
New Peanut Allergy Drug Shows ‘Lifesaving’ Potential - daegloe
https://www.nytimes.com/2018/11/18/well/live/new-peanut-allergy-drug-shows-lifesaving-potential.html
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matthewmcg
We've done this with one of our children who has severe peanut-triggered
anaphylaxis. Over the course of about 18 months, the dosage increased from
milligram quantities of peanut flour dissolved in water to 3 grams of roasted
peanuts. The dose typically doubled each time.

With the initial administration of each up-dose, we would typically see a
barely detectable and mild reaction such as hives or coughing. After a few
daily treatments at each dosage, there would be no discernible reaction. We
have always been aware we were close to the edge of our child's sensitivity
because certain things that seem to increase her immune system loading such as
having a fever or being exposed to large amounts of seasonal pollen require
reducing the dose slightly to avoid reactions.

We have reached a dosage where it is unlikely that our child would ever face a
serious reaction from accidental exposure, which is the goal of the treatment.

I hope that the availability of an FDA approved peanut preparation (and patent
protection for some elements of this) does not increase the cost of performing
this treatment.

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mmikeff
This sounds very similar to a treatment that my daughter is due to start next
year at a Cambridge allergy clinic in the UK. She'll have to take the peanut
based medication every day. She will have the initial dose in a hospital in
case she has a reaction and then take the remainder of the doses home. Every
two weeks we'll go back to the hospital to increase the dose. I'm very excited
about the potential for this to keep her safer, but also terrified at the
prospect of deliberately feeding her peanut.

[http://www.peanut.cuh.org.uk/](http://www.peanut.cuh.org.uk/)

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phkahler
Please don't call it medication. It's peanut protein plain and simple. People
have done this gradually increasing exposure method on their own for years -
though it can be dangerous to do so and is not recommended (I might try it
myself, but would not have my child do it). It's not a big medical
breakthrough, it's a highly controlled increasing dose of peanut protein.

~~~
chapium
According to Webster, Definition of medicine 1a : a substance or preparation
used in treating disease

I think taking a prescribed amount of peanut protein to treat this allergy
fits that definition.

~~~
phkahler
Sure, and some people who have gone through this eat a couple of reese's
pieces each day for maintenance. I'm not kidding with that either. They don't
call it medicine. That word in common usage carries a number of connotations
that I don't think really apply in this case.

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phkahler
>> The goal of the treatment is not to cure the allergy or enable children to
eat peanut butter sandwiches, but to reduce the risk that an accidental
exposure to trace amounts will trigger a life-threatening reaction in someone
with a severe allergy, and relieve the fear and anxiety that go along with
severe peanut allergies.

If ever a hedge a hedge there was, this is it: This works really well and they
can eat a couple peanuts, but we don't actually know why or how or to what
extent it's dependable...

~~~
euphoria
While true, as a parent of someone with a life-threatening milk allergy, I can
tell you that even this seemingly minimal outcome were able to be reproduced
with consistency, it would be life-changing for my family. The amount of time,
anxiety, emotions, and medical payments involved with a life-threatening
allergy is staggering.

It does not seem that they are claiming this is dependable as a "cure", but
they are claiming that it is dependable for incidental exposure, which seems
to be a corollary from the ongoing treatment including eating a peanut a day.

~~~
phkahler
...as a parent of someone with a life-threatening milk allergy...

I'm with you on that. I follow the links to every story like this and they're
almost all the same - hope but no cure.

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pkaye
> Though only 4.3 percent of children receiving the active drug experienced
> side effects categorized as severe, compared to less than 1 percent of the
> children on placebo...

So are they saying <1% (ie atleast one) of children on placebo experienced
severe side effects?

~~~
nraynaud
It’s because they don’t have a good causality link for adverse effect. If
something bad happens, you’re not sure it’s because of the treatment.

So in the accounting, you take everything adverse against the treatment,
wether it’s the placebo or the medicine under test, and you compare the
difference between the two as rate of adverse effect for the medicine under
test. And then there is a giant poker game to balance the benefits and the
risks.

~~~
tikkabhuna
I met someone who worked on the admin side of NHS trials. They said exactly
what you posted, anything noteworthy that happens should be reported. If you
take the placebo and get hit by a bus outside the hospital, it should be
reported. That way if 10% of patients in the study get hit by a bus they have
more data.

Obviously a silly example but if things aren't reported because they don't
appear to be connected to the study, we don't have the data to analyse at a
higher level.

~~~
Nasrudith
The funny thing is that such "irrelevant" data may hint at something real if
it happens frequently enough. Like the whole Parkinson's medication with
increases urge to gamble as a side effect. That sounds like somebody in a
clinical trial making excuses at first glance.

~~~
freehunter
Exactly. If people taking a drug tend to get hit by a bus more frequently, it
could actually indicate that the drug increases risky behavior, decreases
peripheral vision, causes lapses in attention span, etc.

It doesn't mean that getting hit by a bus is a side effect of the medicine,
but rather getting hit by a bus is a potential outcome of one of the side
effects of the medicine.

