[url=<a href=“http://www.nejm.org/doi/full/10.1056/NEJMoa1414850?query=featured_home&#t=article%5DHere%5B/url”>http://www.nejm.org/doi/full/10.1056/NEJMoa1414850?query=featured_home&#t=article]Here[/url] is the study reported in the New England Journal of Medicine about children building tolerance to peanuts through early exposure. It’s interesting because a) it compares kids within a somewhat related population (Jews in the UK versus Jews in Israel) and b) seems well designed and ran for long enough. My only caveats in a quick read are: it’s a decent-sized study but not really large and, of course, isolating a group for study means the effects may be more pronounced within that group versus other groups. (Note: this last effect is mitigated because ethnically Jews in Israel are not exactly the same as Jews in the UK.)
That said, the gist is that Israelis eat peanut flavored stuff all the time. Like 90% of families regularly buy this stuff called Bamba that’s essentially fortified peanut butter. What was noticed is that UK Jews, following the advice to have young kids avoid nuts, developed 10 times more peanut allergies. That pretty much screams “natural experiment”.
Note that neither group had bad events related to nuts. That’s important because, well, what if nuts reduce allergies but kill every once in a while? If I had to make a decision based on allergy versus potential death … I’m glad the study didn’t uncover this.
My own feelings are of course this is true. People have long recognized that exposure yields tolerance. I’m not talking homeopathy, which takes the idea to a scientific absurdity that a solution which has been so diluted not a single molecule of the substance remains in it somehow retains the “memory” of that substance AND that “memory” (which has been tested and not found to exist) somehow acts as effective medicine (which has also been tested and not found to exist). But real examples exist. One of my favorites is a food eaten in the hills of Laos that causes intense sleepiness but which can be tolerated if given in small doses beginning in childhood so adults can eat it without effect. This is different from a more “learned” tolerance like for spicy foods in which you realize you really aren’t being burned.
As to allergies, switching to anecdote, my own experience is that I’m a redhead, which means a higher chance of allergies, and have a parent with notable allergies so the odds, per the doctor, that I have allergies worked out to 85%. But I spent summers on a farm, literally playing on the hay bales and even getting int a grain silo a few times (which I now know was incredibly stupid because one spark and kaboom). I am allergic to nothing. I was tested because I was diagnosed with cough variant asthma. This is one reason we sent our kids to camp in the Maine woods: build up tolerance to allergens.
Think about how the chain of logic and events has shaped this: kids who weren’t exposed to nuts (or perhaps to general allergens) develop allergic reactions; with nuts that can be deadly so the natural reaction is that exposure to nuts is bad; that becomes advice to keep your kids away from nuts at least while they’re young; the logic is that maybe exposure to nuts not only can cause a horrible reaction but also may stimulate that potential; more kids turn up allergic to nuts; people start to wonder if not exposing their kids to nuts causes the allergic intolerance; people start wondering if the kids who had horrible reactions weren’t exposed to nuts and … this is how science works. It isn’t pretty and, in this case, it looks more and more like it caused actual harm to children who never developed tolerance to nuts (with some dying). And it shows why we can’t freeze knowledge in place: once we decide “This is TRUE”, we block the possibility that maybe “This is NOT True”.
That’s interesting. It reminds me of an article I read a few years ago illustrating a study that showed children who live on farms, and thus drink unpasteurized milk and are constantly exposed to dust and germs, have fewer incidences of asthma and have stronger immune systems than children who grow up in cities. This is partly because the immune system has to literally learn what things will actually harm the body and which are innocuous in a given environment. An allergy is the result of the body having a severe immune reaction to an otherwise innocuous substance. So if you grow up in a sterile room, your body will react to every single thing, whereas if you grow up outside doing things and getting dirty, your body will be able to tell real threats from peanuts and wheat.
It’s interesting. My son had his first peanut reaction when he was a toddler, and I gave him a bite of my peanut butter sandwich, so I’m not convinced this is applicable to everybody.
