Sunday, May 04, 2008

Promising News On The Peanut Allergy Front

In the most recent edition of The Lancet, Dr. Wesley Burks of Duke University states:

It is likely that in the next five years there will be some type of immunotherapy available for peanut allergenic individuals.

That is such exciting news! I've been aware of the peanut, milk, and egg oral immunotherapy studies that have been underway at Duke for the last several years and have been waiting eagerly for an announcement such as this (as I'm sure anyone with a loved one who has food allergies has!). I've read about some of the successes they have achieved and things definitely sound hopeful. I have even contacted them about us participating in future studies--we live close enough to Raleigh that we could get up there semi-often if need be. (They haven't called yet though.)

Having gone through 5 years of allergy shots myself for environmental allergies, I know that the basic approach works--desensitizing the body to the allergen by introducing it at regular intervals and building up the amounts of the allergen slowly. What's super tricky about food allergies compared to pollen and dust allergies is that the risk for anaphylaxis is so much greater with a food allergen. Orders of magnitude greater. It's possible, but comparatively rare, for someone to experience a full-blown anaphylactic episode to grass, so allergy shots such as the ones I had, while not without risk, are still relatively safe. It sounds like there will come a time when I can take Ryan to the allergist once a week to get his peanut shot (or whatever form it will come in) and to build up his tolerance and make his life safer.

I do, however, have a few reservations about this news--for example, I take issue with the way it is being reported by some news agencies. This may fall into the Pet Peeve category, but I keep seeing headlines that are touting a "cure" within five years and that is clearly not what Dr. Burks said. He's talking about a treatment only. A treatment that, at least for peanut allergy sufferers, has been successful in preventing reactions to minute amounts of peanut. What it does is provide some room for error--a chance to bite into the wrong kind of cookie, for example. And don't get me wrong--that's a great treatment and I'll take it! But I wish journalists would not equate that with a cure. (And please correct me if I'm mistaken about what Burks's research has shown, I'm having a hard time finding more recent articles.) Dr. Burks himself states (in the above-mentioned "cure" article):

"Whether these types of treatments are likely to cause eventual clinical tolerance to develop remains to be seen," he said.

Regardless--these studies are terribly encouraging and any treatment success will make it easier for Ryan to stay safe in the future, especially when the allergy becomes his responsibility and not mine and Brendan's.

Also, the thing about the genetically-modified peanut. There's been some buzz about this possibility for a while now. As a peanut-substitute, I'm not a big fan of the idea, since we'd still have to avoid all of the real peanuts. It would possibly even make things more difficult, and really, humans can live perfectly happy, healthy lives without ever eating one peanut (delicious and nutritious though they are).

But I can see that there might be a real value in using a genetically-modified peanut in immunotherapy. From this article on Medical News Today (again, referring to Burks's article in The Lancet, all emphasis is mine):

Among the approaches being looked at to reduce the impact of this condition is development of transgenic plants to produce hypoallergenic peanuts. However, as several peanut proteins are involved in the allergic response, Professor Burks says: "The process of altering enough of the peanut allergens to make a modified peanut that is less likely to cause an allergic reaction would probably render the new peanut no longer a peanut." Future treatments are all focused around the attempt to curb the immune response or induce tolerance by the immune system in response to a specific food allergen. Possible approaches include engineered peanut proteins used as immunotherapy and specific oral tolerance induction, in which the food is ingested in increasingly larger amounts on a regular basis.

Honestly, I'm amazed at what scientists are capable of these days, aren't you? The way that sounds to me (a true scientific layman, mind) is that using a "non-allergenic" peanut as part of the immunotherapy program would work a little like vaccines. Change it enough not to cause harm, but leave enough of it intact so that the body can recognize it as a peanut (only in this case the body would be desensitized not to overreact instead of develop antibodies to fight it). Or maybe they can find a way to pinpoint which of the several proteins each individual is reacting to and tailor a therapy toward that. There are many possibilities and I'm glad that there are people out there smart enough to know how to explore them.

And not to be a complete downer here, but I share C. August's skepticism about the five year timeline.

How many times have we seen research about a current affliction gets lots of hype but produces no results?

When Brendan was diagnosed with Type 1 diabetes in 2001, we were so excited to learn that a cure for his kind of diabetes was going to be out in a few years. That hasn't materialized, of course. Not that improvements haven't been made and ongoing research in that area is extremely encouraging. But we've learned not to get ahead of ourselves. These diseases (is peanut allergy a disease? a condition?) are extremely complicated and so getting the treatments and cures just right has got to be complicated, too. Especially when they don't even know for sure what causes the diseases (true for both food allergies and Type 1 diabetes). I'm excited that Dr. Burks is confident enough to say the words "five years" but I'm not going to hold him to that necessarily.

Nevertheless, I'm cautiously optimistic that the studies at Duke are going to yield a kind of therapy for people like my son. Like I said, I have been watching it for a while and one of the reasons that we have participated in the fundraising walks for FAAN is that some of the money we raise is going toward this study. Dr. Burks is one of the leading researchers in this field and if anyone can figure this out . . . well, let's just say my money is on Dr. Burks. Ryan just wishes he would hurry it up already, but I know he's going as fast as he can!


Shea said...

Not the peanut allergy front, but I thought you'd be interested in this promising news on the type 1 diabetes front.

Rational Jenn said...

Shea--thank you so much! That is exciting! I'll forward this on to my husband, too.

Jeanie (aka Scrapdoctor Designs) said...

Thank you so much for your post - I will have to read more about it. I also noticed your "Evolved Homeschooler" emblem, and was curious about that. The reason is that I am pulling my daughter out of public school in favor of homeschooling strictly BECAUSE of her nut allergy! She had too many close calls last year at school, including the principal eliminating the peanut-free table without consulting the school nurse, parents, or anyone! And last month, had a sever reaction with oxygen saturation down to 83% before the epinephrine kicked in. Scary stuff to say the least! I'd love to hear any thoughts you have on the nut issues (and/or the homeschooling) -

Sincerely, Jeanie

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