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New Peanut Allergy Drug Shows ‘Lifesaving’ Potential [nytimes.com]

He still does not knowingly eat peanuts or peanut products, but can tolerate the occasional undeclared traces of peanuts that slip into cookies and cakes from cross-contamination in a kitchen or food processing plant. “I have that protection, that shield for the amount I can tolerate,” he said, adding that he no longer takes the medication but eats two peanut M&Ms a day.

The treatment was not effective in the small number of adults enrolled in the study.

The trial, said to be the largest of its kind, included 551 people, of whom 496 were 4 to 17 years old. All of the participants were tested for peanut allergy at the beginning of the study, and experienced reactions to very small amounts of peanut protein, equivalent to one-third of a peanut or less. Most participants had a history of anaphylactic reactions after consuming peanuts, while over half had asthma and another food allergy. Those who had been hospitalized with a severe allergic reaction within the last 60 days were excluded from the study, however, as were those who had severe or poorly controlled asthma.

The drug is described as a “peanut-derived investigational biologic oral immunotherapy drug,” but the active ingredient is simply defatted peanut flour that is carefully measured and packed into capsules or foil sachets of varying doses that are easily opened so the contents can be mixed into unheated food and consumed.

At first, the participants were fed a dose of three milligrams of the drug, staying on that daily dose for two weeks before moving on to the next slightly higher dose, with the goal of eventually reaching a maximum dose of 300 milligrams, which is roughly equivalent to one peanut. The regimen is stretched over the course of six months, followed by six months of maintenance therapy at 300 milligrams a day.

After the treatment and maintenance phase were completed, children were given a food challenge to see how much peanut protein they could tolerate. Most of those who completed the treatment were able to tolerate up to 600 milligrams of peanut protein, the equivalent of two peanuts; half were able to tolerate 1,000 milligrams of peanut protein.

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