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Peanut Allergy Treatment Trial In UK "A Success"

cold fjord writes: "The BBC reports, 'Peanuts are the most common cause of fatal allergic reactions to food. There is no treatment so the only option for patients is to avoid them completely, leading to a lifetime of checking every food label before a meal. The trial ... tried to train the children's immune system to tolerate peanut. Every day they were given a peanut protein powder — starting off on a dose equivalent to a 70th of a peanut. Once a fortnight the dose was increased while the children were in hospital and then they continued taking the higher dose at home. The majority of patients learned to tolerate the peanut. ... Dr Andrew Clark, told the BBC: "It really transformed their lives dramatically, this really comes across during the trial. ... Dr Pamela Ewan added ... further studies would be needed and that people should not try this on their own as this "should only be done by medical professionals in specialist settings."' The story also notes, 'The findings, published in the Lancet, suggest 84% of allergic children could eat the equivalent of five peanuts a day after six months.'"

45 of 192 comments (clear)

  1. Standard practice... by Anonymous Coward · · Score: 5, Informative

    in treating various allergies in the past 10 years. Good studies since 70's.
    http://www.ncbi.nlm.nih.gov/pubmed/147019

    1. Re:Standard practice... by Shimbo · · Score: 3, Insightful

      It's not a particularly surprising result but it's one thing saying that after the fact, and another to do a good quality trial. 90-99% of science (well, to be honest, pretty much of everything worth doing) takes skill and patience rather than a moment of brilliance.

    2. Re:Standard practice... by DMiax · · Score: 5, Informative

      Correct. But I suspect the hurdle here was to isolate the allergenic factor and administering it correctly. It is not as simple as splitting a peanut in 70 parts: you have to find the right protein, isolate it and dose it. It can be a bitch to do. The results prove that the protein was the right one and that the doses were ok. Finally, the treatment does not work with any substance: there are things that will remain lethal whatever happens as our immune system just cannot catch them. So that is another good news.

    3. Re:Standard practice... by sjames · · Score: 4, Informative

      It seems that it WAS standard practice for a long time then medicine forgot all about it for a few years and decided avoidance was the only useful strategy.

      Now they seem to be back to the idea that desensitization works and avoidance just causes more allergies. Peanut allergy is a growing problem in the UK because expectant mothers were urged to avoid peanuts.

    4. Re:Standard practice... by Chrisq · · Score: 4, Interesting

      It is not as simple as splitting a peanut in 70 parts.

      Excuse my ignorance but why isn't it that simple? If you started feeding people with 1/70 of a peanut and worked your way up wouldn't that have the same effect as extracting the protein responsible fro the reaction and doing the same thing?

    5. Re:Standard practice... by Pino+Grigio · · Score: 3, Insightful

      The thing is, if you just use peanuts you can't charge £100 a shot for the drug.

    6. Re:Standard practice... by marsu_k · · Score: 5, Interesting

      My daughter's milk allergy (yes, milk allergy, not lactose intolerance) was treated this way. It started with an almost homeopathic dosage, one drop of milk diluted to 1/20 per day, gradually increasing the dosage over six months. Now she's able to use dairy products freely, which is great. But the treatment doesn't really get rid of the allergy, it just builds a resistance for it, requiring that she gets at least some milk protein in her diet daily. I'll echo the summary though - don't try this without a medical professional.

    7. Re:Standard practice... by uglyduckling · · Score: 2

      I agree it's based on the same idea, but this is quite a different thing. House dust antigen is relatively harmless and leads to worsening of atopic (asthma, eczema etc.) symptoms in some people. This new trial looks at treating people who have an anaphylactic response to peanuts ("immediate hypersensitivity reaction after peanut ingestion" from the article). People in this category die rapidly if they eat a peanut, which is why they carry epi-pens. Even with immediate epinephrine (adrenaline) some people could end up needing intubation and ventilation when exposed. Treating these sorts of reactions with desensitisation therapy is certainly not "standard practice" and would be groundbreaking if these findings can be confirmed on a wider scale and turned into treatment regimens for non-research settings.

    8. Re:Standard practice... by uglyduckling · · Score: 3, Insightful

      Because these people tend to die when they eat peanuts. You need to know how to do it in a very careful, controlled manner otherwise people will die. Mostly children. That would be a bad thing.

    9. Re:Standard practice... by somepunk · · Score: 4, Informative

      Not every 70th part is the same. Not homogenous. There's different stuff on the surface, probably a couple layers, and then there's the germ of the seed vs the bulk which is food for the germinating plant, and so on.

