
For Children With Peanut Allergies, F.D.A. Experts Recommend a New Treatment - pseudolus
https://www.nytimes.com/2019/09/13/health/peanut-allergy-children.html
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Mathnerd314
> _In July, the Institute for Clinical and Economic Review, a nonprofit
> research organization in Boston that evaluates medical evidence, concluded
> in a report that there was inadequate evidence to justify the immunotherapy
> treatment over simply avoiding peanuts._

To save you some time reading the report, this is because the quality-of-life
results that they normally use to measure effectiveness weren't published in
time. Their rating of the evidence is "promising but inconclusive".

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novia
This is not new. It's new that it has a brand name, but there have stories
released repeatedly about exposure therapy for some time.

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kleinsch
It’s news in that it’s taking a step toward being available to real people.
The previous stories you’re talking about were about research studies, not
drugs available to the public.

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kgwgk
The “drug” is just purified peanut protein. Comparable treatments have been
offered by allergy specialists for a while and not just in the context of
clinical studies.

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dpark
If it’s FDA approved, it’s a pretty big step forward. Previously-available
desensitization therapies for food allergies (OIT, SLIT) are not FDA approved
and thus are not covered by insurance.

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kgwgk
Insurace covers many procedures that are not FDA approved because they don't
require special drugs or devices. Covering OIT with unapproved peanuts would
probably be cheaper than OIT using this $4000/year peanut extract.

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dpark
Insurance doesn’t cover OIT. Perhaps they will once it’s actually a cheaper
option vs the FDA approved treatment that they’re eventually required to
cover. Currently they simply decline to cover it at all because there is no
downside to them.

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kgwgk
But the reason cannot be simply that they "are not FDA approved and thus are
not covered by insurance" given than many non-FDA-approved things are covered.
They could cover them already (and they would if they thought ER visits would
be reduced as a result). And as far as I know some insurance plans do actually
cover these treatments.

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dpark
1\. Yes, they could hypothetically cover whatever they want beyond what is
required by law. They don’t cover food allergy desensitization because
covering it costs money and denying it has no downside for the insurance
companies.

2\. What non-FDA approved treatments are typically covered?

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kgwgk
1\. Anaphylactic shocks also cost them money. And they can also limit access
to drug-based treatments if they don’t find them justified.

2\. Tonsillectomy, physiotherapy... are you really unable to come up with some
examples of surgical procedures and other physical and mental therapies not
based on drugs?

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dpark
You’re right. The limit isn’t just _FDA_ approval. OIT and SLIT have, to my
understanding, no medical approval of any meaningful sort. It’s an extremely
early treatment (relatively speaking) and considered experimental.

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kinkrtyavimoodh
The Western World, and the US in particular, needs to take a long hard look at
why allergies are so prevalent there compared to the East. I am from India,
and while allergies are not unheard of, they are also pretty rare. I went
through 15 years of schooling without anyone in my class ever having anything
like an anaphylactic shock. Compare that to the hysteria about peanuts in my
kid's school in the US.

To be clear I am not blaming the school. If there are kids with deadly
allergies towards everyday foods, yes, there will need to be strong
precautionary measures, but it's insane that we consider this high prevalence
of allergies as normal here in the US, despite strong evidence from other
countries that this doesn't need to be the case.

With our son (born and raised in the US), we basically exposed him to common
allergens from Day 1. We'd rub them against his lips or place a very small
amount on his tongue, and so on. Occasionally put a small bit of peanut paste
in his formula, a bit of shrimp once he was a bit older, and so on.

He's 7 now, and has so far exhibited no common allargies.

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matthewmacleod
This isn’t a terribly helpful anecdote. There is plenty of ongoing research
into why there are higher rates of allergies in developed countries.

I’m sure early exposure to allergens help (and is AFAIK recommended practice
now) but other things play a part - I’m sure I saw some research recently
suggesting that one reason developed countries have higher allergy rates is
due to lower prevalence of parasitic worm infections.

The natural world is complicated.

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aszantu
I think peanut allergies are often linked with other allergies. It comes down
to anti-nutrients, namely lectins I think? Lectins are in all seeds, so even
if you don't react to say beans or wheat, you might react in a way you don't
recognize as reaction. I was depressed for half my life until I accidentally
discovered that leaving out all seeds would solve the depression.

