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FDA approves first medication to reduce allergic reactions to multiple foods
- hmcq6 3y agoHow much is it going to cost for me to eat a pizza? The medicine exists, now it is just a matter of willpower. Edit: I would save up and pay $1000 but twice a month forever? womp womp
- hanniabu 3y agoHow would this differ from an epipen?
- irjustin 3y agoDoesn't replace epipen as this is preventative while epipens are reactionary, but hopefully reduces the situations where one is necessary.
- darknavi 3y agoWell, in the first paragraph: > Xolair is intended for repeated use to reduce the risk of allergic reactions and is not approved for the immediate emergency treatment of allergic reactions, including anaphylaxis.
- nimbleplum40 3y agoThis is taking regularly to reduce the risk of even having an anaphylactic reaction if exposed to an allergen.
- deleted 3y ago[deleted]
- spondylosaurus 3y agoXolair works by targeting IgE antibodies, which are the part of your immune system that responds to allergens. The shot essentially neuters those antibodies to prevent them from reacting as often/severely, which dampens your body's allergic response across the board. (Crucially, IgE antibodies are not the part of your immune system that responds to infectious disease, so anti-IgE meds won't make you immunocompromised in any significant way.)
- whatshisface 3y agoHold on, why even have IgE antibodies then? Edit: >Several lines of evidence suggest that IgE is important in host defense against parasites (see Section 9-23). Many parasites invade their hosts by secreting proteolytic enzymes that break down connective tissue and allow the parasite access to host tissues, and it has been proposed that these enzymes are particularly active at promoting TH2 responses. This idea receives some support from the many examples of allergens that are enzymes.
- kortex 3y agoYep, you got the gist in the ninja edit. The IgE-parasite connection is actually a bit part of the hygiene hypothesis, and I have personal experience with helminth therapy. It put a serious permanent dent in my animal and pollen allergies, long after the session (I forget how long they were active but I re-inocculated N. americanus twice and it was roughly a 2-3 year period). Once you get over the squick factor and the really terrible itching at the site that lasts 12-24h, it's great.
- heywire 3y agoSomewhat related, I am allergic to an assortment of fruits and vegetables (celery, carrots, watermelon, cantaloupe, bananas, etc…). Most of my food allergies are related to Oral Allergy Syndrome. I’ve been taking Flonase now for more than a year for sinus congestion from allergies, and my food allergies have all but gone away. It has been great being able to enjoy these foods without my mouth, throat, and ears itching.
- petesergeant 3y agoI've been taking fluticasone propionate (which Flonase is) as a nasal spray nightly, and it's completely stopped me snoring and cured sleep apnea that previously I needed a CPAP machine for. Great stuff.
- polishdude20 3y agoIs that the stuff that you can have withdrawal from? I remember after using a nasal spray when sick, if I used it too much for a week, the next two weeks id get really clogged up.
- petesergeant 3y agoI didn't think so, and I've also not found that in practice, having definitely run out of it before
- A_D_E_P_T 3y agoWhat you're talking about is oxymetazoline and its analogs, like in Afrin nasal spray. Oxymetazoline is super potent and works immediately on nasal passages, but it can be risky to stay on for more than a few days straight. Steroids like fluticasone don't work immediately, and take a couple of days to kick in, but you can use them indefinitely. Also, in addition to opening nasal passages, they have general anti-allergic effects -- i.e. they can help with itchy, watery eyes and facial swelling.
- brian-bk 3y ago
- gnicholas 3y agoFrom what I read of this, it's very expensive (thousands/mo), requires at least monthly injections at a facility, has a risk of anaphylaxis (so the injections can't be done at home), doesn't eliminate the risk of allergic reactions, and has no off-ramp (so you have to take it forever). Not exactly a silver bullet... My first thought was that it could be good for kids, who are less good at checking for trace amounts of allergens, but then I saw that it requires injections, which kids aren't so great at.
- el_benhameen 3y agoRight. But the selling point isn’t “start packing pb&js for lunch”, but rather “go to a restaurant for the first time” or “worry less about your kid’s life being at risk from a classmate’s snack”.
