"Headline hyperbole - probiotics cure peanut allergy?"
http://foodallergysleuth.blogspot.com/2015/02/headline-hyperbole-probiotics-cure.html#more

QuoteIn the latest edition of medical headline hyperbole, many of us learned last week that "Fatal peanut allergies could be cured by probiotic bacteria, say Australian doctors" and "This Breakthrough Treatment Helped Over 80 Percent of Allergic Kids Tolerate Peanuts."
Sigh

Quote from: CMdeux on January 30, 2015, 12:07:29 AM

Oh yay-- Australia and probiotics, which apparently elevate the success rate to....


(wait for it.... wait for it)



84%.


Wait.  Um--


where have I seen that value before??  (Right-- see my post from 1 year ago.)

Only this time, ONCE MORE, with feeling. probiotics!!

Quote from: CMdeux on January 30, 2015, 12:14:59 AM
This seems to be the direct institutional press on the subject--

http://www.mcri.edu.au/news/2015/january/peanut-allergy/

and here's the abstract:

http://www.ncbi.nlm.nih.gov/pubmed/25592987


If anyone has institutional access, I'd love to actually see the study.  But as noted above, I have a pretty good idea on the basis of the few statements that made it into news stories from press releases.

NOT good experimental design, if I've come even close to correct about those features.

Quote
Further work is required to confirm sustained unresponsiveness after a longer period of secondary peanut elimination and to clarify the relative contributions of probiotics versus OIT.

Massive understatement.

Oh yay-- Australia and probiotics, which apparently elevate the success rate to....


(wait for it.... wait for it)



84%.


Wait.  Um--


where have I seen that value before??  (Right-- see my post from 1 year ago.)

Only this time, ONCE MORE, with feeling. probiotics!!

Hmmmm.  I don't know that we know that. I thought it was the challenges that caused issues. I'll have to go baCk to look. But yes, it would be nice if they categorized things differently.

Exactly-- I don't like the fact that so many of the studies with OIT don't break out the REASONS why people don't finish the study protocol.

We know (because of a member here) that at least sometimes, it's because of repeated anaphylaxis with home-dosing.  Scary thought that this is something that is a "failure to be willing to comply with treatment protocol," isn't it?

Okay, but you have to be wiling/compliant to do any of these.

The exact starting point I was heading for was exclusion criteria. I'm not seeing anything about excluding subjects who can't pass the initial double blind, and I do not mean slight positive past the 1/70th marker. Of course I can infer if one couldn't take the initial dose without serious reactivity up to anaphylaxis that individual was excluded at that time or not even up for consideration. Details, details.

From another link eragon posted, a very excellent one and ever so glad to have brought to my attention http://www.jaci-inpractice.org/article/S2213-2198(13)00457-1/fulltext.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2962301-6/abstract


This is the study referenced in the BBC features.

Quote
Eligible participants were aged 7—16 years with an immediate hypersensitivity reaction after peanut ingestion, positive skin prick test to peanuts, and positive by double-blind placebo-controlled food challenge (DBPCFC). We excluded participants if they had a major chronic illness, if the care provider or a present household member had suspected or diagnosed allergy to peanuts, or if there was an unwillingness or inability to comply with study procedures. Our primary outcome was desensitisation, defined as negative peanut challenge (1400 mg protein in DBPCFC) at 6 months (first phase).

(emphasis mine)-- So the bottom line is that it's unclear (at least from the abstract) whether or not exclusion includes those who dropped out due to side effects of treatment.  You know, if participants became "unwilling" via asthma or other allergic reactivity.

Quote
The primary outcome, desensitisation, was recorded for 62% (24 of 39 participants; 95% CI 45—78) in the active group and none of the control group after the first phase (0 of 46; 95% CI 0—9; p<0·001). 84% (95% CI 70—93) of the active group tolerated daily ingestion of 800 mg protein (equivalent to roughly five peanuts).

84% is roughly in line with what US researchers have found, too, using similar treatment protocols.

That part is comforting, at least-- it suggests that UK peanut allergy is the same beast as in N. America, and that treatments work the same way there as here. 

Same short-term study, though-- six months isn't a long enough follow-up, which is what US researchers have been saying for a year or two now.

Are we to compare the published data on its own and within the standing body? The news articles don't do it for me.

http://www.theguardian.com/society/video/2014/jan/30/peanut-allergy-treatment-cambridge-video?CMP=twt_gu

Yes-- what I read what "another OIT study, different time zone."  What I did not see was the percentage that developed another food allergy or even EE.

OIT will totally work for some, won't work for some, and will cause other stuff for a few. It would be nice to predict who.


An aside: my DS is doing long-term, low-dose SLIT. I am worrying less about side effects with it. 

The titles news articles attach to these individual clinical trials are extremely inaccurate wrt to data presented. All that happens is one more initial OIT trial gets added to the data pile. I'm sure there was some sort of oral challenge to participate the initial dose of 1/70th of a peanut that was "far below" eliciting dose for reaction.

The logic doesn't bear out eliminating cherry-picking a population for early (or at least initial) OIT success. I'm not sure why this is hailed as a breakthrough when we've mounting data that long term success is at best unpredictable.

No OIT is a cure for allergic disease, it is an experimental treatment.

http://www.bbc.co.uk/news/health-25953619 

http://www.bbc.co.uk/news/health-25917272




will post more later.