Comment by gibspaulding
4 years ago
Is there enough of a scientific consensus on how to prevent food allergies to drive policy, or are you just talking about research at this point?
I've heard things like early exposure, breast feeding, and mother's nutrition can help, but always got the impression that allergies are pretty random.
> Is there enough of a scientific consensus on how to prevent food allergies to drive policy
To be honest, this may have already happened, but it would take a generation to see the effects. There was a major breakthrough on this a few years ago. I first heard about it on an episode of Science Vs [1]. That was merely weeks after my second child was born. It was interesting to see the advice from the pediatrician a few months later. The American Association of Pediatrics updated their advice accordingly [2], and my kids' pediatrician handed out informational fliers calling out "this has changed," etc. Hopefully other pediatricians are also updating their advice and doing a good job of educating families.
Check out the Science Vs episode [1] if you want details. The gist of it is that in a controlled study, they found that introducing allergens early reduced the prevalence of allergies by 86% compared to avoiding allergens. This means old advice (what I was told with my first-born) about avoiding allergens could actually increase the risk. The Science Vs episode goes into details about what led researchers to look into this and possible explanations about the mechanism involved.
[1]: https://gimletmedia.com/shows/science-vs/2ohd7e
[2]: https://publications.aap.org/aapnews/news/12250/New-guidelin...
I'm talking about research, but in particular research testing potential interventions.
There has been a fair amount of research (but no solid consensus) on why allergy rates are increasing.
But AFAIK there have been fairly few attempts to try to use any of those competing hypotheses to devise preventive treatments whose effectiveness could be tested experimentally.
There is actually pretty compelling evidence. Enough so that the AAP reversed its guidelines in 2017: https://publications.aap.org/aapnews/news/12250/New-guidelin....
Where I live it's advised to introduce peanuts early to kids (before 8 months) because of this research
Yes. Early introduction of foods is proven to dramatically reduce allergies, and not just for peanut. Everyone should be doing it and we should have recommendations and guidelines for parents.
There is also a lot of evidence that SLIT and OIT are effective treatments for food allergies and most importantly that they are far more effective and safer when started very early, before 2 or even before 1 if possible. Early SLIT and OIT should be prioritized for research.
The current theory is that allergies exploded because our (first) world is too clean and the immune system needs something to do, so it focuses on what it can find - peanuts.
Citation? I think there might be a bit of "telephone game" happening here. The current science shows that avoiding allergens increases the risk of developing allergies. The hypothesis for how that happens is that if an infant's first exposure to an allergen is on their skin (e.g., peanut oil), then their body may classify it as invasive and develop anti-bodies to attack it. If they are first introduced to an allergen as food, then their body classifies it as food. By avoiding feeding allergens to infants, you increase the time window for their bodies to be exposed through the skin and classify it as invasive. I could certainly see this idea transmuting through word of mouth into the "first world is too clean" idea in your comment, but that's pretty far off.
> Citation?
Plenty of papers listed here:
https://en.wikipedia.org/wiki/Hygiene_hypothesis
Anecdotally, this is insufficient to explain the evidence.
I have approximately no allergies but was exposed to a very diverse and not sterile environment from early on, with other siblings being similar. I have two brothers close to my age that did have significant and in some case deadly allergies, who were born and raised in the same environment.
Among my siblings, it is a completely mixed bag of sensitivity. Some were highly sensitive to many things, others were sensitive to almost nothing. If mere exposure to non-sterile environments was sufficient then we should all have had similar sensitivity to allergens but the variance in fact was quite high.
It is a current theory. It is far from being the current theory, and IMO a woefully insufficient one. I'm not a clean freak by any means and still developed a couple dozen food allergies as an adult. Ultimately the immune system is hopelessly complex and this will likely take decades more for us just to arrive at the right theory.
But this is kind of strange, as for example in France, you definitely don't see the same level of allergies as in the US.
I'm not sure if French people would think life is worth living if you couldn't eat the same food as everyone else.
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Maybe it's because peanut butter is extremely popular in the U.S., but not very popular in most other countries?
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Yes. It’s been proven that if you expose babies to all the allergens early on they never develop the allergy.
But not only that. If they already have the allergy, you can actually cure it by slowly building up exposure until they stop reacting to it.
> If they already have the allergy, you can actually cure it by slowly building up exposure until they stop reacting to it.
Very important to note that not everyone can be cured this way, it can be dangerous even fatal, and under medical supervision only. Far too many people think they can cure their own allergy, allergies aren't "real," or cases of grandparents trying to YOLO fix their grandkid by putting small amounts of e.g. peanuts in their food and causing airway obstruction.
This research is, undeniably, exciting, but people overstate it and act like we could just roll it out to everyone with allergies and they'd disappear (and that everyone who still has allergies is "choosing" to). That isn't at all where the science is at today.
I can't eat gluten. I ate plenty of wheat growing up, and suddenly developed a problem digesting it at 18. I was on a full-gluten diet when diagnosed and still felt sick all the time.
So, as someone who was exposed as a baby, and was pretty much doing maximal exposure therapy, you need to write better test cases.