo and OIT placebo taken daily for 18 months.
Phase
Not Applicable
Type of endpoint(s)
Efficacy
Statistical methods / analysis
Sample Size Estimation:
The study sample size will be 200 participants, randomly allocated in a 2:2:1 ratio to PPOIT (n=80), OIT (n=80) and placebo (n=40). This ensures sufficient power to support both primary outcomes. Since the study aims to assess two primary endpoints, generalised Bonferroni-adjustment of p-values and confidence interval limits will be applied in order to warrant a global type I error probability of 5%.
For the primary outcome A - PPOIT vs placebo: We conservatively estimate a proportion of 60% of participants will achieve long term sustained unresponsiveness with PPOIT based on the results of our previous Randomized Controlled Trial; and the natural rate of resolution of peanut allergy is conservatively assumed to be equal to or below 15%. Applying a 2:1 ratio for randomization to PPOIT and placebo arms, sample sizes of n=62 and n=31 will provide 90% power with 2-tailed 0.005 significance level (10% of the global significance level) to detect the difference between 60% long term sustained unresponsiveness in the PPOIT group and 15% in the placebo group.

For the primary outcome B - PPOIT vs OIT: A pilot study of peanut OIT reported sustained unresponsiveness in 30% of participants. A sample size of n=70 in PPOIT and OIT groups will provide 80% power with 2-tailed 0.045 significance level (90% of the global significance level) to detect the difference between 60% long term sustained unresponsiveness in the PPOIT group and 35% in the OIT group.

Allowing for 15% loss to follow up, we will recruit 80 children to each of the PPOIT and OIT groups. In our completed RCT, loss to follow up was 10%.

Statistical Analysis:
Data handling, verification and analysis will be performed within the Clinical Epidemiology and Biostatistics Unit at MCRI. Statistical analysis will follow standard methods for randomized trials and the primary analysis will be by intention to treat.
All available data from all participants who received any investigational product will be included in the analysis of the safety data (referred to as the safety population).
All demographic and baseline continuous outcomes will be presented as mean and standard deviation (or medians and interquartile ranges for skewed data), whilst categorical outcomes will be presented as absolute and relative frequencies in the three groups.

Primary outcome:
The primary outcome is whether a participant has long-term sustained unresponsiveness (passed T2 challenge). Results will be summarised as the number and proportion of infants with long-term sustained unresponsiveness in the 3 treatment groups. Comparison between PPOIT with placebo as well as between PPOIT with OIT will be presented as the absolute and relative risks, accompanied by the respective Bonferroni-adjusted confidence interval (confidence levels: 0.995 and 0.955), with the null hypothesis of no difference between the groups tested using Pearson’s chi-squared statistic (significance levels: 0.005 and 0.045, respectively). Moreover, logistic regression analysis with adjustment for the stratification variables (centre, age category and SPT wheal size) used in the randomization, will be conducted and odds ratios with respective confidence intervals reported.

Secondary outcomes:
Group comparisons (PPOIT vs placebo; PPOIT vs OIT; OIT vs placebo) regarding dichotomous outcomes will be performed using odds ratio estimates with 95% confidence intervals (CIs), obtained from a logistic regression analysis with adjustment for the stratification variables (centre, age category and SPT wheal size) used in the randomization.

Continuous outcomes will be compared using differences between mean values, estimated from normal linear regression models with the same stratification adjustments. Peanut SPT wheal size, sIgE and sIgG4 levels will be reported as mean and standard deviation by treatment group, and presented at end of treatment (18 months), at assessment of sustained unresponsiveness (21 months) and at end of study (30 months). The difference in means between groups and the corresponding 95% CI (PPOIT vs placebo; PPOIT vs OIT; OIT vs placebo) will be obtained by using an unadjusted linear regression and the hypothesis of no difference between the groups tested with a t-test. Analogously, quality of life continuous outcome measures will be summarized by treatment group at end of treatment (18 mos) and end of study (30 mos) and presented as a difference in means between groups and the corresponding 95% CI (PPOIT vs placebo; PPOIT vs OIT), obtained by using an unadjusted linear regression. If continuous outcomes don’t follow normal distributions they will be summarized as median and interquartile ranges (IQR) in the three groups, and comparison between groups will be performed by the Wilcoxon rank-sum (Mann-Whitney) test.

Recruitment
Recruitment status
Recruiting
Date of first participant enrolment
Anticipated
Actual
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
Sample size
Target
Current
Final
Recruitment in Australia
Recruitment state(s)
SA,WA,VIC
Recruitment hospital [1] 5319 0
The Royal Childrens Hospital - Parkville
Recruitment hospital [2] 5320 0
Womens and Childrens Hospital - North Adelaide
Recruitment hospital [3] 5322 0
Princess Margaret Hospital - Subiaco
Recruitment postcode(s) [1] 12782 0
3052 - Parkville
Recruitment postcode(s) [2] 12783 0
6008 - Subiaco
Recruitment postcode(s) [3] 12784 0
5006 - North Adelaide

