“Doctors in Cambridge believe they may soon have a cure for peanut allergies,” BBC News reported. It said the researchers believe a treatment could be available in two to three years.

The news is based on a large randomised controlled trial (RCT) that is about to start. The research follows a successful pilot study of a treatment called peanut oral immunotherapy (OIT), in which allergic children are repeatedly exposed to strictly controlled doses of peanut protein. Its success so far shows that it has good potential and the results from the upcoming RCT are greatly anticipated.

However, it is vitally important that no attempts are made to replicate the treatment at home as severe allergic reactions can be fatal. If the treatment works it will be offered to children with peanut allergies in the safe and controlled manner that will be necessary for its success.

It should be noted that this treatment is not a cure, and several unknowns need to be addressed, including whether this treatment works in adults and the nature of its long-term effects in children.

What is the basis for these current reports?

The news stories are based on research carried out by Dr Andrew Clark and colleagues from Addenbrooke’s Hospital in Cambridge. The team has had success in previous pilot studies with a technique known as peanut oral immunotherapy. This treatment aims to desensitise the immune system to the allergen (the substance that usually causes an allergic response) by gradually increasing its exposure.

A £1 million grant has now been given to Dr Clark and his team by the National Institute for Health Research, to carry out a larger RCT in more than 100 children with peanut allergies.

The results of the pilot studies and the new trial were presented by Dr Clark at the annual meeting of the American Association for the Advancement of Science.

Has this therapy been tested before?

Dr Clark announced the results of a previous trial in 23 children between 7 and 17 years of age. These children were given a very small amount of peanut flour in yoghurt every day, and the amount was increased every two weeks until the children could eat five peanuts a day. Most of the children had some reactions when the dose was increased, including oral itching and abdominal pain. However, by the end of the trial, 21 of the 23 children could eat five peanuts a day and one could eat two peanuts a day.

More information about peanut oral immunotherapy is available from another pilot study published in February 2009. This trial, in four boys with suspected peanut allergy, was covered by Behind the Headlines. Each boy had an allergic response to between 5 and 50mg of peanut protein (a fraction of the approximately 200mg present in a whole peanut). The boys were exposed to increasing daily doses of peanut flour, up to a maximum of 800mg of peanut protein. Each boy was given a personalised dosing schedule depending on their initial tolerance levels. After six weeks of carefully tailored daily treatment, all four boys were able to eat up to 800mg of peanut protein without any serious adverse effects.

More research is needed into this treatment, and the researchers have begun a larger RCT – the best way to establish the effectiveness of a treatment.

What is the new trial?

Dr Clark presented the plans for a larger study (an RCT) during his presentation to the AAAS conference. There is only limited information publicly available about the trial, but it is known that it is a large controlled trial involving 104 participants who will be randomised to peanut OIT or no treatment. The trial will cost £1 million, sponsored by the Department of Health’s Institute of Health Research, and will run for three years. Children will be given the equivalent of up to five nuts per day in a carefully controlled dosing schedule that depends on their initial tolerance.

Are peanut allergies common?

Dr Clark reports that between 1997 and 2007 there was an 18% increase in childhood food allergy. According to Clark, approximately 1 in 50 children have a nut allergy and 10% of reactions to peanuts will be severe ones. Aside from potentially fatal reactions and the fear of them, children with peanut allergies also experience restricted food choices that can affect their social behaviour. While most children will outgrow allergies to milk, eggs, soya and wheat, peanut allergies are more persistent and an estimated 80% of children remain allergic to peanuts for the rest of their lives.

Many people believe that deaths from food allergies are common and the NHS highlights this as a frequently held misconception. This may be due to the fact that the deaths receive a lot of media coverage when they do occur, but in fact, death from food allergies is very rare. For instance, there were six deaths recorded as a result of food allergies in 2008.

Conclusion

The previous success of this treatment shows that it has good potential for treating children with peanut allergy, and the results from the upcoming RCT are anticipated with great interest. Its strong study design will provide robust answers to questions about the efficacy and safety of this treatment for children with allergies.

It should be noted that this treatment is not a cure, and several unknowns need to be addressed, including whether this treatment works in adults and the nature of its long-term effects in children.

Dr Clark said in The Times: “I think in two or three years time we will be in a position where we have a treatment that works, but we are still working on a long-term cure.

