Chad is currently enrolled in “The Peanut Oral Immunotherapy Study: Safety, Efficacy and Discovery”, or POISED, study at the Center. In November 2014, he attended a talk by Dr. Kari Nadeau about food allergies and the POISED study. “The standard answer to combating peanut allergies is avoiding peanuts, but this is really disruptive to daily life, and accidental ingestion is a real fear. At the talk, It felt very comforting to be in a room with individuals with the same concerns as I had,” said Chad.
Chad started avoiding peanuts at an early age as he felt unwell each time he ate foods containing peanuts. “Complete avoidance is difficult, and on the rare occasion I ate something contaminated with peanuts, I did have an allergic reaction. It did seem that these reactions were getting more pronounced, but I did not worry too much about it at that time.” said Chad unaware as a child of the gravity of his allergy. His increasing sensitivity to peanuts was confirmed when he was around 20 years old as he went into anaphylactic shock after eating half of an egg roll that contained peanut butter. According to Chad, “Within five minutes I could not breathe at all. I was gasping for breath.” He was not carrying an EpiPen – something he now realizes he should have done. Previously he had experienced mild to moderate symptoms, but he had not realized just how severely he would react to accidentally eating peanuts.
Now in his early 40’s, after hearing Dr. Nadeau’s talk, he screened and enrolled in the POISED study. He says he was tired of living in constant fear of accidently being exposed to peanuts. During the screening tests, he underwent blood tests, skin prick tests, and double blind placebo controlled oral food challenges (DBPCFC) to a number of allergens. In a DBPCFC, neither the clinician nor the patient knows which food is being tested. Although he was tested for many food allergens, he learned that he was only clinically allergic to peanuts. He qualified and began the clinical trial in July 2015. During the DBPCFC, increasing amounts of allergen were given until an allergic reaction was observed. During the screening process, Chad reacted to 250 mg of peanut flour (about the amount in one peanut). Based on that information, the clinicians were able to determine an initial dose. Since then, he has been coming into the clinic every two weeks for re-evaluation and dose adjustments. This specific study goal is for him to be able to consume 4,000 mg of peanut flour/day without allergic reactions within one year of initiation of treatment.
Chad, like so many of the food allergy patients who are seen at the Center, was diagnosed with moderate asthma as a child and still had mild asthma at time of enrollment in the study. Chad undergoes tests for lung function and other breathing benchmarks at each visit as a safety measure and these measures provide important data for our clinicians and researchers. Allergies and asthma appear to be interconnected — specifically there is a natural progression of these diseases from eczema to food allergies to hay fever to asthma. The natural progression of these diseases has been termed the Allergic March. It is likely that they have a common underlying mechanism of action. One of the questions that remains unanswered is whether immunotherapy for food allergies, in addition to desensitizing individuals to food allergens, can also alleviate symptoms of asthma. Chad and our other volunteers are invaluable in helping us find answers to these questions.
Eleven months into his treatment, Chad feels that the treatment has already made a huge difference in his life. He is now no longer as worried of going into anaphylactic shock due to cross contamination. “I eat cookies now, without fear that it might have been placed next to one covered with peanuts. Because many Thai dishes have peanuts, I have not been to a Thai restaurant in 20 years due to the high likelihood of cross-contamination. When I complete the study, I am going to celebrate by going to a Thai restaurant,” said Chad. He is very glad to be part of the study and said that it was very educational, as well. After his anaphylactic incident, he always carried an EpiPen, but since coming to the Center he now feels equipped with the knowledge and confidence to use it effectively in an emergency.
If immunotherapy is successful, Chad should reach his target goal of 4,000 mg of peanuts per day and eat that meal at a Thai restaurant one year after initiation of treatment. He will then stay on this maintenance dose and be reevaluated every three months for at least one year. Current research indicates that regular consumption of the allergen maintains desensitization, but whether discontinuation of the maintenance dose results in loss of desensitization in all individuals is unclear. What maintenance doses should be given? For how long? These are questions that this study, focusing on a wide range of ages of participants, hopes to answer.
We are grateful to all our study participants for their continued participation and involvement in the clinical trials and the broader community for supporting the Center.
Interview by Vanitha Sampath
Vanitha Sampath received her PhD in Nutrition from the University of California at Davis. At the Sean N. Parker Center for Allergy and Asthma Research, as a medical writer and content manager, she enjoys being in the midst of groundbreaking research in asthma and allergy and is committed to communicating the scientific advances of the Center and spreading awareness of its mission and vision.