New Research Shows Peanut Allergy May Be Prevented Early in Life

[devnull]

I'd like to hear what some of the allergist parents say about this.  There's no way Ruchi Gupta or Michael Pistiner caused their kids' sensitization to peanut. Same for our allergist who believes it's there at birth.

[justme]

Mine wasn't breast fed, so no exposure there and he reacted the first time he tried a little bit of PB at 8 months.

[Mezzo]

I've seen a friend of a friend post "But isn't peanut butter a choking hazard?" Seriously, people will think they should do this on their own.

[Macabre]

Listening to the researchers involved on the Diane Rehm Show. Wow. So helpful.  Will post a link whrn available.

[GingerPye]

A group of kids who could eat peanut were fed peanut and continue to eat peanut.  While I understand the excitement over the results from treatment versus control on a publication standpoint the transfer to real life validity isn't overwhelming when one considers the first wave of peanut allergic kids did not under the conventional thought of the early to mid 2000s from allergy to avoid if high risk.

Meaning if ignorance of high risk avoidance existed then how did such a significant population of sensitized individuals come into being?  And what about the other 7 of the top 8?

Why do I bother.  How quickly allergists forget the blame we shouldered for NOT waiting to introduce.

100% Agreed.  With my two kids I ate PB, ice cream, etc. all through their pregnancies AND when nursing.  Even when my first had eczema, projectile vomiting, not sleeping, etc., dr told me that eliminating potential allergens from my diet would not affect allergy development.

Looking back, I could have maybe made our lives somewhat easier had I eliminated allergens anyway, even though we didn't yet know what she was allergic to.  I tried eliminating milk just on my own, but DD was so allergic to other things that it didn't make any difference.

I just Don't.Need.This.Added.Guilt from this new research study.   

[ajasfolks2]

These were my thoughts on this topic yesterday:

Re: Living with Food Allergies, 2013 and on

[devnull]

Unless they are including some context on the excluded population this has zero application to our lives as is.  On the other hand I very much want to hear more along the lines of SLIT for MFA starting in infancy for individuals with biomarkers as Hugo Von Bever has been extolling for a few years.  But he is concerned with the overall allergic march not just peanut OIT, whatever form of OIT that takes.

[Macabre]

The folks on Diane Rehm said moms should not feel guilt. It's not what we ate. Or didn't eat. One of them talked about the study about peanut dust in the house, not what was consumed or not consumed during pregnancy and lactation that was likely to be a larger factor.

I am not concerned by who was excluded. No study is perfect, but this looked at a much larger population than most and has some nice longevity to it. The fact that it got SO much attention from other allergists at AAAAI tells me that other people who understand scientific method aren't discounting this.  That's huge to me.

So my kid's profile matches the ones included in the study. He has atopic family history. 

As far as other guilt, I have none. I applied current best practices for avoiding allergies 17 years ago. I was more informed than most parents on that front.  It's just that current thinking was apparently wrong.  Not my fault. Frankly, my only guilty feelings are associated with readily giving him Propulsid at 6 weeks becUse I was worried about hige projectile vomiting and his being accepted into daycare at 6 weeks.

[Macabre]

And they do include context in the interview. I found their discussion nuanced and helpful.

Also, it's not like this is big news.  Other recent studies have come to a similar conclusion

[Macabre]

Here's the link:
The Diane Rehm Show

Wednesday, Feb 25 2015 • 10 a.m. (ET)

New Research On Preventing Peanut Allergies

A new study suggests doctors have been giving the wrong advice about peanuts for years.

For reasons not entirely clear, the number of people allergic to peanuts has risen dramatically in recent years. Peanut allergies usually appear in childhood. The condition is sometimes fatal, and there is no cure. For children with risk factors for allergies, pediatricians have long advised complete avoidance of peanuts. But a new study by British doctors — just published in The New England Journal of Medicine — suggests that advice was wrong. The study shows that exposing infants to peanuts could sharply cut the incidence of allergies to the legume. Many pediatricians are optimistic but not ready to issue new guidelines. We discuss the latest research.

Guests

Dr. Sally Joo Bailey assistant professor of pediatrics at Georgetown University School of Medicine.

Dr. Gideon Lack professor, King's College London, and co-investigator of the peanut allergy study published in the New England Journal of Medicine.

Dr. Hemant Sharma acting chief of the Division of Allergy and Immunology, and director of the Food Allergy Program, Children's National Health System.

http://t.co/PA7x5X0Eni

[devnull]

Scientific method doesn't mean much it's too vague.  Study design, population, exclusion, internal and external validity, conclusion, biases, conflicts of interest there are a lot of components beyond what I briefly mention so context becomes key.  I would have to read the paper itself to see a lot of that no news outlet would come close.

In that respect I would actually find the Australia trial on sustained unresponsiveness more novel even though it was double placebo. 

Had to move off my phone.

So my kid's profile matches the ones included in the study. He has atopic family history. 

Not unless he could already tolerate one peanut regularly and would not have had a wheal of over 4mm.  That was the exclusion I read.  How many children they identified 'at risk' but had to exclude to get their target population is something I would want to know.  I'd like to see those numbers even though it has no bearing on the results themselves (which I do not argue in the least) because they clearly identified who was excluded.

Certainly we know immunotherapy works.  Who it works for in terms of sustained lack of response (I have a hard time with the word "unresponsiveness" after discontinuation of very rigid scheduling or dosing under care of the limited amount of allergists qualified to do so with sufficient administrative support for compliance.  So if that was the price of admission, the ability to tolerate one peanut and not have a wheal over 4mm then there is absolutely no way to generalize that to the excluded population.

I believe that is what was in Links' quote on the exclusion criteria and of course if that was wrong, or I read it incorrectly that would be a game changer.

[starlight]

I've seen a friend of a friend post "But isn't peanut butter a choking hazard?" Seriously, people will think they should do this on their own.

Exactly - I thought the whole reason for the delay wasn't due to allergies, it was due to choking on something very sticky and small hard round objects. I wonder how many babies are going to end up in the ER due to choking because of this. And then possibly misdiagnosed because I'm sure choking and throat swelling looks pretty similar in an infant...

[Macabre]

In the interview they talked about using peanut flour

17 years ago the reason for the delay was in fact to try to avoid allergies. There was a whole set of guidelines about when to introduce egg (white, yellow) as well as strawberries. 

Choking was really a separate issue.

[LinksEtc]

Just FYI ...

the full article
http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#t=articleTop

&

Datasets for both the intention-to-treat and per-protocol analyses are available through TrialShare, a public website managed by the Immune Tolerance Network (www.itntrialshare.org/LEAP.url).

------------------------



I keep thinking of (I think it was CM's) whack-a-mole analogy.  If you prevent peanut allergy, do those atopic tendencies pop up in another form (different FA, asthma, etc)?

[LinksEtc]

"What makes current peanut allergy prevention study so much better than past studies?"
http://foodallergysleuth.blogspot.com/2015/02/what-makes-current-peanut-allergy.html?spref=tw

Every now and again, a study comes along that changes things, and I truly believe that the Learning Early about Peanut Allergy (LEAP) study by Du Toit, et al.1 will usher in an era of solid evidence-based guidance in terms of infant dietary recommendations and a much needed "benchmark" for designing future studies addressing allergy prevention.