      --
      Those people who think they know everything are a great annoyance to those of us who do. (Isaac Asimov)
    10. Re:Standard practice... by Paradise+Pete · · Score: 5, Insightful

      there is no really good reason that a tiny, tiny bit of peanut butter in a large meal won't work.

      Yes there is. Peanut butter, no matter how well you stir it, will have random clumps of the allergen and people will die. More stirring does not solve the problem. Random does not mean equal distribution. It means random distribution, some of which will be in larger clumps.

    11. Re:Standard practice... by jellomizer · · Score: 4, Informative

      However I could see a lot of parents trying this, to a disastrous effect, because it could be the kid who has extremely small tolerance, will get too much and hurt themselves. or increasing the dosage goes too fast for the child.

      The real benefit of giving these kids treatments, isn't so they can have a peanut butter sandwich, but have foods that have touched nuts, and go to school and sit at the same table as someone eating a Peanut butter sandwich.

      --
      If something is so important that you feel the need to post it on the internet... It probably isn't that important.
    12. Re:Standard practice... by Anonymous Coward · · Score: 2, Insightful

      Or we can accept that the scientists already had a disscussion all but identical to the one we're having here so far and arrived at the conclusion they have arrived at because they've been talking about it longer than the 5 minutes we have here.

      Seriously, when did we start quesitoning every little method just because we "think" we know better despite the obvious fact we are not all doctors... /rant

    13. Re:Standard practice... by 0100010001010011 · · Score: 3, Insightful

      Blend 70,000 peanuts. Administer to 1,000 people.

    14. Re:Standard practice... by Grishnakh · · Score: 2

      In the UK, no. It'll be dirt cheap, and probably free for the patients since the government takes care of that kind of thing.

      In the USA, no. Your $2000/month figure is too low. Probably more like $10-20,000 per month. And it probably won't be covered by insurance, so we'll have a bunch of parents trying to do it themselves, to disastrous effect.

    15. Re:Standard practice... by marsu_k · · Score: 2

      I knew, this being slashdot, someone would nitpick over that :) OK, so it's not near homeopathic, what I meant was that the initial dose is so small it seems it couldn't possibly have any effect.

    16. Re:Standard practice... by _anomaly_ · · Score: 3, Insightful
      1,000 peanuts and 70,000 people

      ;-)

      --
      "I have no special gift, I am only passionately curious." - Albert Einstein
    17. Re:Standard practice... by ebh · · Score: 4, Interesting

      Who was it who said, "Most scientific discoveries aren't hailed with 'Eureka!', but rather with, 'Hmmm, that's weird.'"?

    18. Re:Standard practice... by sudon't · · Score: 2

      What I'm wondering is why I never even heard of peanut allergy when I was in school. It doesn't show up on the N-Gram radar until the mid-1980's. Is it really a new phenomena, a kind of epidemic? Or have people only recently become more aware of it?

      --
      -- sudon't

      Air-ride Equipped

    19. Re:Standard practice... by vux984 · · Score: 2

      How does that work?

      http://www.telegraph.co.uk/hea...

      The government has already turned the corner, due to the previous recommendation against peanuts apparently "backfiring".

      http://www.nhs.uk/conditions/p...

      Peanuts are safe in pregnancy

      Go ahead and eat peanuts or food containing peanuts (such as peanut butter) during pregnancy, unless you are allergic to them or a health professional advises you not to.

      You may have heard that peanuts should be avoided during pregnancy. This is because the government previously advised women that they may want to avoid eating peanuts if there was a history of allergy (such as asthma, eczema, hay fever, food allergy or other types of allergy) in their child's immediate family.

      This advice has now been changed because the latest research has shown that there is no clear evidence showing that eating peanuts during pregnancy affects the chances of your baby developing a peanut allergy.

      Nobody ever mentioned there was an age "too young" to expose them to it,

      No idea how old your son is, but there was a decade or so where "No peanuts" to babies, and even to pregnant / breastfeeding mothers was a real thing.

      It was going on full volume when our kids were born 10 years ago, and we get notices every year about there being kids with major severe peanut allergies in their classes.

  2. Re:the remaining 16% by nsuccorso · · Score: 2

    They were given a 6th peanut.

  3. Why? by Demonoid-Penguin · · Score: 4, Interesting

    Not why do it, but why does the treatment work? The cited Lancet article doesn't seem to offer any answers (or hint at any efforts to find them).... development of enzyme reserves??

