ACAAI 2018 Perspectives - Episode 2

Simon Murray, MD: Pediatric Peanut Allergies in a Real-World Setting

The introduction of a peanut allergy therapy to US markets would make a difference in the lives of about 2% of children—lives burdened by limited diet and lifestyle options, and a fear of anaphylaxis.

Even if the best-case results from a therapy such as Aimmune Therapeutic’s investigative drug AR101 only entail pediatric desensitization, Simon Murray, MD, would consider that a big win.

In an interview with MD Magazine® following promising trial results of the investigative drug at the American College of Allergy, Asthma & Immunology (ACAAI) annual meeting in Seattle, WA, the Princeton-based internist discussed the public health concerns surrounding peanut allergies.

MD Mag: What is the current state of peanut allergies as a public health issue?

Murray: Well, the standard of care now to treat peanut allergies is avoidance. And if you can't avoid it, then you treat it with epinephrine, because among the reactions that people get to peanuts is anaphylaxis. It's not always anaphylaxis, but they can be quite severe reactions, and anaphylaxis can kill you. You can imagine the dilemma it presents to parents and to children who have this problem, because it’s unpredictable—the peanuts are ubiquitous in food and it takes very small amounts to cause reactions.

So, children have to be very careful about going to restaurants, as an example. Parents have to be very diligent about children that when they attend birthday parties, or even when they visit relatives. It can be burdensome to the children themselves, who get targeted often because they're different than other kids.

Not only is it unpredictable, but it's quite severe when it happens, so it affects parents and children to a great degree—and school systems. The school has to be educated about what can happen, and have to know about these things in advance.

So it's rather complicated, and if you consider the fact that it affects 1 in 50 children, it's going to happen in a school system, a kid is going to have a reaction. It's quite scary, actually, when you see it. I happen to have seen anaphylaxis personally and it's frightening how quickly it develops and how threatening it is to a person's health.

Is there potential for AR101 to increase pediatric patient allergy tolerance through adolescence?

Unfortunately, the ability to desensitize is not sustained, at least now. In a study that was unrelated to this one, other researchers have demonstrated that oral desensitization will go away in as little as 7 to 10 days if that stimulation is not maintained, so it is probably going to be a lifetime of desensitization. Now, I will note that about 20% of people who have food allergies or peanut allergies, they go away when people become adults.

But for 80% of children, they may persist for indefinite periods of time. It’s going to be a lifetime of work, and once you skip for a period of time then you're back to square one.