- jwineinger 3y agoWe did achieve this with OIT for peanut allergy. Once we reached bite-safe levels, our lives literally changed for the better. We didn't have to worry about interrogating anyone serving us food (restaurants, friends, family), and we could go to some places that were just never an option before where cross contamination is likely or even expected, like ice-cream parlors. There's still a protocol we have to follow every day though, so an actual cure is still a dream for us.
- el_benhameen 3y agoThat’s fantastic! I’m glad to hear that it’s been successful.
- nimbleplum40 3y agoFar from a silver bullet, but still exciting as the first medicine of its kind! Accidental exposure happens to pretty much everyone with food allergies, so reducing the risk of anaphylaxis by ~70% is huge and will save lives.
- spondylosaurus 3y ago
- modeless 3y agoI've been following this closely. I'm most interested in Xolair (and another one, Dupixent) as a way to make oral immunotherapy (OIT) safer and more effective. Xolair can reduce reactions for sure, but it can't get people to the point where they can actually eat normal serving sizes of their food allergens. Oral immunotherapy can do that. And Xolair is a twice monthly injection. Nobody wants to do that for the rest of their life, and if OIT is successful presumably you could stop Xolair after. Unfortunately neither Xolair or Dupixent has looked super promising in early study results when combined with OIT. But Dupixent in particular is approved to treat one of the possible side effects of OIT, EoE (inflammation of the esophagus), so I'm still hopeful.
- spondylosaurus 3y agoI've been taking Xolair for the last ~4 years for general allergies (with stellar results) and at least for my regimen, it's only once a month, not twice. My partner was on Dupixent for a while to shrink some nasal polyps—that one is twice a month.
- modeless 3y agoInteresting. I looked at a dosage chart and it seems like you do either once or twice a month based on your IgE level determined by a blood test. So it is twice a month for some people.
- spondylosaurus 3y agoAh, I do get two shots a month because my IgE was wicked high, but I get them both at the same time. One in each arm!
- twothamendment 3y agoMy wife also gets 2 a month, on the same day, but I get to stab her in the gut. Good times!
- lettergram 3y ago
- mgh2 3y agoSounds a bit like: https://en.wikipedia.org/wiki/Dupilumab https://en.wikipedia.org/wiki/Dupilumab
- dukeofdoom 3y ago[flagged]
- dboreham 3y agoThe FDA didn't remove dirt from kids' environment.
- error_logic 3y agoThey also didn't prevent the abundance of pesticides and herbicides which may cause immune responses to other things in food. Then there's all the microplastic and teflon and whatever else seeps into the food supply from industrial equipment operation. We've not only eliminated a lot of "dirt" but introduced a lot of things which can cause issues whether due to volatility or chemical stability causing inability of the body to clear it up.
- dukeofdoom 3y agoBut FDA did stamp the covid vaccine. The study that touted its effectiveness, was used to approve it, was obviously flawed. A billion dollar Fraud, and theft from tax payers that were mandated into taking it. FDA so far has faced no repercussions for it. In fact, for the longest time you would get censored for questioning its effectiveness, or even asking for some accountability.
- kortex 3y agoA) hygiene hypothesis, people ate way more dirt and straight up almost everyone had worms B) the people with really bad food allergies like Coeliac just died young. We have severe amnesia when it comes to just how rough the state of health was until basically the 50s (eradicating Polio is a big turning point). Fortunately, we can learn about history so we don't repeat it :massive eyeroll:
- yosito 3y ago> really bad food allergies like Coeliac Coeliac is just a word that means "relating to the abdomen", Coeliac Disease is a disease of the abdomen characterized by an immune response to gluten that causes the villi in the intestines to consume themselves, among other characteristic symptoms. Coeliac (or Celiac) Disease is not a food allergy.
- rzmmm 3y agoVery cool. I hope some day all autoimmune diseases are prevented and no lifelong treatment is necessary. A lot of exciting research around the hygiene hypothesis, even though the progress has been slow, it's going forward.
