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The first medical treatment for children allergic to peanuts is expected to be approved next year, but its accessibility remains worrisome, even though it consists mainly of peanut flour.
A study conducted in the United States and the Evelina Children's Hospital in the United Kingdom shows that the gradual increase of a very small initial dose of peanut protein over a six-month period has allowed two-thirds of children to eat two peanuts without harmful effects. The article, published in the New England Journal of Medicine, follows a similar trial conducted in Cambridge, UK, four years ago.
The latest results come from scientists funded by Aimmune Therapeutics, which was launched to study this treatment of peanut allergies. They think that they will receive approval for their treatment, delivered in a capsule that is broken and sprinkled on food in the middle of next year.
The difference between their trial of a treatment they call AR101 in 550 children and those who preceded it "lies in the rigor with which the process was undertaken," said Dr. Stephen Tillis , allergist, professor at the University of Washington in Seattle and co-author. of the study.
"It's a pharmaceutical grade treatment product. It's not just peanut flour you can buy somewhere. This is, he said, "a quality that the FDA [Food and Drug Administration, which licences drugs in the US] here would be satisfied with ".
Children participating in the trial were treated in three phases, starting with a very low dose, increased every two weeks for at least 20 weeks, with daily administration at home up to 12 months.
Most children participating in the trial started by reacting to an amount of peanut protein greater than 10mg – a US peanut contains about 300mg and a smaller British peanut about 160mg. At the end of the test, the median tolerated amount was 1000 mg, or approximately four peanuts. "For me, it's stunning," said Tilles.
Scientists believe that children will have to continue consuming peanut protein to stay safe, perhaps all their lives. Peanut allergy is a potential killer. Earlier this month, owners of a take-out restaurant in Lancashire were incarcerated after the death of 15-year-old Megan Lee, victim of an asthma attack after ingesting foods heavily contaminated with peanut protein. Two years ago, Natasha Ednan-Laperouse died after eating a Pret sandwich with sesame seeds.
This makes the treatment of peanut allergy very necessary and potentially very lucrative. Tillis says that their treatment will not be billed as a biological treatment – which is extremely expensive. "It will not be tens of thousands of dollars, but a price comparable to that of an innovative new drug," he said.
Peanut allergy emerged in the 1990s and now affects more than 100,000 children in the United Kingdom – about one in 50 – and more than 1.5 million in the United States. It has been estimated that the treatment market could reach $ 4.8 billion a year.
In Cambridge, Dr. Andrew Clark and his colleagues, whose Lancet document published in 2014 has generated tremendous enthusiasm, are also striving to find a treatment that should be published in a few years. "We've marketed it," Clark said. He says he hopes theirs will be sweeter, pointing out that 20% of kids who dropped out of the AR101 trial, including 12% because of side effects.
Since their report, they have treated 180 patients privately because the NHS will not fund it. Only four have given up, he says. Their treatment, which now costs around £ 17,000 per child, should not cost much less than AR101, but includes staff and hospital costs related to the safe treatment of children.
Dr. Michael Perkin, honorary consultant on pediatric allergies at St George's Hospital in London, explains in an editorial of NEJM that it is worth remembering that the treatment used in Cambridge was "a bag of peanut flour costing peanuts ".
"It's not like it's a kind of miracle drug created with a monoclonal antibody in a smart lab. They have exactly the same peanut flour and put it in a capsule, "he told the Guardian.
However, it is dangerous to try to desensitize a child at home. "The ability to get rid of the right amount of peanuts or buy a bag of peanut flour to do so will be fraught with risk. If a parent's hand wobbles, it could end up with 10, 20 or 50 times the dose and trigger an important reaction, "he said.
This could mean that families would find the money they needed to license their child in the first six months and then buy peanuts to protect them.
"It's definitely a scenario," said Tillis. In the United States, small groups were already practicing what he called "nonconforming peanut immunotherapy" – a treatment with something that does not have a medical license. "Many of these patients end up with food purchased at the store." But he added, "We do not know if that equates to the AR101 maintenance dose."
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