ACAAI 2018 Perspectives - Episode 3
The intricacies of managing a pediatric peanut allergy are exhaustive and burdensome for both the patient and their parents. As Simon Murray, MD, an internist in Princeton, NJ, noted to MD Magazine® in an interview, everyday activities such as going to a friend’s house or out to a restaurant for a meal can be a risk.
With the newest data on investigative drug AR101, presented at the American College of Allergy, Asthma & Immunology (ACAAI) annual meeting in Seattle, WA, showing significant benefits of desensitization in pediatric patients highly allergic to peanuts, such challenges could be eventually cleared by one daily oral therapy.
MD Mag: What do the benefits of AR101 for pediatric peanut allergy equate to in a real-life setting?
Murray: What's interesting to note is that it takes very small of peanut to cause allergies. In this particular study, to be included in the study, you had to respond to a 100 mg or so equivalent of peanut allergen. Now, a peanut is about 300 mg of allergen, so that was like one-third of a peanut—kind of a small amount of peanuts.
But many people react to much less than that. The FDA, the United States government have no standard now to call a product peanut-free. But for gluten, as an example: 20 parts per million is the standard minimum dose to call a product gluten-free. Keep in mind what a part per million is: if you dissolve 4 drops of ink in a 50 gallon drum of water and stir it, that would give you one part per million of ink—very small amount of ink.
And so if you translate the parts per million into 100 mg of peanuts it's going to be something like 20 drops of that solution, I think. That's a very small amount. So therefore, people have to be very careful about going to restaurants where food is prepared, because very often when they clean surfaces or clean utensils, peanut residue gets left on them or on the countertops, or people may put peanuts on and then take them off, if they know the person is allergic—thinking that's enough. That's not.
Your restaurant workers are ignorant as to how little it takes to be sensitive to peanuts. It's a big problem for parents. Some of the advocacy groups recommend interviewing restaurant staffs and getting detailed lists of foods that they prepare, and avoiding restaurants like Asian restaurants, where they’re more likely to use nuts in preparation, or to avoid restaurants that are high-volume, fast-paced restaurants where they serve a lot of customers quickly.
But they recommend interviewing the food servers, and the chef, and the owners of the establishment. I mean, to me, that's a rather difficult thing to do. And then when the kid is not around you, you don't know what they're going to be exposed to. It really takes a lot of education and diligence.
So, this is a potentially great breakthrough, as a matter of fact. Should these oral desensitization products turn out to be positive—and it looks like they helped a significant amount of the people during the desensitization process—it could potentially help quite a few people. It is an exciting breakthrough.
As I said, most desensitization has been done subcutaneously, rather than oral, because the oral desensitization has not been really successful. Even when products are used sublingually, they don't work as well. But this product looks like it had a significant, robust effect to desensitize children who are sensitive highly sensitive to peanuts.