    And what of the annecdotal relationship between peanut allergies and *not* breast feeding?

    1. Re:Why? by Anonymous Coward · · Score: 2, Informative

      as said above, this is normal. The reason for the allergy is an over-response to the antigen. upon normal exposue, The mast cells release their chemicals to try and attack what it regards as foreign. But, we do not want that. So, you put a little bit in there on a weekly basis and monitor the patient for 30 minutes. If no reaction, they are good. If reaction, then epipen can stop it. At that point, back it down. What is different here, is that they started with a much lower dose. IOW, nothing really different, but, peanut reactions are normally SEVERE. They are not like cat/dog allergy, where you get a small rash. just simple exposure to a peanut will kill the majority of these ppl.

    2. Re:Why? by Anonymous Coward · · Score: 5, Informative

      Allergy is an immune system reaction to something that shouldn't be a problem in the first place. It thinks that something (in this case peanuts) is dangerous, and launches a full scale defense.

      The trick here is simply to get the immune system used to the substance causing the reaction, so that it will think it's normal, rather than becoming defensive. This seems to work, as long as you increase the dose slowly. The method has been used with some success against other allergies for some time, but trying it on an often fatal allergy like peanut allergy is new.

      Now, why peanut allergy is so much more dangerous than all the other allergies, I have no idea. But as this trial worked, it does indicate that peanut allergy works like any other allergy.

    3. Re:Why? by oneandoneis2 · · Score: 3, Interesting

      In terms of the actual mechanism: as far as I recall, immune cells develop with a random specificity: It's pure chance what they'll recognise.

      If they're exposed to something that they will react to in their development time, they die: This is how we prevent them from reacting to ourselves.

      So although it won't do anything to existing immune cells, the persistent presence of peanuts will at least prevent any new immune cells popping up that will react to them.

      --
      So.. it has come to this
  4. Luckily by Meneth · · Score: 4, Funny

    I've spent the last few years building up an immunity to iocaine powder. :)

    1. Re:Luckily by TWX · · Score: 2

      My name is Inigo Montoya you killed my father prepare to die!!!!

      My name is Indigo Magenta. You killed my color. Prepare to dye!

      --
      Do not look into laser with remaining eye.
  5. Re:the remaining 16% by sjames · · Score: 5, Interesting

    Contrary to the media hype, MOST people with peanut allergies don't have a fatal reaction. Just in case, the dosing was started in a hospital setting.

  6. Nutty parents by giorgist · · Score: 4, Interesting

    I know of parents that don't give peanuts to their kids since babies, just in case they have allergies. So the kid does not develop protection. They give them allergies out of paranoia

    1. Re:Nutty parents by gnasher719 · · Score: 2

      I know of parents that don't give peanuts to their kids since babies, just in case they have allergies. So the kid does not develop protection. They give them allergies out of paranoia

      The problem is not that the kid doesn't develop protection. The kid develops a very strong protection mechanism against peanuts, so strong that it can kill. Because peanuts are unknown they are assumed to be a threat.

      But you're right; it is a case where trying to protect the children is the worst you can do.

    2. Re:Nutty parents by gnoshi · · Score: 4, Interesting

      The advice being provided by the state-provided Maternal and Child Health Nurses in Australia (or at least, the ones I know of) is now to start giving children pulverized nuts (so they don't choke on them) as part of their diet from the very beginning of consuming food, apparently for this exact reason.

    3. Re:Nutty parents by Anonymous Coward · · Score: 2, Insightful

      Most adults don't swell up and die just because they encounter something new.

      So we shouldn't assume that it's such a great idea to intentionally introduce such allergenic foods to young children without independently reproducible proper scientific studies (too much fraud nowadays) proving that it's a better idea for most.

      http://onlinelibrary.wiley.com...

      . The most effective dietary regimen is exclusively breastfeeding for at least 4â"6 months or, in absence of breast milk, formulas with documented reduced allergenicity for at least the first 4 months, combined with avoidance of solid food and cow's milk for the first 4 months.

      I know some parents introduce some foods before the baby is even 6 months. But as the recommendation says - exclusive breastfeeding for at least 4-6 months.

      So maybe these hyperallergic kids were getting traces of peanuts while they and their immune systems were way too young, or at the same time they were fighting off some infection (plenty of people carrying em etc). And so when later on they get a bigger dose, their immune system goes on all out war.