I thought the nut study was fascinating. My kids lived in the sandbox when they were little, ate food off the floor and spent at least parts of the summer in the woods. Their cousins did the unpasteurized milk thing. None of us have allergies.
I ate what I wanted when I breastfed, and introduced real food at six months.
I never believed in withholding certain foods because of age. I gave my kid peanut butter around six months because it was easy to take with me - didn’t need to be kept cold, etc.
I also didn’t go crazy with the hand washing or disinfecting everything he might touch. We had a big dog so he was also crawling around house getting covered in dog hair and whatever dirt dog brought into house which found it’s way into his mouth. My MIL - who is a clean freak and germophobe was apoplectic and whenever she was here was constantly wiping his hands. Drove me nuts.
Except for an extremely mild case of chicken pox (even though he had the vaccine) he was never sick. Didn’t even miss a day of school because of illness until high school.
I believe pediatricians are now recommending the first food for babies should be fruit - which was not what was recommended when S was a baby 22 years ago.
There is some pretty strong evidence that in this crazy modern world, where everyone runs around with Purell (which actually might do more harm then good, among other things, it is creating stronger germs), where everyone is worried that their kid is going to die of nut allergies and there is ebola lurking around every corner, that it has done the opposite. Kids that used to play outside, including yep exposed to dirt and mud (mudpies, anyone), who in the city would travel around and so forth, has caused undesired effects, the NE Journal of medicine report is not the only one.One of the things about exposure to germs is it allows the immune system to develop naturally, and one of the issues with allergens if I understood what i read, is that if the immune system isn’t ‘fired up’, it can lead to allergic conditions, and conditions like Asthma. The other part is that the immune response to one kind of germ or virus can build up antibodies that work against a range of infections. The classic case of this was smallpox, Jenner noticed that people who worked around cattle and got cowpox didn’t get smallpox, the immune response to cowpox , which is close in structure to smallpox, boosted the immune defense. Our bodies have 6 million years of evolution as human beings give or take a spare hundred thousand years, and our immune system is tuned a certain way, and I think germphobia and fear may be screwing that up. Plus, I find it a shame that kids don’t experience the wonders of playing in a dirt pile or sandpile, or touching things.
There was an article on the NY Times about that, said if you want a healthy kid, let him roll around on the floor of a subway car, and while that was tongue in cheek, they said that they found something like 600 different types of organisms there, and that exposure to them would help a kid develop a good immune system.
And then there are those with plenty of early exposure who develop a nut allergy at age 15. Interesting to see the various costs of different choices statistically; always can have individual circumstances that buck trends.
You never know. That you have done xyz and your kid does not have allergies means little, as not THAT many kids have allergies, media stories notwithstanding. But the ones that do have these haywire immune systems and anaphylixis, well hard to predict.
As a vegetarian at the time I ate lots of peanut butter while pregnant, especially with my twins. Followed the recommendations as I have a family history of allergies, breast milk only for 6 months, introduced solids carefully, no dairy till 1 year. But did give one of my girls PB on a cracker at 11 1/2 months and we ended up in the ER with a severe reaction. She is allergic only to peanuts, and it is less severe than some, she is very aware that it could kill her. But still, it is always an issue to dance around, carefully choosing travel, bakeries, cuisines, and making sure her boyfriend does not ever eat peanuts and kiss her after. I’m not a germ phobe, we live with animals, camp plenty, and eat from our garden and yard sans washing the fruit and vegetables if outside.
Now my control, her identical twin sister, does not have allergies at all, and she sure never had a nut till after age 4. But as a result she hates nuts, not having learned to eat them early in life.
My S also had his first peanut reaction as a toddler. He touched peanut butter and broke out in hives. I never kept a super, super clean house , am not a germaphobic, had a dog when the kids were little and S still ended up with a lot of allergies, food and otherwise.
My take as a pharmacist and mom…expose your kids to whatever germs/foods/pets they will come exposed to on a daily basis. No asthma (contrary to a “germ freak” acquaintance). Never a major illness
So…
kids can crawl on the floor. .
Try all sorts of foods. Everything. They’ll be better for it.
Kisses are good. Go from there.