- Madmallard 3y agoVery expensive Not a great side effect profile Not even very effective Yup sounds like medicine in the 21st century. I think we're going to cull ourselves as a species because we're not at all aligned with doing things that actually make people healthier, unless that also happens to make good money.
- School-Cotton 3y agoWould you prefer the alternative of the 20th century, where this drug doesn’t exist at all?
- Madmallard 3y agoThe 20th century had far fewer people with allergies as a proportion of the general population
- spondylosaurus 3y agoI've been on the shots for four years with zero side effects. My allergist has put hundreds of patients on it and takes it himself.
- jwstanly 3y agoExciting to see FDA approval here. Hopefully next is FDA approval for programs like TIP (https://foodallergyinstitute.com/food-allergy-treatment/ https://foodallergyinstitute.com/food-allergy-treatment/). I'm a TIP grad, its life changing to be cured versus still avoiding your allergens and only having reduced anaphylaxis risk.
- andrewchilds 3y agoIf TIP does work as well as the Food Allergy Institute claims, it should be subjected to a double-blind randomized clinical trial that surfaces the risks and benefits, and then practiced across the US. I'd truly love to see that happen. Until then, I'm deeply skeptical, even with testimonials like yours.
- jwstanly 3y agoThe skepticism is understandable at least academically. From my understanding FAI isn't prioritizing clinical trials because 1) their individualized process with AI/ML work isn't aligned with classical physician/allergist work and 2) that same time could be spent to grow the program's operation and get more patients off the waitlist. The individualized work is also why TIP doesn't scale-- even FAI itself hasn't opened offices outside of SoCal yet (east coast patients like myself have been begging internally for years for them to open locations nationwide). Everyone would love to see FAI be more transparent, but just because they aren't doesn't mean the program doesn't work. Arguing "its not clinically proven, therefore it's not legitimate" feels pedantic when there's thousands of us in remission.
- andrewchilds 3y agoYou could also say that OIT "works", just from reading a couple success stories online. But the whole story is complicated. I know a family that spent enormous amounts of time and money on OIT, and ended up stopping due to a random anaphylactic reaction to a maintenance dose a few years in. I think it's perfectly reasonable to want to know what percentage of people have had a negative/mixed experience with TIP. If it's as safe and effective as they claim it is, that's truly incredible - and I'm glad to hear it worked for you! But I need real clinical trial data before I sign my kid up for it.
- _heimdall 3y agoI'm a little rusty when it comes to statistical analysis, but is 168 total participants ranging from 1 to 56 years old really enough for any meaningful level of statistical significance? Sure the efficacy rates seem really promising here, but that's an extremely small group and if there are any concerns over age-based factors the cohorts are even smaller. Add the fact that this medication is meant for long term use and I really don't know how we can claim any level of certainty with regards to long term safety. The study only followed the 168 participants (including placebos) for 16-20 weeks.
- az226 3y agoIt went from like 6% to 68%, so yeah it’s statistically significant even at low numbers like 168.
- DoreenMichele 3y agoIt's a 16 to 20 week course of treatment and reduces risk of anaphylaxis for accidental exposure to food allergens. There is at least one other drug that is used to treat peanut allergies, but this treats multiple food allergies. Given that anaphylaxis can be deadly and staff at food places can be sometimes less than reliable about food allergy concerns, I can see this being appealing to someone with severe food allergies who wants a more normal life. It would be nice if we figured out what causes allergies and fixed it but, I mean, we may never fully solve that. For some people, "take injections for a few weeks and be able to go out with friends without stressing this will involve another life-threatening health event and trip to the ER" will be of adequate value to endure the course of treatment.
- yosito 3y ago> staff at food places can be sometimes less than reliable about food allergy concerns As someone with Celiac disease, who often eats at restaurants, this is a bit of an understatement. Even in restaurants where things are marked allergen free on the menu, it is often the case that staff will make mistakes. More often than not, staff aren't even informed about the basics of food, things like eggs and dairy being two separate foods, or that they can't just scrape some sauce off of a bun if they put it there by mistake, etc. If I had a life threatening allergy, I would never set foot in a restaurant. It's terrifying.
