January 30, 2014
Cambridge Team Finds Huge Success In Peanut Allergy Treatments
[ Watch the Video: Peanut Allergy Treatment Via Oral Immunotherapy ]
Lawrence LeBlond for redOrbit.com - Your Universe Online
Publishing their findings in The Lancet journal, allergy experts from the University of Cambridge say that at least 84 percent of children in their clinical trial showed they could eat the equivalent of five peanuts per day after six months of treatment.
While the therapy is not ready to be implemented far and wide, the researchers say this is a significant step towards reaching that goal.
For the phase 2 trial – the largest of its kind in the world – researchers, led by Dr. Andrew Clark and Dr. Pamela Ewan from Cambridge’s Department of Medicine, gave children increasingly larger amounts of a peanut protein daily throughout the trial. The oral immunotherapy (OIT) approach was used to help the study participants build up a tolerance to the allergen.
The researchers used children, between the ages of seven and sixteen, for the study. The participants were given just a tiny dose at first, slowly adding more doses over four to six months. At the end of the six-month trial, 84 to 91 percent of the two groups in the study could safely eat 800 mg of peanut protein on a daily basis – about 25 times more than they could eat before the study began.
“Before treatment children and their parents would check every food label and avoiding eating out in restaurants,” Clark said in a statement. “Now most of the patients in the trial can safely eat at least five whole peanuts. The families involved in this study say that it has changed their lives dramatically.”
“This large study is the first of its kind in the world to have had such a positive outcome, and is an important advance in peanut allergy research,” added Ewan. “However, further studies in wider populations are needed. It is important to note that OIT is not a treatment people should try on their own and should only be done by medical professionals in specialist settings.”
For most people, a peanut allergy is a lifelong condition. Unlike other allergies, such as those to cow’s milk, peanut allergies usually do not go away as people age. Because there is no treatment for the condition the only option for allergy sufferers is to avoid peanuts and any products using them completely, which leads to a lifetime of checking every food label they come across to ensure safe eating.
The phase 2 trial now shows there is a potentially viable treatment option.
And while about 20 percent of those involved in the OIT trial reported adverse events, most were mild with oral itching being the most common symptom.
Lena Barden, 11, from Histon in Cambridgeshire, said: “I felt like I had won a prize after I found out I had been picked for the active group. It meant a trip to the hospital every two weeks. A year later I could eat 5 whole peanuts with no reaction at all. The trial has been an experience and adventure that has changed my life and I’ve had so much fun. But I still hate peanuts!”
“The trial has helped me so much. I don’t have to worry when I go out with my friends about what I’m eating and where it’s come from ‘What’s in it? Where’s it been prepared?’ - I don’t have to worry at all,” said another trial patient, Thomas Baragwanath, 16, from Holbeach, Lincolnshire.
"It really transformed their lives dramatically; this really comes across during the trial,” Clark told BBC’s James Gallagher in an interview. "It's a potential treatment and the next step is to make it available to patients, but there will be significant costs in providing the treatment - in the specialist centres and staff and producing the peanut to a sufficiently high standard."
"This large study is the first of its kind in the world to have had such a positive outcome, and is an important advance in peanut allergy research," added Ewan.
Ewan did caution that further studies were needed and that peanut allergy sufferers should not try OIT on their own, noting that this “should only be done by medical professionals in specialist settings."
Prof. Gideon Lack, who is leading similar research at Evelina Children’s Hospital in London, weighed in on the findings.
“This is a really important research step in trying to improve our management of peanut allergy, but is not yet ready for use in clinical practice,” he told the BBC. "A proper risk assessment needs to be done to ensure we will not make life more dangerous for these children.”
Lack warned that 60 percent of those with a peanut allergy are also allergic to other nuts, meaning that a carefree lifestyle is rarely an option.
It is still too early to tell if the OIT build up will continue to last or if these children will revert to their full blown allergies.
Prof Barry Kay, from the department of allergy and clinical immunology at Imperial College London, noted to the BBC that these positive effects may “lead affected individuals to have a false sense of security.”
"Another issue to address is whether there will be long term side-effects of repeated peanut exposure even where full allergic reaction does not occur, such as inflammation of the oesophagus,” Kay added. "So, this study shows encouraging results that add to the current literature, but more studies are needed to pin down these issues before the current advice to peanut allergy sufferers, which is to avoid eating peanuts, is changed."
And Prof Simon Murch, an allergy expert at the Royal College of Pediatrics and Child Health (RCPCH), cautioned that while the results are promising, the OIT treatments are not a cure.
"Nevertheless this study does point towards a promising new direction of therapy and once further testing has been carried out, and techniques refined, it may prove to be a therapy with widespread use in hospitals in future," he told the BBC’s James Gallagher.
The study team said that making the OIT treatment widely available to patients is the next goal. They said further investigation and a licensing review will be required to obtain a product license from regulatory authorities, which could take several years.
While researchers wait for positive news, Cambridge University Hospitals is planning to open a peanut allergy clinic, offering a wide range of services to patients, including immunotherapy programs.