Peanut allergy treatment ‘a success’ via BBC news online
Doctors say a potential treatment for peanut allergy has transformed the lives of children taking part in a large clinical trial. The 85 children had to eat peanut protein every day – initially in small doses, but ramped up during the study.
The findings, published in the Lancet, suggest 84% of allergic children could eat the equivalent of five peanuts a day after six months. Experts have warned that the therapy is not yet ready for widespread use.
The trial, at Addenbrooke’s Hospital in Cambridge, tried to train the children’s immune systems to tolerate peanut protein. Every day they were given a peanut protein powder – starting off on a dose equivalent to one 70th of a peanut.
The theory was that patients started at the extremely low dose, well below the threshold for an allergic response. Once a fortnight the dose was increased while the children were in hospital, in case there was any reaction, and then they continued taking the higher dose at home. The majority of patients learned to tolerate the peanut
Prof Simon Murch, an allergy expert at the Royal College of Paediatrics and Child Health, said: “This is clearly a promising paper but it certainly isn’t a cure.
“Nevertheless this study does point towards a promising new direction of therapy and once further testing has been carried out, and techniques refined, it may prove to be a therapy with widespread use in hospitals in future.”
But he added: ” This is not something that should be undertaken at home, or indeed outside specialist centres.”
Of course, so many parallels with that other GMI – sneaking in under the (neuro)immune radar, start small- really small if necessary, build gradually and carefully, be prepared for a reaction, it’s going to take some time…
Grading, ramping, building up; such a fine, and at times, delicate art. I think formulas fail; they don’t (can’t?) take into account the magnificent variety and sheer complexity of different human experience. That leaves listening, clinical reasoning, maybe a bit of trial and error. Metaphors and analogies can help; “baby steps”, you need to walk (left/right discrimination) before you can run (mirror box), one foot in front of another, the journey of 1000 miles starts with a single step, you can’t eat a whole salami in a single mouthful (anyone that’s taken a GMI course with David Butler will know this one!), pace it don’t race it, patience and perseverance, patience and perseverance, patience and perseverance….
But it can be hard; pacing and graded exposure don’t tend to have a lot of “sex appeal” in a quick fix world or where that “guy down the street reckons he can just crack it back in and I’ll be right”. By necessity, graded exposure will involve a LOT of repetition, possibly hours spent doing the same thing, with only incremental change if any, over and over again every day. How do you motivate a person in trouble to spend an hour, two hours, per day looking at body parts being flashed in front of them? I think the right education and grounding must be essential.
Then, how to progress? The book has some great ideas. Do I follow them by rote? Should I add some background music? When should we progress to some mirror box in the workplace? What happens if there’s a flare-up? Again, listening and clinical reasoning are rocks in the shifting sand.
I’d love to hear about your tips and tricks, successes and ‘opportunities for learning’ regarding graded exposure, the motor imagery kind or otherwise.
As a side note, I wonder if there was any contextual effect in the study. Context is such a big part of GMI – location, environment, emotion, distraction, function. I wonder if eating some peanut protein results in a different reaction if it’s eaten in hospital surrounded by trained staff compared to being at home? What about eating something you *think* is peanut protein. What about watching someone else eat peanuts?
I know, the story is about peanuts, not Macadamia nuts, but you’ve all seen what I did there.