MedicalResearch.com Interview with:
Dr Paul Turner FRACP PhD
MRC Clinician Scientist and Clinical Senior Lecturer, Imperial College London
Honorary Consultant in Paediatric Allergy & Immunology
Imperial College Healthcare NHS Trust
Hon Consultant, Royal Free Hospital / Royal Brompton & Harefield NHS Foundation Trust
Clinical trials specialist (Paediatrics), Public Health England
Clinical Associate Professor in Paediatrics, University of Sydney, Australia
Dr. Nandinee Patel, MD
Section of Paediatrics
Imperial College London
London, United Kingdom
MRC & Asthma UK Centre in Allergic Mechanisms of Asthma
London, United Kingdom
MedicalResearch.com: What is the background for this study?
Response: Current desensitisation protocols for peanut allergy use defatted roasted peanut flour, which can be difficult to accurately measure in very low doses needed for desensitisation (and thus has resulted in the development of AR101 by Aimmune which is likely cost many thousands of dollars for a course of treatment).
We have previously observed that some children with food allergy to roasted peanut (such as peanut butter) are nonetheless able to tolerate boiled peanuts without reacting. We performed in vitro protein analysis studies which demonstrated that boiling peanuts resulted in around 50% of protein leaching out of the peanut into the cooking water. Furthermore, we found evidence for preferential leaching of allergen epitopes such as Ara h 2 as well aggregation of proteins resulting in a hypoallergenic peanut product.
We therefore sought to assess whether boiled peanuts could be as effective and safe to induce desensitisation.
MedicalResearch.com: What are the main findings?
Response: We recruited 47 children, aged 8-16yrs, with peanut allergy. The majority reacted to under ½ a peanut kernel at double-blind food challenge at the start of the study, before treatment
In the 32 children randomised to oral immunotherapy using boiled peanut, 75% of patients were able to tolerate 1.4 g peanut protein (approx 6-8 peanuts) without developing an objective allergic reaction. 58% could eat more than 20 peanuts without reacting.
Under 11% of doses caused an allergic reaction during the year, and half of these reactions were very transient and mild in nature. There were 19 episode of anaphylaxis occurring in 10 patients (0.2% of all doses administered). Given this, we would not recommend oral immunotherapy being performed without stringent safeguards by experienced healthcare personnel.
There was a significant increase in the quality of life for the children and their patients during the trial.
MedicalResearch.com: What should readers take away from your report?
Response: Oral immunotherapy using boiled peanut is effective in children with peanut allergy. It has a favourable safety profile and was acceptable to participants and their families, making it a potentially feasible therapeutic option for the treatment of peanut allergy.
We hope boiled peanut may provide a treatment option that is effective, safe and potentially a far cheaper alternative method of delivering OIT. We hope this may increase the affordability and accessibility of oral immunotherapy in the future.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We are about to launch a study which will perform a head-to-head comparison of boiled peanut with roasted peanut flour to induce desensitisation in peanut-allergic children. This will allow us to directly compare both clinical effect and safety.
Paul Turner is funded by the UK Medical Research Council and Imperial/NIHR Biomedical Research Centre. He is a member of advisory boards for Aimmune Therapeutics and DBV Technologies.
Successful Desensitisation And Sustained Unresponsiveness Using Modified Peanut: Results From The BOPI Study
Nandinee Patel, MD,Marta Vazquez-Ortiz, MD, PhD,Abigail Robb, BSc ,Mohamed H. Shamji, BSc MSc PhD FAAAAI,,Dianne E. Campbell, MBBS FRACP PhD,Paul J. Turner, FRACP PhD
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