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Peanut allergy cured in majority of children in immunotherapy trial

theguardian.com

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Re: Peanut allergy cured in majority of children in immunotherapy trial

#131

Post by jogjayr »

nikolay wrote: post #47
option_greek wrote: post #42

Earlier quoted context omitted.

Isn't Yogurt a common thingy in various countries. At least, in India it is known to have been used for a long time (specifically the clarified butter derived from the yugurt[1]). [1] https://en.wikipedia.org/wiki/Ghee

Ghee is clarified butter and has nothing to do with yogurt. Now, when the native to Bulgaria bacteria has been spread around the globe, yogurt is available worldwide, but not until recently.

Beg to differ. Here's how my mother makes ghee at home:

1. Heat milk and milk cream (mostly milk cream), let cool, add yogurt culture

2. After yogurt is set, add water and churn

3. Extract the butter that you get from churning, drink the leftover buttermilk :-)

4. Heat the butter till it's ghee

Re: Peanut allergy cured in majority of children in immunotherapy trial

#132

Post by hanklazard »

nibstwo wrote: post #69
S_A_P wrote: post #39

My daughter has Celiac disease. It was diagnosed at age 4 when her growth chart showed she did not gain a single pound and grew ¼" from age 3-4. We did a biopsy of her small intestine and it was completely smooth. (Should be almost like velvet) Herblood levels also showed high sensitivity to gluten. We have her on a strict gluten free diet and she has since followed the growth chart perfectly. However she is sensitiv…

I have Celiac. Unfortunately immunotherapy is not currently done in a way that would make much of a difference for us. Celiac is typically an autoimmune response to Gliadin protein as a result of human leukocyte activation genes HLA-DQ2.2/2.5 or HLA-DQ8. In either case, it is happening at the cellular level for every cell that comes into contact with the protein. The intestines are hard hit mostly because they spend…

In regards to autoimmunity, antigens themselves don't destroy cells--antigens only provoke a pathogenic immune response when presented to the immune system.

You're not wrong with regards to the celiac, gliadin, and the association with the HLA alleles that you've mentioned. However, I'll point out that those particular HLA genes make up MHC class II proteins. These are the proteins present on what are known as professional antigen presenting cells, a small group of specialized immune cells throughout the body. MHCII proteins present foreign antigen to TH4 cells (helper T cells) which can then activate a larger immune response.

Epithelial cells of the intestinal villi have not classically been thought to be professional antigen presenting cells, and thus should have very small levels of expression. I found one older study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC508181/) that suggests these intestinal villi cells can express class II but nothing since. All of this suggests that the pathogenesis of celiac disease is not as simple as intestinal villi cells expressing high levels of the HLA proteins encoded by the genes you mentioned and provoking a direct immune response--rather, like seemingly every autoimmune disease, the story is much more complicated and likely involves the activation of CD4+ T cells, generation of pathogenic autoantibodies, and a larger network of pro-inflammatory players.

Re: Peanut allergy cured in majority of children in immunotherapy trial

#133

Post by 0xbear »

True story: in Russia (and I can only assume other Eastern European countries) peanut allergy is so rare that I've never even heard of it until I emigrated. Pollen allergy is about the same, ragweed pollen allergy can be really bad too. But not peanut allergy.

Re: Peanut allergy cured in majority of children in immunotherapy trial

#134

Post by jvolkman »

sageikosa wrote: post #3

When in her teens, my daughter developed a peanut allergy during her time in drum corps such that it was confirmed with skin patch tests and she had to carry an epi-pen. After about a year it just went away and she's back to "normal".

I do wonder about how many kids that think they have peanut allergies (or otherwise) have actually lost or outgrown them.

My anecdote: our daughter was diagnosed with a peanut allergy at ~7 months of age. She developed hives after eating some peanut butter and we confirmed the allergy at our allergist's office with a skin test. We were told to give it another shot in ~5 years, but to avoid all nuts and carry an epi-pen in the meantime.

But just about a year later after an insurance change, our new pediatrician encouraged us to do another test with our new allergist. A blood test came back negative, and the ultimate test - eating increasing amounts of peanut butter in the allergist's office over a couple of hours - was fine.

Re: Peanut allergy cured in majority of children in immunotherapy trial

#135

Post by hanklazard »

Physician-scientist here. My graduate work was in an immunology lab. Just wanted to clear up some confusion I've seen in multiple posts.

While both peanut allergy and celiac disease involve pathogenic immune responses, they represent very different types of problems and this study's results do not suggest any relevance to celiac.

