Two new peanut allergy treatments are on the verge of approval | Hacker News Reader

Two new peanut allergy treatments are on the verge of approval

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103 pointsJumpCrisscross60 comments

Last year I learned that 20% of adults who were diagnosed with a peanut allergy outgrow it after childhood. It is worth getting tested again if you grew up with a peanut allergy.

I had signed up for a trial of one of these drugs. Having grown up in the 80s with a severe peanut allergy that required the use of the epipen more than a few times I was keen for anything that could help, even just something that would lessen the reaction so maybe I could choke down some benadryl rather than stabbing myself with that ~2 gauge (hyperbole) epipen that now costs a fortune.

First thing they did during the trial was give me two peanut tests, skin prick and blood test. Both came back negative despite positive results decades earlier as a child.

I would have never thought to get tested again on my own. Not being allergic has made such a huge difference in my life - I was always flippant about my allergy and had developed good safeguards to protect myself. But the amount of stress is caused me was amazing to have lifted. Hope that these drugs can bring that to others (or just get tested again and maybe you're one of the lucky ones!)

More anecdata; a friends father never had a peanut allergy, then almost died. Friend said peanuts weren't part of his fathers diet for years, his father decided to have a pbnj, bam, almost died. I had never heard of adult onset peanut allergy before.

My son has a peanut allergy, I can only hope he outgrows it as well.

Sounds more like anaphylactic shock than allergy from how your describe it...

Anaphylactic shock can be an allergic reaction, it's not an either/or distinction.

My father outgrew his peanut allergy when he was 15 and said I would too, but sadly I didn't. I still carry an EpiPen around and flat out avoid going to Thai places.

On the other (anecdata) hand, my wife has been severely allergic to peanuts for decades, and still is... she can tell if someone is eating peanuts nearby.

This is me but with coffee. And coffee is everywhere.

Coffee ? So sorry to hear that.

so, i have to ask: do you like the taste of peanuts/peanut butter now?

As the parent of a child with a severe, life-threatening peanut allergy, these treatments could be a Godsend. It's hard to describe the life change that occurs when a normal food like peanuts suddenly becomes a disguised killer that could take my child away at any moment. The speed with which it strikes is stunning; according to our allergist, we have only minutes to administer EpiPens to avoid the runaway anaphylactic reaction. And we've done so. The tragic story that begins the article seems a testament to this - if a reaction isn't countered in time, it can't be.

I miss Snickers.

While I appreciate your concern and caution, I feel like the medical community has worked the public into a bit of hysteria over peanut allergies.

So few people die from peanut allergies each year it's hard to actually get good numbers on the phenomenon. And yet I have several friends who report having someone deathly allergic to peanuts in their family. It seems incongruent.

It's certainly a confusing subject, especially now that more attention is being paid to it. We've had our share of acquaintances comment that their kids are also allergic because one time they ate something with a peanut and had an itch later that day. In our case there's immediate throat/tongue swelling so it's an obvious one.

In all seriousness, the best bet for concerned people is to see the doc and get tested. Our kid's reaction to the prick test was ~10x the normal "allergy" reaction - the doc immediately stopped the test and gave him medicine. (As mentioned elsewhere, kids do grow out of the allergy so it's important to retest!)

According to our allergist, the problem with peanut allergies in particular is that the reaction can vary dramatically for the same person. Ingesting it one time may cause nothing but hives, whereas another will result in throat constriction within minutes. Cue the news stories where people with seemingly minor allergies are suddenly in the hospital. For example, recently a girl in CA with a known allergy took a bite of a peanut butter brownie and then spit it out. Her parent, who was a doctor, waited 20 min to administer the EpiPen. She died.

(Disclaimer: not a doctor, probably didn't remember everything right, etc.)

I'm pretty sure my daughter will not stop breathing if she eats a peanut. I'm also 100% certain her stomach will empty itself in a way that makes 'The Exorcist' look like a gross-out comedy in comparison. We've also seen her break out head to toe in hives. While neither is life threatening, they're also not pretty and are violent enough that her throat closing is not unimaginable.

I understand your position. But (there's always a "but") I have a friend whose kid is severely allergic, their daycare didn't take it particularly seriously(!), for reasons similar to yours. So of course one day there is a PBJ near the kid, he has a crazy reaction, the staff call the parents "we're afraid to use the epipen" at which point the mom hangs up and calls 911 herself, invoke FMLA and has to hightail to the ER

"The Family and Medical Leave Act of 1993 (FMLA) is a United States federal law requiring covered employers to provide employees with job-protected and unpaid leave for qualified medical and family reasons." (Wikipedia via Google)

Thanks! As a parent working in the US, the FMLA is a fact of life, but that isn't true for everyone on HN

http://www.jacionline.org/article/S0091-6749(14)01737-0/abst...

