The story focuses on a long-term follow-up study of patients with peanut allergies who had received immunotherapy and probiotics to minimize allergic response to peanuts.
A story in a nationwide publication that suggests there may be a “cure” for peanut allergies — such as the story we are reviewing here — would likely raise hopes for families and individuals living with peanut allergies. But those hopes would be unfounded. The research this story was based on involved fewer than 50 patients, only 24 of whom received the relevant treatment — something the story doesn’t tell readers. And the treatment was not universally successful at eliminating peanut allergy even for those 24 patients. What’s more, there is no discussion in the story of costs or risks associated with treatment.
The word “cure” should never be used hastily, something we just pointed out about a different TIME story last week.
The NIH states that “peanut allergy is a growing health problem for which no treatment or cure exists. People living with peanut allergy, and their caregivers, must be vigilant about the foods they eat and the environments they enter to avoid allergic reactions, which can be severe and even life-threatening.” A 2010 study stated that 1.4 percent of people in the U.S. report having an allergy to peanuts or tree nuts. In short, peanut allergy poses very real risks for those with peanut allergies, and can pose a particular challenge for parents of children with peanut allergies — who have to maintain constant vigilance regarding the possibility of peanut contamination in places where their kids eat, play or attend school. As a result, new research findings related to addressing peanut allergies garner a lot of attention. This story may leave readers with more questions than answers.
Cost is not addressed. Would this be a relatively inexpensive treatment? A costly one? Is it too early to tell? Readers won’t be informed of this.
Here is how the story addresses benefits regarding the follow-up study: “In the follow-up, which tracked the children for four years after they were treated with the combination therapy, 67% of those who got the combination probiotic and peanut therapy were comfortable eating peanuts, compared to only 4% of those who did not get the treatment. Fewer children in the treated group had an allergic reaction to the peanuts, and they also showed smaller reactions to skin prick tests with peanut allergen.” The description does offer some numbers, but does it adequately “quantify the benefits”? We’ll say yes. However, there are significant problems about the evidence discussion, which we’ll go into under the heading of “Quality of Evidence,” below.
Harms aren’t mentioned, which is problematic. The type of immunotherapy used in conjunction with probiotics for this study is called peanut oral immunotherapy. In a 2016 research summary document, the American Academy of Allergy, Asthma & Immunology describe this type of immunotherapy as “one of the more promising new treatments” for peanut allergies. Specifically, the summary noted that “Multiple studies have now shown [oral immunotherapy] to be efficacious at desensitizing peanut-allergic children, but this efficacy comes at the expense of high rates of allergic adverse events, and the risk/benefit ratio of [oral immunotherapy] is an area requiring more study.” This is a complex area, and the research summary is worth reading, but the key point here is that there are risks associated with oral immunotherapy — and this story doesn’t acknowledge them.
The story focuses on a follow-up study that involved only 48 participants. The story doesn’t tell readers how many people were involved in the study, nor whether the number of participants is important. The study was a follow-up to a randomized, double-blind, placebo-controlled trial — all of which is important to understanding how robust these findings are, and none of which is mentioned in the story. And while the story offered numbers on one measure of benefit (how many patients who received the combination treatment were eating peanuts compared to those who received placebo), it offered no numbers on the other outcomes that were assessed. That can affect how readers view the findings. For example, readers may have had a different perspective on the findings if the story had instead focused on these numbers from the journal article: “Four [combination]-treated participants and six placebo participants reported allergic reactions to peanut after intentional or accidental intake since stopping treatment, but none had anaphylaxis.”
The story does include input from one independent source, and that source highlights some significant questions regarding the study. For example, as the source notes, it’s not clear what role (if any) the probiotics played in the study outcomes. In other words, it’s not clear if the combination therapy achieved better results than would have been achieved using only immunotherapy without the probiotics.
But while the story did touch base with an independent source, it did not clearly address conflicts of interest. Here’s a line from the Aug. 16 news release issued by the Murdoch Childrens Research Institute (MCRI), where the relevant clinical trials were conducted: “This follow up study was initially funded by MCRI and the Australian Food Allergy Foundation. It then received a $15 million funding commitment in 2016 from capital investment firm, OneVentures. A biotech company Prota Therapeutics, was jointly set up by the MCRI and OneVentures to develop [a combined probiotics and oral immunotherapy treatment] towards an FDA approved product with a plan to make the vital treatment available globally to people with peanut allergy.” That’s the sort of thing readers should know.
As noted above, the story notes that it is not clear whether the combination therapy works better than treatment that uses only immunotherapy. And the story does refer, briefly, to earlier immunotherapy studies. That’s enough to earn a satisfactory rating here. However, a little more information on standard treatments and up-and-coming immunotherapy research would have made the story much stronger.
The story doesn’t address how far along in the development process this combination therapy is, nor how far removed it may be from clinical use.
The novelty here would appear to be that this is a long-term follow-up to a study that used probiotics in conjunction with oral immunotherapy for peanut allergy. That’s inferred here, rather than stated explicitly, which isn’t necessarily a deal breaker. But after talking about what impact probiotics might have had in the treatment results, the story ultimately tells readers that figuring out what sets this research apart “may have to wait for another study.” Having to include language like that is likely a sign to steer clear of a headline like this one: “New Therapy May Cure Kids of Peanut Allergy.” Then again, the new therapy may not.
By talking to an independent source, the story goes beyond a news 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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