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Experimental treatments may reduce the sensitivity of children with peanut allergies.



(Reuters Health). Peanut allergy can be life-threatening, but a new study suggests that the peanut protein itself can be used to slowly set the intensity of an allergic reaction.

After daily exposure for 24 weeks to the equivalent of one peanut in the form of powder sprayed on food, two thirds of the volunteers in the study were able to tolerate the amount of peanut protein found daily in two peanuts. This response received only 4 percent who received confusion or a placebo.

However, the treatment did not work for adults. And side effects, such as abdominal pain and vomiting, prompted almost 12 percent to abandon the study (versus 2 percent in the placebo group), and 14 percent needed adrenaline to stop severe allergic reactions.

“This is not something to start at home,” said Dr. Michael Perkin of St. George’s University of London in an editorial in the New England Journal of Medicine, where the study also appears. The details were published Sunday at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Seattle.

Aimmune Therapeutics, which makes peanut powder known as AR101, is paid for in a study involving 551 adults and children. The company announced a summary of the results in February. New details will help professionals to assess the risks and limitations of therapy.

Even when it works, it is unclear how long this advantage persists when a person stops taking peanut powder a day. Co-author Dr. Brian Vickery, director of the Atlanta's Children's Hygiene Allergy Program, said that researchers plan to conduct a follow-up study to ensure that less frequent powder consumption will be equally effective.

At the moment, “sustainable, potentially lifelong, regular consumption may be required to maintain resistance to allergens,” said Perkin.

Much smaller studies have shown that tiny amounts of peanut can increase tolerance, and some allergists are already giving it to patients, Vickery said. "The debate continues about whether this is the right thing to do."

A standardized powder, similar to AR101, makes it easier to adjust the dose, because the amount of allergen is strictly controlled, and you know that there is no contamination from nuts and germs, he said. “As soon as you complete the update, can you switch people to peanuts?” This can happen; probably, be.

Peanut allergy accounts for the majority of food allergy deaths, and this condition affects about 2 percent of children in the United States. Approximately 1 percent of the reaction is difficult. In extreme cases, inhalation of peanut dust can cause a crisis.

“There are children who will react to a milligram of peanuts. For these children, life can be hellish, because even with the best care in the world, they can meet the micro-contamination of food and react, ”said Dr. Gideon Luck, the head of children's allergies at King's College London, who did not participate in the new study. "Therefore, for these children, I think this is a real step forward."

The treatment is not for the faint of heart.

The need for an injection of adrenaline to cancel the allergic reaction more than doubled in children who received peanut powder. Fourteen percent of children needed an injection once, 5 percent had two or more episodes, including two children who had six episodes.

Treatment is a “great commitment,” said Vickery. “This requires many changes in lifestyle, many visits to the doctor, many observations. This is definitely not a cure. ”

But experience can be transformative for people, he added. “It can really free people in ways they never experienced,” alleviating the fears of traveling by plane, sleeping in a friend’s house, and other impressions that carry the ghost of an accidental impact. “It allows people to be comfortable in situations that would otherwise be really difficult for them.”

SOURCE: bit.ly/2qUA6BA and bit.ly/2FsBAgr Journal of New England Medicine, November 18, 2018.

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