Lancet suggests peanut immunotherapy may worsen reactions – new “drugs” for peanut allergy may be a flop – what’s next?

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Sufferers of peanut allergy have had a bad week, with two different proposed treatments for the hypersensitivity to the common food allergen appearing to show weak results, as well as The Lancet publishing a meta study suggesting that these forms of immunotherapy might be a failed approach to begin with.

The lancet’s peanut allergy meta study..

After pooling the results of 12 clinical trials that included a total of more than 1,000 patients, researchers found that compared with avoiding peanut exposure and placebo treatments, oral immunotherapies were associated with three times the risk of anaphylaxis and nearly twice the number of serious adverse events, according to the study.

The risk of anaphylaxis among children receiving oral immunotherapy turned out to be more than three times higher than in kids avoiding the allergen or treated with placebo medication. Children on immunotherapy were two times more likely to use epinephrine, compared to children on a placebo or completely avoiding peanuts.

Oral immunotherapy was also associated with a higher risk of serious adverse events and allergic reactions such as vomiting, upper respiratory tract reactions, and swelling.

This is rather unfortunate, as the immunotherapy approach appears to work relatively well for other allergens. The lancet meta-study can be found here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30420-9/fulltext

The website ‘allergic living’ has posted an opinion piece that runs contrary to what the Lancet has published, mentioning some cases of the immunotherapy having successful results, and allergen avoidance not necessarily being the best comparison to immunotherapy treatment.

So what about those peanut allergy drugs?

We have read many reports about peanut allergy “drugs”, and let us make this clear before we use the word “drug” again; the two peanut allergy therapies on the market from both DBV and Aimmune both appear to consist of peanut extracts and follow the immunotherapy approach mentioned above.

DBV’s approach in the PEPITES phase 3 trial appeared to miss primary endpoints, showing a minor improvement over placebo. Their therapy involves the application of peanut allergens to the skin. More on this is available in an article from Biospace. Despite the weak efficacy of the treatment, DBV is proceeding with a Biologics License Application and hopes the FDA will approve the therapy anyway.

AImmune’s approach in the PALISADE phase 3 trials appeared to also have similar results – mild improvements for peanut tolerance versus placebo, and adverse effects across the treated and placebo wings, although this is no surprise, as the therapy consists of oral administration of peanut allergens in increasing doses. Like DBV, Aimmune plans to move forward with the last steps of commercializing the treatment, despite the weak efficacy.

Our take..

Both of these clinical approaches for peanut allergy treatment are essentially commercialized versions of a regimen that is simple and cheap to administer. This is yet another case of transitioning natural medicine into a patented and likely much more expensive therapy. We suspect this will be no magic bullet for those afflicted with Peanut Allergies.

One interesting aspect is that Nestle has invested $273 million into Aimmune. We do wonder what the motivation is, given that Nestle is a major seller of peanut-laden junk food. Perhaps they aim to be a peanut supplier for the therapy? one can only guess.

And we have to leave this on a positive note! There is another promising peanut allergy treatment in the works showing promise called PVX108. It works like a vaccine, and contains genetically modified peanut allergens designed to train the immune system to accept peanuts without life threatening side effects along the way. Phase I trials appear to show promising results.

Another therapy along similar lines of PVX108 called HAL-MPE1 is undergoing Phase I clinical trials. But less is known about the results – we will know more about the results this year.

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