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If approved, a new treatment for peanut allergy could allow children to eat small amounts of peanuts without a serious allergic reaction.
For children allergic to peanuts, every bite of food outside the home is an anxiety issue.
Exposure to peanut traces in cookies, cakes or other foods as a result of cross-contamination can result in a serious allergic reaction and even hospitalization.
The findings of a new study could lead to the approval of a new treatment reducing the risk of this type of life-threatening reaction, providing relief not only to children, but also to their parents.
The treatment is not a treatment for peanut allergy. It is also not designed to allow children to eat peanut butter and jelly sandwiches. Instead, the goal is to allow them to tolerate small amounts of peanuts.
"Being able to safely eat one or two peanuts is a huge improvement in children's quality of life – for example, when they go to a friend's house during the night or in a potluck, they avoid peanuts while being able to accidentally ingest a meal. small amount, "said Dr. Stephen Tilles, one of the co-authors of the study and former president of the American College of Allergy, Asthma and Immunology.
For many children allergic to peanuts, this is sufficient protection.
"Some children never want to eat peanuts. They just want to be protected in case they are exposed to it, "said Dr. Tina Sindher, Clinical Assistant Professor at the Sean N. Parker Center for Allergy and Asthma Research at Stanford University. , who did not participate in the study.
The results of the research were presented Sunday at the American College of Allergy, Asthma and Immunology in Seattle and published Monday in the New England Journal of Medicine.
In the study, 372 children with known peanut allergy consumed an increasing amount of peanut protein each day for six months, starting with trace amounts. This was followed by six months at a "maintenance dose", the equivalent of one peanut a day.
This type of treatment is called oral immunotherapy and aims to strengthen the tolerance of the immune system to an allergen.
By the end of one year, more than two thirds of these children aged 4 to 17 years were able to consume 600 milligrams of peanut protein – the equivalent of two peanuts – over the course of a year. A food challenge 'presenting only mild symptoms'.
In contrast, only 4% of the 124 children who took a peanut-free powder during the study – the placebo group – were able to tolerate the same amount of peanut protein.
Half of the children in the treatment group were also able to safely consume 1,000 milligrams of peanut protein during the food challenge.
This treatment, however, may not work for everyone.
Almost all children had adverse reactions during the study. The most common among children who took peanut protein were gastrointestinal pain, vomiting, nausea, itchy skin, coughing and throat irritation.
About one-third of the children in the treatment group had only mild symptoms, compared with 50% in the placebo group.
Serious adverse events occurred in 4.3% of children in the treatment group and less than 1% of children in the placebo group.
In addition, during the study, 14% of children in the treatment group received injections of epinephrine in a severe allergic reaction, compared to 6.5% of children in the placebo group.
Some side effects were severe enough that some children dropped out by the end of the study – almost 12% of children in the treatment group. Sindher is not surprised by this high dropout rate.
"We see him all the time at the clinic," she said. "Some children do not tolerate oral immunotherapy. For example, some people have anaphylactic reaction at the dose they have been taking for two or three weeks in a row. There is a lot of variability in the real world. "
Unfortunately, it is not possible to predict which children will have bad reactions.
"It's hard to know who will follow treatment one or two years later," said Tilles. "But this trial suggested, at least after a year of treatment, that a large proportion of patients are still doing well."
Although the study made the headlines of the allergy community, some reservations were made. The powdered protein used in the study, known as AR101, was developed by Aimmune Therapeutics, who designed and sponsored the clinical trial. The New York Times reported that 5 of the 13 leading authors were employees of Aimmune Therapeutics. The others are paid to sit on the scientific board of the company.
The treatment must still be approved by the US Food and Drug Administration before being available at the clinic. But there will probably be a strong demand for it.
According to the Food Allergy Research & Education website, the rate of peanut or nut allergy among American children more than tripled between 1997 and 2008.
About 40% of children with food allergies have had a serious allergic reaction such as anaphylaxis.
This is not the only potential treatment for life-threatening and fatal food allergies.
Multiple treatments for peanut and other food allergies are under development. Sindher said that many of them are designed to help children tolerate oral immunotherapy.
DBV Technologies has submitted a request to the FDA for an immunotherapy patch that delivers very small amounts of peanuts to the skin – micrograms and not milligrams.
Sanofi is working on immunotherapy delivered under the language. In addition to peanut protein, it includes a compound that can increase the tolerance of the immune system to peanut allergens.
Another treatment tested uses omalizumab – the allergy drug Xolair – parallel immunotherapy. This medicine blocks an antibody that is involved in the allergic reaction to peanuts.
Stanford researchers are also testing a DNA-based vaccine that could reduce the body's inflammatory response to peanuts. The vaccine does not include peanut protein, which reduces the risk of anaphylactic reaction during treatment.
Sindher does not think so.
"At least we find that the incidence of peanut allergies is increasing every year," she said. "But we offer more treatments. We are also trying to learn more about food allergies in order to contribute to prevention strategies. "
A study conducted in 2015 found that early introduction of peanuts in some infants could reduce their risk of developing peanut allergy.
These treatments may offer children more options than just "avoid, avoid, avoid" and carry two EpiPens wherever they go.
"If treatments work, kids will be protected if they eat the equivalent of a peanut," Sindher said. "This is what we call the bite test. If a child has accidentally eaten a cookie containing peanuts, he will not need to be taken to the hospital. "
However, there is one area of research that could significantly reduce the use of this type of treatment: the genetic engineering of a hypoallergenic peanut, which researchers are currently working on.
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