Funding & Sponsors
Funding source category [1] 292946 0
Government body
Name [1] 292946 0
National Health and Medical Research Council
Address [1] 292946 0
Level 1
16 Marcus Clarke Street
Canberra ACT 2601
Country [1] 292946 0
Australia
Primary sponsor type
Other
Name
Murdoch Childrens Research Institute
Address
The Royal Children's Hospital,
Flemington Road,
Parkville,
Victoria
3052
Country
Australia
Secondary sponsor category [1] 291717 0
None
Name [1] 291717 0
Nil
Address [1] 291717 0
Nil
Country [1] 291717 0
Other collaborator category [1] 278848 0
Hospital
Name [1] 278848 0
Women and Children's Hospital Adelaide
Address [1] 278848 0
Women's and Children's Hospital
72 King William Road
North Adelaide
South Australia
5006
Country [1] 278848 0
Australia
Other collaborator category [2] 278849 0
Hospital
Name [2] 278849 0
Princess Margaret Hospital
Address [2] 278849 0
Roberts Road,
Subiaco,
Perth,
Western Australia
6008
Country [2] 278849 0
Australia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 294451 0
The Royal Children's Hospital Human Research Ethics Committee
Ethics committee address [1] 294451 0
The Royal Children's Hospital
Level 4, South Building
50 Flemington Road
Parkville Vic 3052
Ethics committee country [1] 294451 0
Australia
Date submitted for ethics approval [1] 294451 0
Approval date [1] 294451 0
12/02/2016
Ethics approval number [1] 294451 0
35246A
Ethics committee name [2] 294452 0
The Women's and Children's Health Network (WCHN) Human Research Ethics Committee’s (HREC)
Ethics committee address [2] 294452 0
72 King William Road,
North Adelaide,
South Australia,
5006
Australia
Ethics committee country [2] 294452 0
Australia
Date submitted for ethics approval [2] 294452 0
Approval date [2] 294452 0
Ethics approval number [2] 294452 0
Ethics committee name [3] 294453 0
Princess Margaret Hospital Ethics Committee
Ethics committee address [3] 294453 0
Roberts Road,
Subiaco,
Perth,
Western Australia
6008
Ethics committee country [3] 294453 0
Australia
Date submitted for ethics approval [3] 294453 0
Approval date [3] 294453 0
Ethics approval number [3] 294453 0

Summary
Brief summary
At present there is no cure for food allergy. People with a food allergy need to avoid the food they are allergic to in order to stay safe. However we know that accidental exposure is common. Research shows that 50% of children with a peanut allergy are accidentally exposed to peanut within 2 years.

Researchers have begun to look at the effectiveness of 'oral immunotherapy' as a treatment for food allergy. In oral immunotherapy, patients with food allergy are given small amounts of the food they are allergic to and tested for food allergy after a set amount of time. Results have been mixed. Studies suggest that oral immunotherapy can induce desensitization (short term ability to tolerate the food allergen while the patient continues on therapy) but has a limited ability to induce sustained unresponsiveness ( longer term ability to tolerate the food allergen after treatment is stopped for at least 2-4 weeks or longer). We previously conducted a Randomized Controlled Trial to evaluate a novel combination treatment approach involving administration of probiotic together with oral immunotherapy - Probiotic and Peanut Oral Immunotherapy (PPOIT). In our study we found that just over 80% of children who received PPOIT tolerated peanut after stopping treatment for more than 2 weeks compared with only 4% in the placebo group. PPOIT was highly effective at inducing sustained unresponsiveness - if 9 children were treated with PPOIT, 7 would benefit.

PPOIT participants received a daily dose of probiotic together with peanut protein (peanut flour) for 18 months. The probiotic was taken as a fixed daily dose. The dose of peanut protein was commenced at very low levels then increased every 2 weeks over a period of 8 months to reach a maintenance dose of 2g peanut protein.

This study (PPOIT-III) will build on our previous PPOIT and PPOIT-II study. PPOIT-III is a multi- site randomized controlled trial to evaluate the effectiveness of Probiotic and Peanut Oral Immunotherapy (PPOIT) in inducing desensitisation or tolerance in children with peanut allery compared with Oral Immunotherapy (OIT) alone and with Placebo. Children will take increasing doses of peanut protein and a set amount of probiotic for 16 weeks. Children will then continue on a set maintenance dose until a total of 18 months treatment is completed. Children will be tested for peanut allergy at the start of the study, at the end of PPOIT treatment T1 (18 months) and T2 (12 weeks) and T3 (1year) after treatment.

The discovery of a safe and tolerable treatment for food allergy will have great public health benefit.
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 63746 0
Prof Mimi Tang
Address 63746 0
Allergy and Immune Disorders
Murdoch Childrens Research Institute
Flemington Rd
Parkville
Victoria
3052
Country 63746 0
Australia
Phone 63746 0
+61 3 9345 5911
Fax 63746 0
+61 3 9345 4848
Email 63746 0
mimi.tang@rch.org.au
Contact person for public queries
Name 63747 0
Ms Christine Axelrad
Address 63747 0
Allergy and Immune Disorders
Murdoch Childrens Research Institute
Flemington Rd
Parkville
Victoria
3052
Country 63747 0
Australia
Phone 63747 0
+61 3 9345 6974
Fax 63747 0
Email 63747 0
Christine.Axelrad@rch.org.au
Contact person for scientific queries
Name 63748 0
Ms Christine Axelrad
Address 63748 0
Allergy and Immune Disorders
Murdoch Childrens Research Institute
Flemington Rd
Parkville
Victoria
3052
Country 63748 0
Australia
Phone 63748 0
+61 3 9345 6974
Fax 63748 0
Email 63748 0
Christine.Axelrad@rch.org.au