And the best prevention is giving small kids peanut based foods

But since some genius thought the best course of action was not exposing kids to it, we have the present situation (especially in the US)

According to my pediatrician, research shows that exposing children to peanuts earlier decreases the likelihood of a child developing a peanut allergy.

I gave my son a bite of the peanut butter cookie I was eating, when he was six months old, nearly killed him. So this "expose them early and it's not a problem" maybe true part of the time for some allergens, but certainly not all the time for all allergens.

Edit: Down voters care to comment?

Peanuts are one of the specific allergens for what was actually said upthread (early exposure is the best way of reducing the likelihood of developing an allergy) has been shown to be true; the explosion in peanut allergies in the US is a direct result of bad recommendation to generally avoid early exposure which has now been lifted and replaced with different guidance.

That doesn't mean, however, that there is no risk of developing an allergy even with early exposure.

I didn't downvote, but "expose them early and it's not a problem" isn't the advice, the advice is that early exposure reduces the chances of allergies.

In any case, it is a statistical assertion, not a guarantee.

Do you think peanut butter might be the problem? As in most Americans don't eat raw peanuts but processed versions which might be more concentrated and exacerbate the allergies?

Peanut butter though is just peanuts, same concentration of everything as a peeled peanut. Large companies put lots of salt and sugar in too, I can't stand the sweet ones.

Maybe there's greater availability of some protein, or something, because of the processing?

Ask an allergist/pediatrcian what they would do with their children. The answer most likely would be to "challenge" nut allergies with low doses if symptoms occur and introduce a variety of foods early on as appropriate.

If you read the research on that one. It seems pretty badly done in my opinion.

Maybe, maybe not. It's just unclear.

My wife ate a ton of peanut butter during her pregnancy. One would think it would have protected our son, but it didn't. He's now eight and the peanut allergy is getting worse.

The evidence is pretty convincing. You saying "it's just unclear" is just you misinterpreting "decreases the likelihood" to include "to zero".

Another problem related to the increase in peanut allergies is the increase in bogus science surrounding the treatment of allergies in general:

https://www.theguardian.com/society/2015/jun/04/bogus-allerg...

Never heard about peanut allergy here in India, looks like a first world problem.

It largely is. That is, globally peanut is among the most common severe food allergies, but it's still fairly rare. But in the developed world (IIRC, particularly the US) popular guidance to mitigate the risk of peanut allergies in very young children (who can't communicate symptoms.as effectively, so, if they have an allergy, are at greater risk of consuming more and/or having treatment delayed) was to avoid any exposure.

It turns out that that guidance actually increased the incidence of severe peanut allergies immensely, because it made it much more likely that when people were exposed later, they would develop an allergy, and peanut allergy is far less common where children are usually exposed at a young age.

Yeah, disease of affluence, they call these things:

https://en.wikipedia.org/wiki/Diseases_of_affluence

It's weird how acknowledged the problem is in the US (and Europe?) and how rare it is elsewhere. Trying to convince people in certain countries that peanut allergies are real can be really difficult, because they have never heard of such a thing. It's also even hard to find information online about the worldwide prevalence of peanut allergies because almost all of the data is US-based, with the occasional tidbit from the UK or continental Europe.

There's something called the Hygiene Hypothesis which states that "a lack of early childhood exposure to infectious agents, symbiotic microorganisms (such as the gut flora or probiotics), and parasites increases susceptibility to allergic diseases by suppressing the natural development of the immune system".[1]

In other words, it could mean that excessive hygiene in childhood could be causing allergies.

[1] - https://en.wikipedia.org/wiki/Hygiene_hypothesis

Probably not so much excessive hygiene, but antibiotic use. Some studies already indicate higher rates of allergies in kids who as toddlers took antibiotics.

Quite likely - some of the more recent thinking is that it is linked to a loss of gut bacteria - which makes sense for our case as our boy had antibiotics young, and first reacted to nuts at 4 months.

India does have a huge problem with lots of people dying from poor food (and other) sanitation practices, though. When your house is burning down you don't notice a light left on in the attic.

Possibly. Or the people who have it just die for unexplained reasons.

you don't need Gregory House to diagnose an anaphylactic shock

Money quotes:

> Big Pharma was unmoved, believing it would be impossible to patent a medicine that was essentially a ground-up peanut.

> [One of the companies working on the issue] has ties to the food industry, which has a vested interest in finding treatments for allergies.

Make of this what you will.

1. Companies investing hundreds of millions want to ensure a return 2. Food companies want customers to eat (and not die from) their products.

Groundbreaking, I know.

Of course it's reasonable within the system. Inward and outward reasonableness of a system are sometimes quite orthogonal.

It's pretty unexpected that the motivation to work on a medical treatment is not altruism (nor even direct gain from selling the treatment) but is to enable the controlling capitalist(s) to make more money selling food that otherwise the untreated could not consume.

