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Experimental treatment can desensitize allergic children to peanuts

(Reuters Health) – Groundnut allergy can be life threatening, but a new study suggests that peanut protein itself may be…

(Reuters Health) – Groundnut allergy can be life threatening, but a new study suggests that peanut protein itself may be used to slow down the intensity of the allergic reaction.

After 24-week daily exposure to a similar nutritional nasal spray in food, two thirds of volunteers in the study could tolerate the amount of peanut protein found in two peanuts daily. Only 4 percent who received a dummy, or placebo, powder had this answer.

However, the treatment did not work for adults. And side effects such as abdominal pain and vomiting resulted in nearly 12 percent withdrawing from the study (against 2 percent in the placebo group) and 14 percent needing epinephrine to stop serious allergic reactions.

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

Aimmune Therapeutics, which makes the peanut powder known as AR1

01, paid for the study, involving 551 adults and children. The company announced a summary of the results in February. The new details help experts to measure the risks and limitations of treatment.

Although it works, it is not clear how long the benefit persists when a person stops taking peanut powder daily. Co-author Dr Brian Vickery, Head of Child Care in the Atlanta Food Allergy Program, said researchers are planning a follow-up study to see if less frequent consumption of the powder will be as effective.

Currently, “long-term, potentially lifelong, regular consumption may be needed to maintain allergen tolerance,” said Perkin.

Much less studies have suggested that small amounts of grounded peanuts can increase tolerance and some allergists already give it to patients, said Vickery. “It’s an ongoing debate if it’s right to do.”

A standardized powder like AR101 makes it easier to adjust the dose because the amount of allergen is tightly controlled and you know there is no contamination from tree nuts and microbes, he said. “When you have completed the update, you can switch people to peanuts? It may happen.”

Groundnut allergy accounts for the bulk of food allergy and the state affects about 2 percent of the children in the United States. In about 1 percent, the reaction is difficult. In extreme cases breathing dust can cause a crisis.

“There are children who will respond to milligrams of peanuts. For these children life can be hell because even those with the best care in the world can come across microcontamination of food and react,” says Dr. Gideon Lack, Head of Child Allergy at King’s College London, who was not involved in the new research. “So for these kids, I think this is a real step forward.”

The treatment is not too weak heart.

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

The treatment is “a big commitment,” said Vickery. “It requires many lifestyle changes, many doctor visits, a lot of monitoring. This is definitely a non-try-at-home treatment.”

But the experience can be transformative to people, he added. “It really can liberate people in ways they have never experienced,” relieves the fear of flying by air, sleeping in a friend’s house and other experiences that carry the spectacle of accidental exposure. “It allows people to be comfortable in situations that would otherwise be really challenging for them.”

Source: bit.ly/2qUA6BA and bit.ly/2FsBAgr New England Journal of Medicine, online November 18, 2018. [19659017] Our Standards: Thomson Reuters Trust Principles.

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