PEANUT ALLERGY TREATMENTS ARE ON THE HORIZON
Peanut allergy is one of the most common food allergies. Allergic reactions to peanut can be severe and potentially life threatening. Between 1997 and 2008, the number of children in the U.S. with peanut allergy more than tripled. The primary treatment for peanut allergy has been avoidance. Now, there are some promising treatment options on the horizon.
Aimmune Therapeutics, based near San Francisco, recently published results of its landmark 554-patient Phase 3 PALISADE efficacy trial of AR101 for treatment of peanut allergy. The PALISADE study enrolled highly allergic patients between the ages of 4-17. When they say highly allergic—they mean it: 72% had a history of anaphylaxis, more than half had asthma, and 2/3 had multiple food allergies. At the study entry, none of the patients were able to tolerate 30mg of peanut protein (1/10th of a peanut). After approximately 1 year of AR101 treatment, which consists of carefully processed and measured peanut powder (held in capsules that are then sprinkled onto food) patients completed an exit food challenge. Of those who completed the study of AR101 treatment, 96.3% tolerated a single highest dose of 300mg of peanut protein at exit (compared to 8.6% in placebo group). 84.5% tolerated at least 600mg of peanut protein (compared to 4.3% in placebo group), and 63.2% tolerated 1000mg of peanut protein at exit (compared to 2.6% in placebo group). About 20% of patients did not complete the study, and of those that did not complete the study, 12.4% withdrew due to treatment-related adverse events. 2.4% experienced serious adverse events, compared with 0.8% in the placebo group. The chief medical officer, Dr. Daniel Adelman at Aimmune emphasized that the “intent of our drug is not to necessarily allow patients free range on peanuts, but rather to protect them from accidental and inadvertent exposures that are part and parcel to everyday life.”
Another treatment option that is still being explored for peanut allergy includes Viaskin’s Peanut Patch. While Viaskin did not meet its endpoint in its Phase 3 clinical trial published in Oct 2017, it is still investigating the use of the Peanut Patch in further studies. DBV Technologies, the French company that developed the Viaskin Peanut Patch, noted that while 35.3% of patients responded to the immunotherapy treatment after one year, the difference between the treatment group and the placebo group of the study did not meet the statistical significance required by the FDA. However, there may still be hope, as previous studies have shown that the patch may be more effective the longer it’s worn. Results from a Phase 2 study released in March 2017 and published in the Journal of the American Medical Association showed that 83% of children aged 6 to 11 were able to tolerate 10 times the amount of peanut after three years of wearing the patch. DBV Technologies will be presenting its data at the AAAAI conference this month in Orlando, FL.
In the meantime, Stanford’s Sean N. Parker Center for Allergy & Asthma Research continues to study oral immunotherapy (OIT) with peanuts, tree nuts, milk and other food allergens, with and without Xolair (a biologic drug used to help block the allergic response). They are also currently conducting twin studies to help better understand food allergies, and are currently enrolling patients for an adult Peanut allergy trial. All of this research is exciting and we are staying up- to- date on the newest treatments available.
So what does this mean for you? Well, it means that if you have a food allergy, there is real hope on the horizon. If you or one of your family members have a food allergy, or are unsure whether you have a food allergy, schedule a visit with one of our providers. We will review your history, and order appropriate allergy testing. We will then discuss which foods require avoidance, which ones are safe for you to eat, and which ones may be able to be introduced with an Oral Food Challenge in the office. While allergen avoidance is still the primary recommendation for food allergy, the future of food allergy treatment is looking bright!