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A new study has shown that an experimental immunotherapy treatment introducing small doses of peanut protein in people with peanut allergies to desensitize their immune system could in reality increase the risk of anaphylaxis.
In the United States, more than 50 million people suffer from allergies – an overreaction of the immune system to a substance that does not affect most other people – and this trend is on the rise. Some are harmless, others go away with age, and others are like nut allergies, all through life.
About 8% of children and 4% of adults suffer from food allergy, causing 200,000 visits to emergency rooms a year. There is currently no FDA-approved treatment to prevent or reduce the symptoms of food allergy, and for people with peanuts in particular, the only option is to vigilantly avoid the problem and to consistently wear an epinephrine injector.
Oral immunotherapy is an emerging experimental treatment that attempts to desensitize the immune system over time with increasing and increasing doses. The goal is not necessarily to eliminate allergy, but to reduce the risk of death by accidental exposure. In clinical trials, it was found to be successful because the patients on treatment passed the food tests monitored without reaction.
However, a review of 12 studies involving more than 1,000 patients followed for one year after treatment showed that this treatment itself significantly increases allergic and anaphylactic reactions rather than preventing them.
Their findings, published in The Lancet, showed that people treated with peanut oral immunotherapy had an anaphylaxis risk of 22%, compared to 7% for those who had not received treatment, ie three times more. Affected individuals were also 8% more likely to use their EpiPen if they were on treatment, twice as many as those who did not.
It is important to note that the researchers do not claim that the treatment does not work, as it has been clearly demonstrated in a clinical setting, but that their analysis highlights the gap between the results obtained in a clinical context and the actual applications. .
There is even a suggestion that the way the treatment is carried out (patients are asked to avoid exposure to peanuts with the exception of their doses) could contribute to the increase in allergic reactions in the real world. The researchers also noted that passing a food allergy test in a controlled environment may not be the best way to predict a person's risk of future allergy in a real-life setting.
"This protection you get from an immunotherapy – which can change every day," said CNN's lead author, Dr. Derek Chu, himself allergic to peanuts. "If you exercise within two to four hours, or if you take a hot shower or if you have an empty stomach, this can change the way your body interacts with the food to which you are are supposedly rendered insensitive. "
The review had reservations, the sample size was small and patients were only followed for one year. The more we know about immunotherapy treatment, the more we can improve not only the treatment, but also the trials designed to test its success. In the meantime, patients can make more informed decisions about the benefits and risks of oral peanut immunotherapy.
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