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josho
I’m bothered that medical research has seen influence by the MBAs. Ie. we
don’t research looking for cures anymore because then you’ll only sell the
drug once. Instead research management therapy so that you can have lifelong
customers that need your product (pill) daily for the rest of their life.

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tptacek
This is popular narrative, especially on message boards, but is there any
evidence that drug researchers are somehow biased towards medications that
manage rather than cure conditions? Or is it just that cures are harder to
discover than mitigations?

If you look at a list of current blockbuster drugs, you'll find that they are
not primarily lifetime scripts. For instance, the second best-selling drug of
2015, Gilead's Harvoni, cures Hep C in a couple months. Most anti-cancer
agents, which dominate the blockbuster lists, are not taken permanently.

Humira, AbbVie's arthritis med, has topped the charts for years, and is taken
long-term, but it seems unlikely to me that if AbbVie or some other pharma
found a way to _permanently cure_ arthritis that they wouldn't sell the hell
out of that product.

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giardini
Given a _cure_ (not a "maintenance" drug), companies would "sell the hell out
of" that product until there were no more customers; then the market would
collapse and the corporation would go bankrupt. The medical market is slightly
more "graceful" in that new customers enter the market each generation.

This is not "popular narrative", it's established economic reality for any
good that can be either rented or sold.

Compare selling vs renting a software package. Once a market is saturated no
more sales can be made and the seller's company will likely collapse. In
contrast, a renter collects each year until the software is superceded (but
can add improvements each year to postpone that) or no longer useful.

I once worked for a company that sold a software package for a one-time
(large) purchase fee plus a trivial annual maintenance fee. The employees
walked the halls puzzling "What happens when we sell our last package?".
Answer: company saw the light and tried to change from a purchase model to a
rental model. All customers revolted and some threatened to sue (for software
support ad infinitum). The company collapsed. Luckily I was gone by then.

And yes, the MBAs are responsible largely: they do good b/c they can tell you
what business model to use to achieve your goals. Few industries are more
concerned about how to make money than the pharmaceutical industry:

[https://duckduckgo.com/?q=business+models+for+pharmaceutical...](https://duckduckgo.com/?q=business+models+for+pharmaceuticals)

But we also need corporations that are willing to develop true cures instead
of "managements". Most MBA's aren't interested in that; maybe government can
help by providing better incentives.

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Tomte
That's all great, but we're not talking about software, and you haven't
addressed your parent poster's point in the slightest.

Of course someone _could_ prioritize "management". That's not interesting.
Interesting is the question whether they actually do, and you cannot argue
that from first principles, philosophy-style. You need observations, news
reportings, whatever. But facts, not "I could imagine...".

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rypskar
it is good to see some progress with allergy treatment, especially peanut
allergy. Many do not understand how having peanuts in the same room can cause
allergy, so it is difficult to avoid it.

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dwightgunning
I once shook hands with a new acquaintance who, unbeknownst to me, had just
been snacking on a few peanuts at a bar:
[https://photos.app.goo.gl/7tvD65JmV45M4Mpw5](https://photos.app.goo.gl/7tvD65JmV45M4Mpw5)

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NeedMoreTea
A handshake? Well that's me educated today. I'd always presumed food allergies
required you to _eat_ the problem food.

I don't think I have ever, not once, seen a media piece on allergies point out
that eating isn't always required. That seems like a major failing in the
reporting of allergies over the years.

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est31
In fact the skin reaction is utilized for allergy testing:
[https://en.wikipedia.org/wiki/Skin_allergy_test](https://en.wikipedia.org/wiki/Skin_allergy_test)

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NeedMoreTea
Now those I knew of, but they mostly use a pin prick or scratch, and then
measure the reaction and swelling in the skin. Which if anything, reinforces
the misunderstanding the allergen needs to get into the system directly.
Though I hadn't encountered the patch tests wikipedia mentions.

The article and mention of handshake leave me with an entirely different
impression of how careful I might need to be if I started in food preparation
etc.

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trophycase
Soooo, kind of like homeopathy?

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phyzome
In the broad, pedantic sense... yes! This is literally homeopathy, with "like
cures like". So are vaccines.

...but no, not in the common sense. :-)