Isn't that a very real example of the lives of millions only being improved because their current hardship is losing capital holders a sales opportunity.

That opening story just broke my heart. As a parent of a child with a severe peanut and tree nut allergy, it has been completely drilled into me: If my child is exhibiting an allergic reaction, administer the EpiPen and call 911 for an ambulance immediately.

Another interesting read: "about 80 percent of the children who received the peanut protein plus probiotic treatment were able to consume about 0.1 ounces (4 grams) of peanut protein without a reaction. What's more, when the parents of these children were interviewed about three months after the study ended, most said that their child was still able to include some peanuts in his or her diet (varying from five peanuts to 3 tablespoons of peanut butter a week)."

http://www.livescience.com/49638-peanut-allergy-treatment-pr...

Peanut allergy is not a thing in Israel. Kids here are exposed to peanuts from a very early age through consumption of a very popular peanut snack (Bamba). Apparently this prevents the onset of peanut allergy.[1] It's funny (weird? ) people are being guided to avoid foods which causes them to be more susceptible to allergy which makes a good business opportunity for some pharma company.

[1] https://www.nih.gov/news-events/news-releases/study-finds-pe...

If you have a baby, introduce them to watered down peanut butter or powder between 4-6 months [1]. Many healthcare groups are still advocating for parents to wait until 12 months before introducing peanut, but that is totally wrong. My friend followed this advice from Kaiser Permanente last year and his child is allergic.

[1] http://www.npr.org/sections/thetwo-way/2017/01/05/508348588/...

My niece underwent a similar treatment the past few years, but just using trace amounts of actual peanuts and then building up to larger quantities. As far as I know, there was no commercially-produced patch or capsule involved. My sister in law blogged about it here: http://girlvspeanut.blogspot.com/

It's funny it takes hundreds of millions of dollars to test putting peanut flour on people.

Going by first principles it's probably under $100.

from the article:

About 2 per cent of American children are now allergic to peanuts, a figure that has more than quadrupled since 1997.

1. $400+ million to turn peanut fragments into a treatment. What?!?!?!

2. I think this treatment could potentially be a lot more deadly than the problem. It's a case of unintended side effects...in this case over-confidence vs. a strict no peanuts ever policy.

Imagine a kid has had the treatment and can eat 3 or 4 peanuts without a problem...a year or two later, maybe older & wanting to show off or over-confident, the child eats 12 peanuts...has an anaphylactic attack and dies. This case vs. a child who religiously avoids all peanuts, never considers them. A possible unintended effect related to psychology that I think should be considered.

3. Antibiotic use in infants and toddlers have been linked to a higher risk of allergies (maybe peanut allergies though I don't know if that's been studied & maybe that's why peanut allergies are a big problem in the US but not in India where most people don't take a lot of medicines)...try to avoid them if possible in small children though please listen to your doctor's advice. Antibiotics have some side effects which aren't great but on the whole have saved an incalculable number of lives.

"3. Antibiotic use in infants and toddlers have been linked to a higher risk of allergies (maybe peanut allergies though I don't know if that's been studied & maybe that's why peanut allergies are a big problem in the US but not in India where most people don't take a lot of medicines)...try to avoid them if possible in small children though please listen to your doctor's advice. Antibiotics have some side effects which aren't great but on the whole have saved an incalculable number of lives. "

Gonna have to back that up with a whole heap of citations there.

I'm allergic to peanuts from the USA but not from the ones from India. I'm from India but live/work in the US and just get a few pounds of peanuts every time visit India.

With milk, I'm lactose intolerant to the milk in US but not in India. Cow vs buffalo is one difference.

Never drive an emergency to the hospital. Always call an ambulance.

That seems silly. I am a 3 minute drive to the ER. Vs a 3 minute drive for an ambulance here, then a 3 minute drive back.

I never knew that peanut oil was used as a vaccine adjuvant.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2130368/pdf/jhy...

If you care about what's true and what's not true, please downvote this. There is no peanut oil in modern vaccines. Even if there were, there are almost always no peanut allergens in peanut oil. This is completely wrong and dangerous propaganda. [1] http://www.chop.edu/centers-programs/vaccine-education-cente...

[2] http://www.skepticalraptor.com/skepticalraptorblog.php/antiv...

Bingo.

Going to respond to your comment too just in case you don't check replies to the parent: This is wrong. There is no peanut oil in modern vaccines. Even if there were, peanut oil is usually safe because it contains no peanut allergens. Even if it was in small concentrations, it would be used in such small quantities in vaccine doses that it would be diluted past nothing. Even if all of this were true, the proposed effect would have to be proven, and there is zero evidence for this hypothesis. But none of these things are true, and instead we are left only with propaganda.

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