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New treatments for peanut allergies only raise same old questions for me

Time:2019-01-09 10:29wine - Red wine life health Click:

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Photo: SHUTTERSTOCK

Photo: SHUTTERSTOCK 

Whenever I see a report touting possible new peanut allergy treatments, I devour it. I can't help it. It's an occupational hazard for any health journalist whose reporting specialty and medical history intertwine.

I write about the business of health care, focusing on how consumers interact with the system - what we pay, what we get and why American care costs so much. But in this particular instance, I have another kind of authority: 26 years of life-threatening allergies to nuts and peanuts.

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So when recently sparked optimistic headlines after releasing clinical trial results that its allergy product, AR101, would reduce the risks linked to an accidental exposure to peanuts, I received the usual wave of questions from friends, co-workers and my parents: Would you try it? Could this help?

Aimmune, based in Brisbane, California, is just one company eyeing the prize. Childhood peanut allergy diagnoses increased more than 20 percent in the United States from 2010 to 2017. The global market for relief is worth as much as $2 billion. The French drugmaker DBV Technologies is also working to commercialise a peanut allergy patch. Other companies, including industry giant Sanofi, are following their lead.

If any one of them succeeds, it could change my life.

My allergies to peanuts first surfaced when, as a 15-month-old, I picked Thai noodles off an aunt's plate and developed hives on my face. A few months later, I ended up in the hospital after I tasted my mum's kaju barfi, an Indian dessert with cashews (to which I am also allergic). Nobody in my family had ever heard of peanut allergies.

I've carried epinephrine since I was seven. My friends are trained to inject it in my leg, the standard procedure for an emergency allergen exposure, although luckily I haven't had to take a shot of it since I was 4. (A classmate had a peanut butter sandwich for lunch.) My mum also recalls having to pick me up early from day care because the class was making peanut butter bird feeders. And I spent too many years of pre-adolescence eating lunch at the designated "peanut-free table."

Now, I can only dream of flying to visit my parents for Christmas without worrying about whether my seatmate's snacks might induce anaphylaxis. And yes, kissing someone who has just eaten peanut butter would put my life in danger.

But are these pills and patches a true breakthrough for people like me?

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I approached the question as I would any other assignment. I read the research, called immunologists, and spoke with economists and drug pricing experts about whether these treatments offer meaningful benefit.

One of the first things I heard: "We are still in the infancy of these treatments," said Corinne Keet, a paediatric allergist at Johns Hopkins University School of Medicine.

Medically, there's a lot we don't know about the risks, how much these drugs could help and how long any effects would last. "None of these treatments have been shown to prevent fatal reaction," Keet said.

The idea behind them is to desensitise people. Aimmune's "peanut pill" is modelled on the oral therapies some specialists use to wean allergic kids slowly back on to nuts. This approach has gained popularity in recent years, especially for children with multiple allergies, or when it's a substance particularly hard to avoid.

A colleague's young daughter who was born with multiple allergies used that very treatment, as did a younger cousin of mine who, for the first several years of her life, was allergic to almost everything but fruits and vegetables. In my case, this therapy came into vogue after I was too old to have a good chance of it weakening my sensitivities.

How it works: Kids ingest tiny, escalating doses of peanut protein. They then stay on peanut protein - Aimmune recommends the pill, although other doctors I spoke to suggested a little bit of peanut - as a maintenance drug.

But it's unclear how much the new therapies would improve upon that ad hoc oral immunotherapy that are already being offered by allergists.

"There's excitement, there's caution and a lot of unanswered questions," warned Erwin Gelfand, a pediatrics and immunology professor at the University of Colorado's School of Medicine.

According to Aimmune's results, published in the New England Journal of Medicine, two-thirds of allergic children could ingest 600 milligrams of peanut without harm after going through treatment.

To be clear, even with Aimmune's help, someone like me still couldn't safely eat peanut butter and jelly. But it would desensitise me enough that I could taste a friend's wine if he recently ate peanut-topped pad thai.

Still, the treatment comes with caveats.

While 496 children started the trial, only 372 completed it. Of the 20 percent who backed out, half did so because of adverse events. About 14 percent of children getting treatment still had to take epinephrine, and one experienced anaphylaxis, a severe reaction that can involve rashes, vomiting, a tightening throat and difficulty breathing. (For an allergic kid, even the possibility is maybe one of the most terrifying things you can imagine.)

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