Share food and drinking glasses (unless someone is obviously ill).
Don’t over react about “germs”. The human body builds antibodies against “bad” stuff.
But…
Strangers outside immediate friends/family–not okay. Not “our” germs. Take extra care when traveling…
Or in waiting rooms at doctor’s office. (I avoided that as much as possible).
The study goes along with the so-called hygiene theory but I believe that there is more going on.
My D3 had plenty of nuts and peanuts as a young child. She became deathly allergic to both anyway, when she was older than 7. Exposure, or the lack of it, must not be the only factor. She also became allergic to shellfish which she had not eaten at all. We found that out through testing.
Also, the study is not about nuts at all, but about peanuts, which are a legume. Not sure if that has anything to do with it but they shouldn’t be lumped together.
I’m from the gouf school…the only time the kids got sick was after summer when they went back to elementary school and to a room full of “stranger germs” and then we all would get sick. As they grew they developed more immunities and fortunately the annual fall colds stopped. I can’t even recall the last time I had a cold…definitely more than 5 years ago but I’m deathly allergic to penicillin and sulfa, like anaphylaxis allergic and I’m slowly developing bee sting and shellfish allergies bad enough that it requires a trip to urgent care and I’ve been told to be careful because each exposure gets worse.
I grew up with cats, dogs, and basically lived outside. I ate whatever I wanted whenever I wanted. I didn’t start developing allergies until later in life (early teens) and they are getting worse (and no, it’s not because I stopped being exposed to things. I was an outdoor athlete until my late teens). I am now very allergic to things that never used to bother me like cats and grass. Just last winter I had to go on a winter-long treatment for an allergy to the cold (yes, that is a real thing). I do have asthma, just like my father and sister despite all growing up in very different environments.
I do believe that there is merit to exposure while young but I also don’t believe it’s some sort of magic bullet. I am firmly in the camp of children should be exposed to many things and I abhor the over-sanitation of everything. But it also seems that there is an under current of blame on this thread for people that do have allergies. Perhaps it is not conscious but, again, I spent summers outside all over the country. We camped very often and I was always outside in the water. And yet, now I am miserable from allergies pretty much year round. On the other hand, my red-headed spouse who spent most of his childhood inside playing video games is allergic to absolutely nothing.
My H’s niece has a deadly peanut allergy that she has not grown out of. I remember her mother eating PB sandwiches while nursing her. She was not wrapped in cotton wool. She also has milder allergies to various animals. As a teen, she developed rheumatoid arthritis, an auto-immune disease, in some of her joints. She was advised by the university-based pediatric rheumatologist to adopt a gluten-free diet in an effort to minimize inflammation.
Clearly, some people have immune systems that do not function like everyone else’s.
I looked at the article finally. There is a link between babies with eczema and the later development of food allergies. Unlike the study, my D3 had mild eczema, ate a whole lot of everything, and still developed food allergies.
I remember seeing a notice about a treatment that can be given to babies with eczema that helps to forestall the future development of food allergies. That was at least 10 years ago.
As for the UK study, it seems completely oversimplified to me. There must be 1000 environmental factors that are drastically different between Israel and the UK. How about exposure to sunlight for one? It sure is considered significant in the development of MS. Maybe the British kids drank too much tea? Maybe the water that made their tea was different? And there is genetics too.
There is a way to desensitize people who are allergic to peanuts and it involves reintroducing the peanut protein in microscopic doses, and very gradually increasing it. The doses are so small that you can’t try this at home.
Some of it is just genetic, though. I’m allergic to shellfish. It’s no big deal to deal with, I don’t eat shellfish, problem solved. I can be around small amounts of it and if I take a bite or two nothing really happens. This tendency runs in one side of my family; it has nothing to do with exposure one way or the other. FWIW - Neither of my kids have this.
I also developed an allergy to cats as an adult - or maybe more accurately didn’t notice it til then, as I was never around cats. Still can’t be but don’t want to anyway
, am not a germaphobic, had a dog when the kids were little and S still ended up with a lot of allergies, food and otherwise.