- feverzsj 3y agoOmalizumab is mostly used as a last resort. It requires long-term treatment, and the symptoms usually come back quickly after stopping the treatment. Most doctors will try antihistamines first, they are safe and cheap.
- joshmarinacci 3y agoThere’s something I don’t understand. I took allergy shots to treat my sinus allergies to grass pollen, pet dander, and rag weed. It’s not perfect but it built up my tolerance to these so that I can have cats and survive grass season. Why can’t a similar treatment work for food allergies.
- mbrubeck 3y agoThere is a treatment called Palforzia for peanut allergy that works similarly.
- munchbunny 3y agoOral immunotherapy is currently the baseline treatment for things like peanut allergies, and it works, but it requires daily dosing. Also, for adults that start doing it, it often leads to feeling like you have perpetual digestive discomfort. Many people decide the discomfort isn’t worth it and stick with avoidance, especially for things like nut allergies where avoidance is quite doable in the US. The good news is that if you diagnose food allergies early and start someone on oral immunotherapy when they’re extremely young (<2 years old), the early evidence is that you can build up significant tolerance with basically no side effects. That’s the boat my child is in - we started them on peanut OIT at just over 1 year old, and the worst symptoms were a skin breakout or two, and today they’d probably be able to eat a couple peanuts with no reaction. The downside is they have to continue their daily dose forever. There are some interesting alternatives coming into the market though. Edit: they will still need to always keep epipens nearby, but at least now there’s no fear of anaphylaxis when someone nearby on the plane eats a bag of peanuts.
- acquacow 3y agoI wonder if this would work at all for my garlic intolerance.
- zzz999 3y agoSo cheap too
- hereme888 3y agoSo Xolair can cause anaphylaxis at any point in time, even if it didn't cause it initially. Is accidental exposure to these food allergens so common, even after being careful, that those at risk are willing to take that risk and spend the cost?
- p0w3n3d 3y agoXolair (omalizumab) is already approved in my country, however, there is some risk of cancer developing ( _its use has been recently linked to potential increased cancer risk_ ), and having been informed about it, I decided that my allergy is not as bad, to try it out, at least at the moment
- Madmallard 3y agoI’ve been dealing with a seemingly impossible condition for the better part of a decade now seemingly related to allergies and aberrant immune function. The problem is extremely consistent and simple to describe. Every food I eat for more than a few days trends toward causing an anaphylactic reaction. I’ve heard every response imaginable from doctors, especially all the unhelpful and harmful gas-lighting type responses. “You can’t be allergic to everything!” I’ve changed hospital centers multiple times until now I see basically some of the absolutely most credentialed providers in the world. Their best guess is a condition called MCAS. This is a poorly described syndrome basically summarized as aberrant allergic type responses without a known cause. It is a diagnosis of exclusion. What’s absolutely insane about it is that it is “not criteria for disability” according to United States current standards. It has got to be the most insane thing that someone with a rare, life-threatening condition is struggling to stay alive and at the same time struggling to survive financially. My primary care provider didn’t believe me for over a year until I brought beans to his appointment, a food I definitely do not have IgE allergy to (but have been eating for a week prior to that appointment), ate one bite, then he just watched me turn pale, have my HR go from 75 to 125, and have immense discomfort that lasted for a few hours. My stomach also ballooned out like I was pregnant. Even after that, he is like “I think you have something like splenic sequestration.” Yeah, I've never had changes in hemoglobin levels on labs at the emergency room. It really is like dystopian. It took 6 years before providers checked things like tryptase and PGD2, known immune mediators, to notice they are variable and for some sometimes out of the normal range. I guess I bring this up because I really am at a loss for how to deal with this condition. I take all of the standard MCAS medications, which seem to reduce the severity of my reactions, however they do not prevent me from having to constantly switch what I eat or drink. I constantly struggle with malnutrition and disordered eating because I cannot eat anything regularly and stably. Many patients with MCAS take Xolair after they try other medications that do not work well enough to see if it will help. We really need more efforts to deal with these types of problems and more medication research. More biological research as well because clearly immune knowledge is severely lacking. Supposedly many patients that develop Long Covid also develop problems with their mast cells too, so problems like this have to be increasing in incidence. Asthma, an immune system problem that used to be rare, has an almost 10% incidence now in the United States.
