Downloaded from http://adc.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Original article
ARCHIVIST
Peanut allergy: progress at last The publication of the STOP II trial from Cambridge in The Lancet produced significant mass media interest (Anagnostou K and colleagues. 2014 doi.org/10.1016/S0140-6736(13)62301–6). It was billed, with some justification, as having proved the first effective treatment for peanut allergy in children. Using oral immunotherapy (OIT) to bring about desensitisation is not new, but so far trials have been less successful in children than in adults, and peanut allergy has proved particularly difficult. The researchers studied 100 children age 7 to 16 from their specialist clinic at Addenbrooke’s and the wider community. Each had a history of an immediate hypersensitivity reaction to peanuts, confirmed by positive skin prick tests and a positive response to a doubleblind placebo-controlled food challenge. The study was randomised and double-blind with a cross-over design. The treatment group consumed an increasing daily quantity of refined peanut flour, starting at 2 mg and progressing in 2-weekly stages to 800 mg of peanut protein, and maintaining this for 6 months. The primary outcome was the ability to tolerate 1400 mg without reaction. At the end of the study, none of the control group were able to tolerate this, while 91 % (95% CI 79 to 98) were able to tolerate 800mg (about 5 peanuts), and 54% (95% CI 35 to 72) could tolerate 1400 mg (about 10 peanuts). During the treatment, as expected, some developed side-effects (oral itching, abdominal pain, nausea, vomiting, rashes, wheeze). These were mostly mild, and only two in the treatment group withdrew; only one needed to use an adrenaline autoinjector (which they all had). Quality-of-life measures showed a marked improvement in the treatment group. Immunological measures (skin-prick tests, basophil activation, etc) showed no or only minor changes after treatment, suggesting that the allergic tendency had not gone away. These are strikingly optimistic results. Previous studies of OIT have been much less positive, and an accompanying editorial by Matthew Greenhawt ponders why this might be (The Lancet 2014 doi.org/10.1016/S0140-6736(13)62671–9). This STOP II trial was conducted with great attention to experimental design and used a more cautious dosing regime than previously. Greenhawt advises caution about the long-term benefits: we do not yet know for how long tolerance will be sustained, or whether patients will develop other clinical problems in the future if they consume peanuts while still biologically allergic. Commenting on behalf of the RCPCH for the BBC, Prof Simon Murch said: “This is clearly a promising paper but it certainly isn’t a cure… it points towards a promising new direction of therapy and once further testing has been carried out, and techniques refined, it may prove to be a therapy with widespread use in hospitals in future. This is not something that should be undertaken at home, or indeed outside specialist centres." (www.bbc.co.uk/news/health-25917272) Competing interests None. Provenance and peer review Commissioned; internally peer reviewed. Accepted 4 February 2014 Arch Dis Child 2014;99:341. doi:10.1136//archdischild-2014-306139 Zamvar V, et al. Arch Dis Child 2014;99:336–341. doi:10.1136/archdischild-2013-304482
341
Downloaded from http://adc.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Peanut allergy: progress at last
Arch Dis Child 2014 99: 341
doi: 10.1136/archdischild-2014-306139 Updated information and services can be found at: http://adc.bmj.com/content/99/4/341
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Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Original article
ARCHIVIST
Peanut allergy: progress at last The publication of the STOP II trial from Cambridge in The Lancet produced significant mass media interest (Anagnostou K and colleagues. 2014 doi.org/10.1016/S0140-6736(13)62301–6). It was billed, with some justification, as having proved the first effective treatment for peanut allergy in children. Using oral immunotherapy (OIT) to bring about desensitisation is not new, but so far trials have been less successful in children than in adults, and peanut allergy has proved particularly difficult. The researchers studied 100 children age 7 to 16 from their specialist clinic at Addenbrooke’s and the wider community. Each had a history of an immediate hypersensitivity reaction to peanuts, confirmed by positive skin prick tests and a positive response to a doubleblind placebo-controlled food challenge. The study was randomised and double-blind with a cross-over design. The treatment group consumed an increasing daily quantity of refined peanut flour, starting at 2 mg and progressing in 2-weekly stages to 800 mg of peanut protein, and maintaining this for 6 months. The primary outcome was the ability to tolerate 1400 mg without reaction. At the end of the study, none of the control group were able to tolerate this, while 91 % (95% CI 79 to 98) were able to tolerate 800mg (about 5 peanuts), and 54% (95% CI 35 to 72) could tolerate 1400 mg (about 10 peanuts). During the treatment, as expected, some developed side-effects (oral itching, abdominal pain, nausea, vomiting, rashes, wheeze). These were mostly mild, and only two in the treatment group withdrew; only one needed to use an adrenaline autoinjector (which they all had). Quality-of-life measures showed a marked improvement in the treatment group. Immunological measures (skin-prick tests, basophil activation, etc) showed no or only minor changes after treatment, suggesting that the allergic tendency had not gone away. These are strikingly optimistic results. Previous studies of OIT have been much less positive, and an accompanying editorial by Matthew Greenhawt ponders why this might be (The Lancet 2014 doi.org/10.1016/S0140-6736(13)62671–9). This STOP II trial was conducted with great attention to experimental design and used a more cautious dosing regime than previously. Greenhawt advises caution about the long-term benefits: we do not yet know for how long tolerance will be sustained, or whether patients will develop other clinical problems in the future if they consume peanuts while still biologically allergic. Commenting on behalf of the RCPCH for the BBC, Prof Simon Murch said: “This is clearly a promising paper but it certainly isn’t a cure… it points towards a promising new direction of therapy and once further testing has been carried out, and techniques refined, it may prove to be a therapy with widespread use in hospitals in future. This is not something that should be undertaken at home, or indeed outside specialist centres." (www.bbc.co.uk/news/health-25917272) Competing interests None. Provenance and peer review Commissioned; internally peer reviewed. Accepted 4 February 2014 Arch Dis Child 2014;99:341. doi:10.1136//archdischild-2014-306139 Zamvar V, et al. Arch Dis Child 2014;99:336–341. doi:10.1136/archdischild-2013-304482
341
Downloaded from http://adc.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Peanut allergy: progress at last
Arch Dis Child 2014 99: 341
doi: 10.1136/archdischild-2014-306139 Updated information and services can be found at: http://adc.bmj.com/content/99/4/341
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
