As I was doing the ironing this morning… I caught, The Food Chain on the World Service – an investigation into licensed medicines to treat peanut allergy. You can download the programme and listen for yourselves but here is a quick overview.
Immunotherapy (gradually persuading the immune system that peanuts – or any other food – are harmless by eating tiny but increasing amounts over a prolonged period) has a 100 year history and has been extensively used in the US for many years. Unfortunately, back in the 1980s in the UK it was very poorly implemented without the correct safeguards and with fatal consequences. As a result immunotherapy has been off the medical menu for all food allergies – until the 2014 trials at Addenbrokes demonstrated that it could be both a safe and an effective treatment for peanut allergy. But, unless you can get onto the Cambridge Peanut Allergy Clinic programme and have nearly £15,000 to spend, it is simply not available in the UK.
In the US peanut immunotherapy is available but, because it is not a drug treatment, it is relatively unlicensed and unregulated.
So, is there a better way? Well, both the French DBV Technologies and the US Aimmune Therapeutics think they have found one. DBV by putting ever increasing doses of peanut protein on a patch which can be stuck on the skin; Aimmune by putting measured amounts of peanut into a capsule for daily dosing. Both companies are now in Phase 3 trials (the last large scale trials required by the US Food and Drug Administration) before a drug can be launched onto the market.
Why, you might ask, does a treatment which does not involve any drugs – just peanut protein – require FDA drug approval? Mainly because no pharmaceutical company was prepared to put the money into research to produce a treatment unless they could patent it so as to amortise their investment. You cannot patent peanuts – but you can patent the delivery system – patches or capsules. But the FDA insisted that if they were to be able patent their systems as drugs they and to go through full drug trials – phases 1, 2 and 3.
Since both companies are now in Phase 3 trials, both of these systems may be available even by 2019 and it is hoped that the cost will bring the treatment within the reach of relatively low income families – or possibly even be available on the NHS?
Aimmune are also in talks with Nestlé, one of their significant investors, about how they could deliver prophylactic treatment along with infant formula that might pre-empt the development of peanut allergy. This is following on from the successful LEAP research that showed that the early introduction of peanut into the diet of infants dramatically reduced the likelihood of at risk children developing peanut allergy.
Not that everyone is totally convinced. Johns Hopkins Director of Pediatric Allergy and Immunology, Professor Robert Wood is not enthusiastic. Because peanut immunotherapy will not necessarily ‘cure’ the allergy, because the treatment itself is not risk free, because it may need to be on going and because it only treats peanut allergy yet most children with peanut allergy will also have other food allergies which will not be affected, he believes that for now at least avoidance remains the better treatment – and the one that most families will adopt.
Like the presenter of the programme, I doubt that he is right. In my experience, being able to at least eliminate the risk of accidental peanut contamination leading to anaphylaxis, even if the treatment does need to be continued and is not a cure, is very desirable. And it will dramatically improve the Quality of Life of peanut allergy sufferers both adults and children. Hugely preferable to continuing with total avoidance and the stress that achieving total avoidance under all circumstances brings with it. I would be interested in the views of peanut allergy sufferers, or the parents of peanut allergic children.
Meanwhile, watch that space…