    4. Re:Nutty parents by MozeeToby · · Score: 2

      All the research today shows at the very least no increase in risk of allergies by starting common allergens earlier, and several studies show improvement with it. If you don't have a family history of food allergies, there is basically nothing you cannot feed to your child as soon as they are able to safely chew and swallow it. The only exceptions are corn syrup and honey (which can cause infant botulism) and diary milk (mostly because it doesn't have enough iron and they should be on formula or breast milk).

      Keep a bottle of infant benedryl around and pay attention to their reaction when trying out new things.

  7. Re:"There is no treatment" by uglyduckling · · Score: 3, Insightful

    Then you probably didn't have an anaphylactic "immediate hypersensitivity reaction after peanut ingestion" as the article says. If you had, your mother probably would have been terrified of putting you near a peanut ever again.

  8. Feed your kids, people by Gothmolly · · Score: 5, Insightful

    Feed your kids real food, people, and let them play in the dirt. Get a pet. If you want your kid to have a healthy normal life, expose them to things in normal life. If you wrap them in Triclosan-scented everything and feel them gluten/soy/sugarfree Brawndo for years, they'll never learn to metabolize or tolerate anything else. Life carries risk, and as much as public education has taught you that causality is a human construct, it ain't - learn to deal with things or they'll deal with you, you pussies.

    --
    I want to delete my account but Slashdot doesn't allow it.
    1. Re:Feed your kids, people by F.+Lynx+Pardinus · · Score: 2

      Same here. I developed an allergy to a certain type of tree nut. Before I went into shock as a child, my parents fed me all sorts of food and nuts, no hesitations. It's bizarre when people assume that food allergies are caused by parental avoidance--usually they just happen.

    2. Re:Feed your kids, people by orgelspieler · · Score: 4, Insightful

      OK. So I have two kids. Both of them were raised essentially the same way. If anything, the younger was coddled more, and spent less time in daycare. Yet the elder has severe dairy allergy, and the younger has none. My brother and I grew up in the same house exposed to the same pets, playing in the same dirt. I am allergic to cats now. He is not. My wife has peanut allergy; her sister does not. The list could go on, but you get my point.

      Are you really implying that people should feed their kids food they're allergic to? "Well son, sure you can't breathe and you're covered in hives, but at least Gothmolly doesn't think you're a pussy!"

      Do you really think it's as simple as "go play in dirt and you won't get allergies"? I've got a different unsupported hypothesis pulled out of my ass. The reason why more sanitary countries have more allergies is because in the developing world, the people with allergies don't live long enough to pass their genes down to the next generation. Had I been born in some third world country, I would have died before I turned 10 due to respiratory problems.

    3. Re:Feed your kids, people by operagost · · Score: 2

      You thought playing in the dirt in 1964 was safe? Brother, that's when we were dumping the nastiest stuff.

      --

      Gamingmuseum.com: Give your 3D accelerator a rest.
    4. Re:Feed your kids, people by MrYingster · · Score: 2

      Unheard of != did not exist.

      Of course things were less well known back then, but there were also smaller communities, so there were less chances of running into people with allergies. Now we have social sites where we see the communication of thousands of people we've never met in real life. I only know 4 people will peanut allergies personally, and only live near 2 whom I see on a regular basis, yet in this thread, I've already read posts from 10 or more people with the allergy. My point is, just because we didn't hear about it as often back 50 years ago doesn't mean it wasn't a frequent occurrence. Other factors have to be accounted for.

      Secondly, I've always wondered if a reason for less prevalence of allergies in the past was due to kids with allergies dying from the allergy without the allergy ever being diagnosed...

  9. Louis CK covered this by Gravis+Zero · · Score: 3, Funny
    --
    Anons need not reply. Questions end with a question mark.
  10. Nuts to me by aggles · · Score: 2

    My allergy to peanuts and cashews has been going strong for over 50 years and I'm still alive. Peanuts and cashews are the worst, and to me, the difference is like between a bee (peanut) and yellow-jacket (cashew) sting. Similar reaction, but stronger and nastier. Peas, lima beans and lentils also cause an allergic sensation, but won't get me sick

    As a kid, today you get protected, but once out on your own, shit happens. In third grade, I knew I couldn't eat the peanut butter candy we were making in class, but wanted to help, so I stirred it. That got me sent home with my eyes swollen shut. Later in life, I've been hit by a "maple frosted" donut, learned about mole sauce and sate sauce the hard way (note to self; watch out if the E on the end of the sauce's name is pronounced as A). Those cut up garlic pieces in the dipping sauce at the Thai restaurant were actually chopped peanuts. Those rice crispy squares only had 1 tablespoon of peanut butter in the batch, but it got me. The chicken salad sandwich with cashews did too. I could probably die from a large dose, but sense it pretty quickly. What gets my goat is the warnings on packaged goods saying the product was made in a factory that uses peanuts. I ignore those labels and only sensed peanuts in M&M plains and a Hershey White Chocolate candy bar.