“It’s likely to be a treatment that lasts at least two or three years, and we hope that once that’s over we can withdraw the treatment and maintain long-term tolerance, but we need a long-term study to find out.”

Most importantly, these trials are taking place under carefully controlled conditions and in no way should attempts be made to replicate them at home. Several safety precautions are in place should any of the children have an allergic reaction, and the amount of peanut given is carefully measured for each child’s own personal initial tolerance levels.

The short period of two to three years until a working treatment is encouraging. Until it is available, parents should continue to manage their children’s exposure as they have been doing. Peanut allergies can be successfully managed by vigilantly avoiding exposure and by treating accidental exposures with appropriate medications – antihistamines or adrenaline as advised by your doctor.

Lawrence Yun, NAR chief economist, said commercial real estate almost always lags the economy. “Because of the lingering impact from the deep recession over the past two years, vacancy rates will trend higher and many commercial property owners will need to make rent concessions,” he said.

“With the job market expected to turn for the better later this year, we’ll see rising demand for office and warehouse space, but that isn’t likely before 2011,” Yun said. “At the same time, improved consumer confidence would help sustain the retail sector and encourage more people to enter the rental market.”

Yun notes that commercial vacancy rates remain high in most market areas and are depressing rents.

The Society of Industrial and Office Realtors®, in its SIOR Commercial Real Estate Index, an attitudinal survey of more than 700 local market experts,¹ suggests a flattening level of business activity in upcoming quarters with 55 percent of members expecting the market to improve in the second quarter.

The SIOR index rose 0.2 percentage point to 35.5 in the fourth quarter, compared with a level of 100 that represents a balanced marketplace. This is the first gain following 11 consecutive quarterly declines. Although some indicators show that a decline in commercial property values is beginning to flatten, 86 percent of respondents report prices are below replacement costs.

Nearly nine in 10 survey participants said new commercial development is virtually nonexistent in their market areas, and rent concessions are reported almost everywhere.

An independent survey earlier this month showed a couple dozen banks are willing to expand commercial credit this year, which is critical. The lending expansion is aided by the Federal Reserve’s Term Asset-Backed Loan Facility, which is encouraging issuance of commercial mortgage-backed bonds. In addition, regulators are prodding lenders to extend terms for many existing commercial loans.

“We have a long way to go for satisfactory levels of commercial credit, but these are important first steps,” Yun said. “Given that about $1.4 trillion in commercial debt will come due over the next three years, more extensive action is needed and the Fed needs to more actively help resuscitate commercial mortgage-backed securities. The credit improvement will mean more commercial property sales in 2010, even some at deeply discounted prices.”

Looking at the overall market, commercial vacancy rates generally will stay at elevated levels, according to NAR’s latest COMMERCIAL REAL ESTATE OUTLOOK.² The NAR forecast for four major commercial sectors analyzes quarterly data in the office, industrial, retail and multifamily markets. Historic data were provided by CBRE Econometric Advisors.

Office Market

With a lot of sublease space currently on the market, vacancy rates in the office sector are forecast to rise from 16.3 percent in the fourth quarter of 2009 to 17.6 percent in the fourth quarter of this year; the longer term outlook is for vacancies to average 17.4 percent in 2011.

Annual office rent is projected to decline 7.2 percent in 2010, following a drop of 12.7 percent last year. In 57 markets tracked, net absorption of office space, which includes the leasing of new space coming on the market as well as space in existing properties, should be a negative 27.3 million square feet in 2010.

Industrial Market

There is proportionately less industrial sublease space on the market than in the office sector, but obsolescence remains a factor. Industrial vacancy rates will probably rise from 13.9 percent in the fourth quarter of last year to 14.9 percent in the closing quarter of 2010; they could average 14.5 percent next year.

Annual industrial rent is likely to fall 9.6 percent this year, after declining 10.9 percent in 2009. Net absorption of industrial space in 58 markets tracked is seen at a negative 93.5 million square feet in 2010.

Retail Market

Retail vacancy rates are expected to edge up from 12.4 percent in the fourth quarter of 2009 to 12.7 percent in the same period of this year, and may hold at that level in 2011.