- nostrademons 3y agoThere's also oral immunotherapy, where you give children increasing amounts of peanut (or other food allergens) to desensitize their immune system. Initial studies showed it was effective in achieving desensitization in 71% of patients (vs. 2% of controls) and remission in 21% (vs. 2% of controls): https://www.nih.gov/news-events/nih-research-matters/oral-immunotherapy-peanut-allergy-young-children https://www.nih.gov/news-events/nih-research-matters/oral-im... It's largely limited to young children (the immune system under age 5 is more resilient than it gets later), but for parents that are willing to front the fairly considerable expense and inconvenience up front, it does offer the prospect of actually outgrowing the peanut allergy and not suffering from it as an adult.
- legitster 3y agoI had an interesting conversation with a doctor recently. They suggested that people have overreacted to the risk of anaphylactic shock. We automatically treat it as a life ending event, but I guess even if you go into shock it's a pretty long tail event that causes permanent damage. All this to say its hard to even get an EpiPen now. People using it unnecessarily during any panic attack and ending up in the ER is a bigger risk than the allergy itself. It might be fair to say these treatments would be just as much as a psychological treatment - you have millions of people living in constant fear that this could help.
- andrewchilds 3y agoIn my experience epipens and generics are easy to come by, and as a parent that has given epipens to a kid, passed out and deep in anaphylactic shock, and hearing ER nurses casually talk to each other about how many epipens they've given to kids that didn't make it, I think you might feel differently if you lived through that first-hand.
- legitster 3y agoThat's the thing, I grew up hearing stories all the time of people almost dying. It wasn't until my doctor turned us down for an Epipen after our kid went to the ER for croup that he actually explained how rare it was for allergies to kill someone. Out of curiosity I looked at actual case rate numbers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589409/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589409/ Less than 200 a year and more than half from drug related allergies. That's getting into death from lightning strike numbers or deaths from chicken pox. (Obviously, this doesn't factor in the specific risk to someone with a known allergy, or without access to Epipens/care. But still a pretty low risk compared to the attention it gets.) I also found a statement put out just last year by the American College of Allergy, Asthma & Immunology: > "Injectable intramuscular epinephrine is the first-line treatment for anaphylaxis. Epinephrine is touted as "life-saving," in particular because observational studies have identified lack of prompt epinephrine treatment as a critical risk factor associated with anaphylaxis fatality. Although association is not causal, few would argue that epinephrine is not the optimal treatment for anaphylaxis, and do we have sufficient proof to suggest that epinephrine is actually "life-saving"? Epinephrine indeed works swiftly to reverse such symptoms of an immediate allergic reaction. However, there are abundant observational data that many cases of anaphylaxis are inherently self-limited and may resolve within 1 to 2 hours in most cases with or without treatment. In this perspective, the intent is to address and reframe the reality of the evidence we do have for what epinephrine does and does not accomplish and provide a perspective regarding the common "dogma" regarding the drug. There is a danger in using terms such as "life-threatening" and "life-saving" for anaphylaxis and epinephrine treatment, especially under the caution of frequently cited rhetoric that subsequent reactions are likely to be progressively more severe or potentially fatal. Use of such descriptions risks negatively polarizing our patients and adversely affecting their quality of life, given these terms can potentiate unnecessary fear. Epinephrine is in fact a wonderful drug, but it is important to not lose sight of the evidence for what it actually does in anaphylaxis treatment and why it is important to use this drug in anaphylaxis, as opposed to an emphasis on what it does not do."