From the uncertainty of its opening headline to its thorough examination of concerns raised by national experts and local docs and their patients, this story nicely conveys the complexity that so often accompanies new medical research. A bit more detail in a few areas would have made this a five-star story.
Families of children with food allergies often live in terrible fear of accidental exposure to allergenic foods. And recent positive reports about immunotherapy are making more patients and familes wonder if this option is available to them. While the signs from early research are encouraging, a headlong rush to try an uNPRoven treatment could yet cause more harm than good and carries serious–potentially fatal–risks. "First do no harm" applies even in desperate situations such as this one.
The article notes that traditional immunotherapy requires frequent office visits for the administration of shots. One can imagine that the take-at-home approach discussed here might cut down on the cost of therapy by eliminating these visits and their associated expense. However, we can’t really say for certain because the story does not mention costs at all.
We’re going to ding this otherwise solid story for some vague and careless language in this area. For example, the story says that immunotherapy-treated patients in one study could consume "100 times more milk protein" than patients treated with a placebo. But we’re never told what this figure translates to in terms of tolerance for actual milk–a teaspoon or a full glass? Similarly, a description of another study notes that "many" allergic patients could tolerate an egg or a dozen peanuts after several months of treatment. We can’t think of a reason not to communicate exactly how many children (i.e. absolute numbers of people) experienced these benefits.
We’re also concerned that the anecdotes are not entirely representative of the typical experience of immunotherapy patients. The story opens by describing a severely milk-allergic patient who is now "secure in the knowledge that she’ll be able to safely eat anything the cafeteria dishes up." While the impression we get is of someone who is essentially cured of her allergy through immunotherapy, the reality is that many patients will have to continue to avoid the foods to which they are allergic even after treatment. The benefit for these patients is that eating a small amount accidentally won’t trigger a deadly reaction.
Is immunotherapy ready for prime time? The story tells us why many experts believe the answer is an emphatic no. The most serious concern is that severely allergic patients may die from immunotherapy that isn’t performed in a closely monitored research setting with access to emergency care.
The story nicely captures the limited nature of the current evidence supporting immunotherapy for food allergy. The headline clearly alerts readers that this is treatment is "in the works" and that it is "untested." And the positive anecdotes from patients are balanced by acknowledgment that immunotherapy remains "far outside mainstream practice" and "potentially fatal."
One can quibble with certain details–for example, there was no acknowledgment that a study cited to support immunotherapy was an uncontrolled case series that needs to be interpreted very cautiously–but these lapses are more than made up for by statements such as: "current studies are very small and not everyone gets good results." The story also points out that nobody knows how long immunotherapy treatment must be maintained and whether the allergies may later return.
The food allergy prevalence figures cited in the story (4% of children) come from high-quality epidemiological research, and the story overall didn’t overhype the effects of food allergies on patients. We should point out that one of the anecdotes about an allergic reaction ("He turned blue and went limp in my arms," a mother tearfully reports) was a bit sensational and came close to the disease-mongering threshold. But – even though it was an example of "the tyranny of the anecdote" – we didn’t think this alarming image was enough to throw the entire story out of balance.
The story sought multiple perspectives and provided a well-balanced account of both sides of this issue.
The only proven way to cope with a food allergy is to avoid the offending food. The story points this out.
The article explains that immunotherapy for food allergy is being offered by a handful of doctors against the advice of nationally recognized experts. While this is enough to satisfy the criterion, the article could have done more to explain how FDA regulations may or may not apply to this kind of treatment. Presumably, the techniques being used by these "rogue" physicians do not fall under the FDA’s jurisdiction and so are available for use without official FDA sanction. But it would be useful to know the details of how the preparations being used in this treatment are produced and what regulatory regime applies to them.
Oral immunotherapy is an update on the long-established practice of using allergy shots to desensitize patients to certain allergens. The story accurately provides this context and doesn’t suggest that the technique is inappropriately "new."
It’s clear that this story is not based on a press release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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