The peanut allergies that they are referring to in this study are one of the most striking examples of what's known as a Type I hypersensitivity (IgE-mediated/anaphylaxis). In this type of reaction, high levels of IgE, a class of antibody, generated toward a specific antigen become loaded onto mast cells and on re-exposure, cause mast cell degranulation and subsequent smooth muscle contraction. For this reason, anaphylactic responses frequently involve closing of the airway, nausea/vomiting, and other dysregulations of smooth muscle activation and require a strong adrenurgic agonist like epinephrine to counteract this activation.

Celiac pathogenesis is not a Type I hypersensitivity. To my knowledge, the exact mechanism of pathogenesis is not known, but it is likely a combination of Type III (antibody-mediated) and Type IV (T-cell mediated) hypersenitivities.

Anyway, I'm not trying to ruin anyone's hope here, but this study has no relevance for celiac. What this has shown is that there is the potential for food allergies to be systematically eliminated with long-term increasing exposure to the problematic antigen, in this case, peanut antigen. This has been done for some time with other, less aggressive types of IgE-mediated conditions like dog and cat dander allergies. So in that way, it's not all that surprising of a result, but I'm certainly glad to see that this was able to be done safely. This is really great news for the millions of people out there with anaphylactic food allergies.

All that being said, I do hope that celiac can be managed more effectively with immune-modulatory (or other) treatments in the future and my sympathies go out to those who have been affected by this horrible disease.

Re: Peanut allergy cured in majority of children in immunotherapy trial

#137

Post by herewegohawks »

Very severe peanut allergy here - honestly go away with this crap of comparing your gluten allergy. I have to carry an epipen and worry about risking my life when I so much as eat food that was on the same table as baked goods that MIGHT have traces of peanut butter.

Re: Peanut allergy cured in majority of children in immunotherapy trial

#138

Post by makmanalp »

0xbear wrote: post #133

True story: in Russia (and I can only assume other Eastern European countries) peanut allergy is so rare that I've never even heard of it until I emigrated. Pollen allergy is about the same, ragweed pollen allergy can be really bad too. But not peanut allergy.

I've wondered too. Very similarly in Turkey - growing up I'd never even heard of anyone with serious allergies to anything really, except perhaps seasonal allergies, which mostly meant a runny nose. Certainly I'd never seen an epi-pen in my life, and no allergies people took serious medication or did immunotherapy for. Do we have a proper explanation for this?

edit: one study citing a need for more data: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879010/

another old article (2011) on the Hygiene Hypothesis: https://www.nature.com/nature/journal/v479/n7374_supp/full/4...

Re: Peanut allergy cured in majority of children in immunotherapy trial

#139

Post by nikolay »

jogjayr wrote: post #131
nikolay wrote: post #47

Earlier quoted context omitted.

Ghee is clarified butter and has nothing to do with yogurt. Now, when the native to Bulgaria bacteria has been spread around the globe, yogurt is available worldwide, but not until recently.

Beg to differ. Here's how my mother makes ghee at home: 1. Heat milk and milk cream (mostly milk cream), let cool, add yogurt culture 2. After yogurt is set, add water and churn 3. Extract the butter that you get from churning, drink the leftover buttermilk :-) 4. Heat the butter till it's ghee

Thanks for this! I'll try to reproduce it!

But what I meant is that ghee is not made with yogurt and not solely from fermented milk - and ghee doesn't have to be cultured either (most brands available in US stores are not). Again, my point was, that for fermented milk to be called "yogurt," it needs to have a particular Lactobacillus profile, which is not traditionally available in India. Nowadays, maybe you use the imported starter cultures just like Japan, USA, and EU does.

Re: Peanut allergy cured in majority of children in immunotherapy trial

#140

Post by compsciphd »

azernik wrote: post #95
gehwartzen wrote: post #78

The AAP also recently changed its guidelines for introducing peanuts to babies based on a study [1] showing a pretty dramatic decline in the development of the allergy with early exposure vs total avoidance. [1] http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#abstract

For a bit of extra anecdotal evidence - in Israel a common easily-digested semi-junk food is Bamba, peanut puffs. Rates of peanut allergy are very low there. What you have instead is milk allergies, and briefly doctors recommended delaying introducing milk to infants. (This advice has also changed.)

with that said, sesame is also a huge product in Israel (techina, chummus....) and rates of allergies to it are higher than average. With that said, sesame is not something little kids are going to be eating as much of or creating dust in the air.
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