Average retail rent is forecast to decline 2.4 percent in 2010, following a drop of 4.0 percent in 2009. Net absorption of retail space in 53 tracked markets should be a negative 3.4 million square feet this year.

Multifamily Market

The apartment rental market – multifamily housing – is poised to gain from a rise in household formation. Multifamily vacancy rates are likely to decline from 7.4 percent in the fourth quarter of last year to 6.6 percent in the fourth quarter of 2010, and possibly edge down to 6.1 percent next year.

Average rent is projected to decline 3.4 percent this year, following a decline 3.6 percent in 2009. Multifamily net absorption is expected to be 115,000 units in 59 tracked metro areas this year.

The COMMERCIAL REAL ESTATE OUTLOOK is published by the NAR Research Division for the commercial community. NAR’s Commercial Division, formed in 1990, provides targeted products and services to meet the needs of the commercial market and constituency within NAR.

The NAR commercial components include commercial members; commercial committees, subcommittees and forums; commercial real estate boards and structures; and the NAR commercial affiliate organizations – CCIM Institute, Institute of Real Estate Management, Realtors® Land Institute, Society of Industrial and Office Realtors®, and Counselors of Real Estate.

More than 81,000 NAR and institute affiliate members offer commercial brokerage services.
The National Association of Realtors®, “The Voice for Real Estate,” is America’s largest trade association, representing 1.2 million members involved in all aspects of the residential and commercial real estate industries.

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Streety reports he is feeling healthy, both emotionally and physically. His left arm, injured by a .45-caliber round, has healed well.  He is continuing with the physical therapy on his right hand so he can return to work and help other officers train and prepare for similar types of attacks.

The case against the defendant, Christopher Eddy, is progressing. Tammy Temple, who was in the car during the shooting, was in court today. She pleaded guilty to being an accessory after the fact to premeditated, attempted first-degree murder on a law enforcement officer and was sentenced to two years in prison and three years probation.

On July 15, 2009, Streety was checking a subject in a wooded area when the man shot him six times. With Streety seriously wounded and on the ground, the subject escaped, triggering a manhunt that lasted two days.

Throughout this difficult situation, Streety has persevered. His message to his fellow officers is to always be thinking and planning for the “what-if” scenarios.

“Wear your vest,” Streety said. “Sweat washes off; bullets don’t.”

To read more about the night of Officer Streety’s ordeal, go to the Police One Web site at www.policeone.com/pc_print.asp?vid=2000595.

Streety was recently nominated for America’s Most Wanted’s 2010 “All-Star” award.  To view the nominees or vote, go to www.amw.com/allstar/2010/.

By having a coordinated national network, CDC can summarize national data to understand better how to prevent adverse transfusion events such as reactions to blood products, medical errors, and process problems. The system, called the Hemovigilance Module, is part of CDC’s National Healthcare Safety Network (NHSN). NHSN is an Internet-based surveillance system that allows healthcare-associated infection data to be tracked and analyzed to allow CDC and healthcare facilities to maximize prevention efforts. The Hemovigilance Module was developed by CDC in collaboration with AABB, an international association representing organizations involved in transfusion and cellular therapies.

“This is an important advance in monitoring the safety of transfusions for patients nationwide,” said Matthew J. Kuehnert, M.D., director of the CDC’s Office of Blood, Organ, and Other Tissue Safety. “This system will enable healthcare facilities to better recognize blood transfusion-related adverse events so that they can improve the care of patients who have transfusions.”

Hospitals will submit data confidentially to CDC through the Hemovigilance Module. CDC will review the national data in collaboration with AABB and other partners to help identify ways to improve the safety of blood transfusion. Previously, transfusion-related events were monitored by facilities on their own. Now, hospitals that join the Hemovigilance Module will have access to standardized data analysis tools, as well as an opportunity to see how their data compare to other hospitals throughout the United States.

“Healthcare facilities that join the Hemovigilance Module will now have a yardstick by which to measure their current safety initiatives and their future efforts,” said Dan Pollock, MD, chief of the branch that leads CDC’s NHSN. “Through this system, healthcare facilities can also see how their performance stacks up to similar facilities nationwide, with a goal of designing the best processes to protect patients’ health and reduce healthcare costs.”

CDC provides the module at no cost to hospitals and healthcare facilities. The agency also provides participating facilities with training and ongoing user support at no cost to the facilities.