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(Reuters Health) – The allergy to peanut can be life threatening, but a new study suggests that peanut protein can itself be used to slowly reduce the intensity allergic reaction.
After a daily exposure of 24 weeks to the equivalent of a peanut in the form of a powder sprinkled on food, two-thirds of the volunteers participating in the study were able to tolerate the amount of peanut protein found in two peanuts a day. Only 4% of people who received a powder substitute or placebo had this answer.
The treatment did not work for adults, however. And side effects such as abdominal pain and vomiting pushed nearly 12% of participants to drop out of the study (versus 2% in the placebo group) and 14% needed epinephrine to end severe allergic reactions.
"It's not something to start at home," said Dr. Michael Perkin of St. George's University in London in an editorial of the New England Journal of Medicine, where the study also appears. The details were unveiled Sunday at the annual meeting of the American College of Allergy, Asthma & Immunology (ACAAI) in Seattle.
Aimmune Therapeutics, which manufactures peanut powder AR101, funded the study, which involved 551 adults and children. The company announced a summary of results in February. The new details will help experts assess the risks and limitations of therapy.
Even when it works, it's unclear how long the benefit will persist once a person has stopped taking peanut powder daily. Co-author Brian Vickery, director of the Atlanta Healthcare Children's Food Allergy Program, said the researchers were planning a follow-up study to determine whether less frequent use of the powder would be equally effective.
For now, "sustained, potentially life-long consumption may be needed to maintain tolerance to allergens," said Perkin.
Much smaller studies have suggested that minute amounts of ground peanuts could increase tolerance, which some allergists already give patients, Vickery said. "There is a debate going on to find out if it's the right thing to do."
A standardized powder such as AR101 facilitates the adjustment of the dose because the amount of allergen is tightly controlled and you know that there is no contamination by walnuts and microbes, he said. "Once you have finished the update, could you switch people to peanuts? This may happen will probably be. "
Peanut allergy is the cause of the majority of deaths due to food allergy and affects about 2% of children in the United States. In about 1% of cases, the reaction is severe. In extreme cases, the inhalation of peanut dust can cause a seizure.
"There are kids who will react to milligram amounts of peanuts. For these children, life can be catastrophic because even with the best care in the world, they can suffer micro-contamination of food and react, "said Dr. Gideon Lack, Head of Pediatric Allergy at King & # 39; s London College, which did not participate in the new research. "So for these kids, I think it's a real step forward."
The treatment is not for the faint of heart.
The need for an epinephrine injection to reverse the allergic reaction has more than doubled in children taking peanut powder. Fourteen percent of children needed injection once, 5 percent had two episodes or more, including two children having had six episodes.
The treatment is "a big commitment," Vickery said. "It requires a lot of lifestyle changes, a lot of doctor visits, a lot of supervision. It is definitely a treatment not to try at home. "
But experience can transform people, he added. "It can really free people like they have never done before," relieves the fear of flying, spending the night at a friend's house, and other experiences of accidental exposure. "This allows people to feel comfortable in situations that would otherwise be very difficult for them."
SOURCE: bit.ly/2qUA6BA and bit.ly/2FsBAgr. The New England Journal of Medicine, online November 18, 2018.
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