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kristianc
Yeah - who'd have thought that exposure to an allergen in small amounts could
help build up resistance to that allergen?

The levels of peanut allergies correlates quite heavily with early-years
education and parents freaking out about keeping schools and homes a nut-free
zone.

~~~
gregmac
We discovered my child's peanut allergy at around 8-9 months old, when she had
barely-noticeable redness around her mouth the first time we gave peanut
butter to her, followed by full-on hives the second time. She's been tested by
an allergist a couple times since then, and still has a strong reaction.

Our home was not nut-free prior to that point, and obviously she did not
attend school. Had we exposed her directly to peanuts earlier, would it have
made a difference? Right now, no one knows because the underlying cause of
these allergies is unknown. I have no allergies at all, and my wife has only
seasonal allergies (ragweed for sure, maybe pollen).

So who'd have thought exposure to an allergen would help? Well when she was
born the prevailing advice was explicit to _avoid_ exposure in the first few
months. That advice has reversed recently (and after my child was born), based
on a study in 2015 [1]. There are still babies that get peanut allergies even
when they're exposed at only a few months old, so it's not like this is fool-
proof.

Maybe in a few years/decades the underlying cause of food allergies will be
well understood, and we'll look back on this time in the same way we currently
look back on the attitudes of smoking in the early 20th century.

[1] [https://www.health.harvard.edu/blog/new-guidelines-
preventin...](https://www.health.harvard.edu/blog/new-guidelines-preventing-
peanut-allergy-babies-2017011711049)

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ggm
Reading around, this and related OIT work on adults. At least one of the drugs
in stage2 trials is also good for asthma. (etokimab)

As a partner of somebody with severe nut anaphylaxis I'm heartened by the news
but still watching from the sidelines

~~~
fnbr
(I'm also the partner of someone with severe nut anaphylaxis.)

Can you link me to anything? I was pretty discouraged by the result as the
article explicitly says that the trial didn't work on adults:

"The treatment was not effective in the small number of adults enrolled in the
study."

~~~
ggm
[https://www.foodallergy.org/about-fare/blog/update-on-
immuno...](https://www.foodallergy.org/about-fare/blog/update-on-
immunotherapies-for-peanut-allergy)

[https://ir.anaptysbio.com/news-releases/news-release-
details...](https://ir.anaptysbio.com/news-releases/news-release-
details/anaptysbio-announces-positive-top-line-proof-concept-data-anb020)

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refurb
I’m really curious to see how much Aimmune charges for their drug, which the
article states is just defatted peanut flour.

Of course, a lot of money went into the regulatory process of running the
trials and getting it approved, but I still suspect people will be critical if
they charge $15,000 per year for it.

~~~
flurdy
In a similar Guardian article, the treatment course is stated to cost £17,000
GBP. Hopefully available free via NHS soon as I have a daughter with nut
allergies.

[1] [https://www.theguardian.com/society/2018/nov/18/peanut-
aller...](https://www.theguardian.com/society/2018/nov/18/peanut-allergy-
treatment-around-the-corner-but-cost-raises-concerns)

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raverbashing
I'll make sure my kids eat (some) peanuts/peanut products before they develop
an allergy.

~~~
le-mark
Careful with that line of thinking. My son was 6 months old when I gave him a
small bit of the peanut butter cookie I was eating. He could have died. I
would not wish that experience on anyone.

~~~
jwineinger
4-6 months is exactly the recommendation now though. See
[http://peanutallergyfacts.org/resources/prevention-of-
peanut...](http://peanutallergyfacts.org/resources/prevention-of-peanut-
allergies/) and
[http://www.allergy.org.au/images/pcc/ASCIA_PCC_Guidelines_Al...](http://www.allergy.org.au/images/pcc/ASCIA_PCC_Guidelines_Allergy_Prevention_Infants_2016.pdf).

> One of the most significant advances in food allergy occurred with the
> release of the results from The Learning Early about Peanut Allergy (LEAP)
> study in early 2015. Led by Dr. Gideon Lack of Kings College in London, LEAP
> showed a reduction in the development of peanut allergies of up to 86
> percent by children who were exposed to peanut protein early

I say this not to diminish the scare you had. My son is allergic to peanuts so
I know the fear. But if a population can see 86% reduction in new allergies,
I'm all for it.

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thanosnose
Israeli scientists have already shown that early childhood exposure to peanuts
can prevent these allergies.

[https://www.timesofisrael.com/israeli-kids-help-prove-
early-...](https://www.timesofisrael.com/israeli-kids-help-prove-early-
exposure-to-peanuts-prevents-allergies/)

Also, peanut allergies hardly affect anyone. As a society, why waste resources
on such endeavors when we have diseases like cancer that affect millions every
year?

~~~
thomnottom
* In kids that don't already have the allergy. In which case early exposure may kill them.

~~~
thanosnose
Even kids with allergies benefit.

"—Among children with some reaction to peanuts on the skin test: Only 11
percent of peanut eaters developed an allergy versus 35 percent of
abstainers."

