The American Academy of Pediatrics issued those guidelines in 2000, and even though they were rescinded 8 years later due to lack of evidence, most families continued to avoid allergens in infancy.
In the years that followed, we’ve seen food allergies among children increase by more than 50% and nut allergies have tripled!
We followed the avoidance guidance with our first child, only to find out that she had developed an allergy to most nuts by age 3. Our daughter is now 11 years old and she’s an incredible little girl, but the fear of food is always there and she will likely have to carry an epi-pen for life. But I’m writing to share some good news.
Groundbreaking new research and updated pediatric feeding guidelines have the potential to help parents prevent food allergies and potentially end the food allergy epidemic, if we just follow the science.
In the biggest step yet towards that goal, the recently-released USDA, HHS Dietary Guidelines for Americans 2020-2025 (DGAs) include recommendations around infant health and address food allergy prevention for the first time in history. The DGAs which are issued every five years and serve as the cornerstone of federal nutrition policy, recommend feeding babies infant-safe, potentially allergenic foods once they’ve successfully started other solids around 6 months, but not before 4 months.
The report also specifically encourages peanut introduction in the first year of life to reduce the risk of peanut allergy – joining the American Academy of Pediatrics (AAP), the National Institute of Allergy and Infectious Diseases (NIAID) and many other organizations now recommending early peanut introduction, based on the groundbreaking 2015 Learning Early About Peanut Allergy (LEAP) Study, a five-year clinical trial led by Dr. Gideon Lack.
The LEAP Study found that up to 86% of peanut allergies could be prevented by regularly including peanut foods in high-risk infant diets, starting in the first year of life until age 5. The results were so powerful that they changed pediatric feeding guidelines around the globe.
Shortly after our third child was born, I remember reading a quote about the LEAP Study from NIAID Director, Dr. Anthony Fauci who said, “We’re talking about saving thousands and thousands of kids from peanut allergies.” This statement really rocked my world and gave me hope that we might be able to prevent our third child from developing a food allergy like his older sister; and that if early introduction was adopted on a large scale, it could change the lives of an entire generation!
We were determined to try it, but found early introduction difficult because nuts and nut butters are a choking hazard for babies and the entire baby food industry was allergen-free. So my husband JJ and I partnered with the pediatric allergist who led the LEAP Study, Dr. Gideon Lack, to launch Mission MightyMe - a line of foods that makes it safe and simple to include nuts and other common food allergens in infant diets, as pediatric guidelines now recommend.
“The LEAP Study proved there’s a critical window in the first year of life when most babies’ immune systems can learn to tolerate peanut protein and prevent a food allergy from ever developing,” said Dr. Lack. “The old guidance that advised parents to avoid feeding peanuts to their babies until age three may have inadvertently made the rates of peanut allergies worse.”
The LEAP Study was based on Dr. Lack’s observation that peanut allergy rates in Israel, where consuming baby-safe peanut foods in infancy is a cultural norm, are a fraction of the rates in the UK, US and Australia, where avoidance has long been the norm.
Having early introduction products on the baby aisle in the U.S. is an important step, but there are still very few options and adoption has been slow. The new DGA’s are the strongest reinforcement to date of the research and guidelines, however many parents and healthcare providers are still following the outdated advice to avoid potentially allergenic foods in infancy and missing the crucial window to prevent food allergies.
There are a number of barriers, including parents' fear of introducing allergenic foods, difficulty incorporating those foods into a baby’s diet and limited face time with pediatricians. A recent study showed that only 30% of healthcare providers are fully implementing the new guidelines with their patients, something Food Allergy Dietitian and Mission MightyMe Advisor Sherry Coleman Collins says must change.
“Clinicians should keep in mind that early introduction of potential allergens is a best practice when it comes to prevention at this point,” says Coleman Collins, “much like making recommendations about baby sleeping on his or her back to prevent SIDS. The science has changed and we need to change with it.”
If there was a vaccine for food allergies, I would’ve given it to my children in a heartbeat to prevent them from carrying the burden of a life-long and potentially life-threatening condition. What if that was as simple letting them eat a variety of foods early on, like our grandparents did, so their immune systems learn to accept, rather than reject them. The science shows that in many cases, it is.
Based on the LEAP Study data, if peanut allergy prevention was adopted on a mass scale in the United States, we could potentially prevent more than 150,000 peanut allergies each year. The emerging data for other food allergens, especially egg, is also very promising. Australia is a step ahead of the U.S. and the results are encouraging. Australia changed their feeding guidelines in 2016 based on the LEAP Study, promoted the guidelines aggressively and saw them adopted more quickly, resulting in a 16% reduction in peanut allergies already.
I’ll always wonder if I could have prevented my daughter’s food allergy, but I think it’s important that parents don’t blame themselves. We were all working with the best information we had at the time. However, I’m reminded of a quote by Maya Angelou, who said, “Do the best you can until you know better. Then, when you know better, do better.” Now that the research and science has evolved and we know better, let’s equip families with the knowledge, confidence and tools, to do better so we can raise a generation free from the burden of food allergies.