    For me, the smallest bit ingested means I'm going to puke. It might take 10 minutes or three hours, but it is going to happen. Normally, once I know it is in my system (seconds after swallowing), I'll drink a bunch of water and try to puke it out of my system. That sort of works. I also get wheezy and my throat closes a bit, but not as bad as others report. Then, I get sleepy. Even the dust in the airplane gets my eyes itchy. Years ago, I tried the desensitization approach on my own, but didn't like the reaction and stopped pretty quick.

  11. Re:Sorry by DrProton · · Score: 2

    The actual "disease" here is affluenza, or perhaps it's anxiety that overprotective mothers project onto their children. I grew up in a small town, had pets, played in the dirt every day. Nut allergies were unheard of. It's also very interesting that farmers and dirt poor people in 3d world countries don't get these allergies. This is a problem that city dwellers construct. It's called the hygiene hypothesis.

    It is very suspicious that neither the BBC article nor the Lancet abstract report a mortality statistic. Is there some problem counting bodies of people who drop dead after nut ingestion? Please don't quote me the stupid 150 deaths/year number one sees in peanut allergy articles here in America. That number was an extrapolation from a single study done of farmers in a county in Minnesota. There were no deaths from anaphylactic shock identified in the study. Somehow, the authors waved their hands and estimated 150 deaths/yr in the entire US. Meredith Broussard covered this in an article published in Harper's in Jan 2008, "Everyone's Gone Nuts." It's behind a paywall, unfortunately. I recall that the article quoted a statistician at the CDC who said there was no more than a handful of deaths in the US from anaphylactic shock in a year. Of course, the food allergist nut cases (pun intended) attacked her in droves.

    There is an article by Broussard online. It covers the money trail and details how some people profit from the nut allergy scare.

    I think the nut allergies are a bit like the terrorism scare. It is massively overblown. Falls in bathtubs and lightning strikes are far greater threats.

    --
    "Mit der Dummheit kaempfen Goetter selbst vergebens." - Schiller
  12. Re:Sorry by dogbowl · · Score: 2

    Wow. Thanks for the insight. If only you could have been around to honor us with your knowledge a few years ago.

    My wife routinely ate peanut butter during her first pregnancy but our child still has a peanut allergy. Maybe you should specify that it is the 'crunchy' variety everyone needs and not the 'smooth' that my wife prefers.

    --

    These pretzels are making me thirsty.
  13. Re:suggestions are changing by mjr167 · · Score: 5, Informative

    And it is going to take a long time for those new recommendations to make their way into the general public. There are piles of parenting help books that old parents gleefully shovel onto new parents. There are articles and magazines and Grandma and the crotchety old lady down the street. Everyone has an opinion about how you should be raising your kids and how you are doing a shitty job at it and your kids are going to die or need therapy or be a bum because you didn't give them the special new omega whatever supplement that promotes brain growth.

    And the advice is constantly changing. My husband is the youngest of three. His eldest brother slept on his stomach as a baby. Their mom was told to put the middle one on her side using this bizarre wedge pillow everyone had to buy or your baby would die, and by the time he was born, we had decided that babies had to sleep on their back. They just recently came out telling us to keep kids in rear facing car seats until they are two and they are pretty much in booster seats until they turn 21 now.

    On top of that, you only ever really get one shot at being a parent. You might get a couple tries with different kids, but each kid is only ever a baby once.

    So give the parents a break. They've never done this before, are sleep deprived, are the scourge of all the non-parents in the grocery store, and all they really want to do is go home, drink a beer, watch a TV show that doesn't involve a super hero named 'Word Girl' from the planet Lexicon, fall asleep, and not get woken up by a 30 lb bouncing bundle demanding pancakes at 5AM on a Saturday.

  14. Re:Sorry by Belial6 · · Score: 2

    Usually the answer to the question of "Is it enviornment or genetics?" is YES.