How Peanut Allergies Became an Epidemic & What We Must Do to Solve It
By Catherine Mitchell Jaxon, Co-founder, Mission MightyMe
Recent articles published in The Wall Street Journal and The New York Times covered the story of how pediatric allergist and Mission MightyMe co-founder, Dr. Gideon Lack, made the game-changing discovery that decades of incorrect (albeit well-meaning) medical advice to avoid peanuts and other allergens in infancy, may have actually caused peanut allergies to soar.
We were one of the many families that followed that advice to avoid allergens in infancy, only to find out that our daughter had developed an allergy to most nuts, after she had an anaphylactic reaction at age 3.
How could she be allergic to something she’s never even eaten, we wondered? But in hindsight, that was precisely the problem. As Pamela Paul writes in the New York Times, “That should not have been surprising, because the advice violated a basic principle of immunology: Early exposure to foreign molecules builds resistance.”
In the year 2000, in response to concerns over an uptick in peanut allergies, the American Academy of Pediatrics had issued guidelines advising that babies avoid allergens like peanuts, egg and milk in the first few years of life. The rationale was that avoiding these foods altogether might help prevent an allergy, despite no concrete evidence to support that.
Unfortunately, rather than stopping the rising tide of food allergies, this avoidance approach added fuel to the fire. Since removing allergens from infant diets became the norm, the rate of peanut and tree nut allergies has more than tripled, the rate of food allergies among children has more than doubled, and today 1 in every 13 children has a food allergy, turning a once rare condition into a massive public health problem.
Allergist and immunologist, Dr. Gideon Lack, was an early skeptic of the avoidance recommendations, though he is quick to point out that for many years, he too recommended babies avoid allergens, because there simply wasn’t concrete data to suggest otherwise.
The story of how he realized we were on the wrong track, and his decades-long work to course correct, is a fascinating one that should actually provide more hope for the scientific process, than doubt. That same year the AAP issued the avoidance guidelines, Dr. Lack was giving a lecture to a group of about 200 allergists in Israel. He asked them how many had seen a case of peanut allergy in their practice and to his astonishment, hardly any doctors raised their hands. In the UK, just about every hand in the audience would have gone up because peanut allergies were on the rise - the UK had issued avoidance guidelines two years prior.
Rather than dismiss it as coincidence, Dr. Lack honed in on an observation he had made about Israeli infant feeding practices. Whereas peanut foods were banned in the U.S. and the U.K. at the time, peanut puffs were one of the most common first foods for babies in Israel. Dr. Lack wondered whether by feeding babies peanut puffs early, Israeli parents were unknowingly inoculating them against peanut allergies.
To test his hypothesis, Dr. Lack conducted an observational study in 2008, comparing the rates of peanut allergy among Jewish children in Israel to Jewish children in England (to ensure genetics weren’t a factor) and found that indeed, the rate of peanut allergies among the children in England was ten times higher than that of the children in Israel.
After this study was published, The AAP rescinded the avoidance guidelines, however didn’t go so far as to recommend proactively introducing peanuts or other allergens, so avoidance remained the norm.
Then in 2015, Dr. Lack and his team published a seminal study called the Learning Early About Peanut Allergy Trial (LEAP). The LEAP Study was a multi-year, NIH-funded, clinical trial which found that early and frequent consumption of peanuts over the first few years of life actually protects long-term against the development of peanut allergy, while avoiding peanuts increases the risk five-fold.
“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.”
Our third child was born the same year the LEAP Study was published and it gave us hope we might be able to prevent another food allergy in our family. I remember reading a quote from then-NIAID Director, Dr. Anthony Fauci, who said, “The results have the potential to transform how we approach food allergy prevention….We’re talking about saving thousands and thousands of kids from peanut allergies.”
The LEAP Study findings reversed feeding guidelines around the globe to recommend the early and regular consumption of peanut foods and other common allergens, once a baby starts solid foods.
“But by then, thousands of parents who conscientiously did what medical authorities told them to do had effectively given their children peanut allergies,” writes Pamela Paul in the New York Times.
“Compounding the tragedy,” Marty Makary writes in the Wall Street Journal, “is knowing that America’s epidemic of peanut allergies is a largely avoidable consequence of our policy of peanut abstinence.”
The story of how the medical community got it so wrong on peanut allergies, is one of several examples detailed in a new book by surgeon and Johns Hopkins University public health researcher, Marty Makary, “Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health.” In the book, Makary argues that the medical establishment often clings to outdated dogma, despite conflicting evidence, and patients pay the price.
As a family who paid the price in this instance, I have a slightly different take. Science evolves as new information comes to light, and conducting randomized clinical trials like LEAP - that are necessary for concrete data - is a process that takes years. That is how science works.
In this case, the flawed and outdated recommendations were reversed once new, robust evidence came to light. And now the real challenge is public health education, because for nearly two decades parents have been told to avoid allergens in infancy. Now not only are they being told the opposite, but based on the LEAP Study and the updated AAP guidelines, we know this approach isn’t effective unless babies - especially those at high-risk - are fed peanut foods early (as early as 4-6 months), often (3x per week), and enough (the AAP recommends 6 grams weekly). Introducing a food once and forgetting about it doesn’t do the trick.
We also know that based on a 2021 survey, only 40% of parents are getting this message from their pediatricians, so there is still a lot of work to be done.
While there are certainly other factors contributing to the rise in food allergies, food avoidance in infancy is a crucial piece of the puzzle. What we now need is a concerted public health campaign, much like the “Back to Sleep” campaign in the 90s, which encouraged parents to put babies to sleep on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS), even though for years they had been told the opposite. The science had changed, and therefore our actions had to follow suit.
With our third child, we were able to follow the research and updated guidelines to include nuts in his diet early and often, and thankfully he is food allergy-free. We also partnered with Dr. Lack to launch Mission MightyMe - a line of foods that makes it simple for other families to regularly include nuts in their children’s diets, starting in infancy. As the guidelines have changed, the baby aisle is slowly changing as well to offer more options to parents and this is a good thing.
I’ll always wonder if we could have prevented our daughter’s food allergy, but I think it’s important that parents (and doctors) don’t blame themselves. We were all working with the best information we had at the time.
I’m reminded of a quote by Maya Angelou, “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 ensure the next generation is free from the burden of food allergies.
Please note: This blog post is for information purposes only and shouldn’t be used as personal, health, nutritional, or medical advice. Always consult your pediatrician with any questions about what to feed your child.
