Nutshell: Oh, Nuts
By Charlene Oldham
Teachers can find ready-made signs on the internet that proclaim to kids, parents and passersby that a classroom is nut free. And it’s common practice for some schools to distribute handouts suggesting allergy-safe snacks along with school supply lists. The precautions have become a modern necessity for many given that more than 5 percent of children in the United States suffer from food allergies, a figure that has climbed from 3.4 percent since the late 1990s according to data from the Centers for Disease Control and Prevention. Experts say a number of factors could be contributing to the rapid increase, including the fact American kids’ immune systems aren’t exposed to as many allergens early in life.
“The simple answer is that we don’t definitively know why food allergy among children has risen at such a dramatic rate,” says Dr. James R. Baker Jr., chief executive of Food Allergy Research & Education. “What we can say, however, is that there is some general agreement in the scientific community that the rise could be attributed to a combination of genetic and environmental factors. Certainly, in countries without the level of food hygiene we have in the U.S., there are much lower rates of food allergy.”
The good news is that innovative treatments and a growing body of research now suggests avoidance won’t always be the only way to deal with food allergies, meaning peanut butter and jelly could eventually make a cafeteria comeback.
While experts say kids with allergies should still avoid foods that have caused bad reactions in the past, doing the opposite has proven promising for some patients participating in controlled research of oral immunotherapy (OIT). OIT involves giving children increasingly higher doses of the food they are allergic toward to gradually retrain their immune systems to tolerate it without an adverse reaction. Researchers at Johns Hopkins Children’s Center are conducting several studies related to OIT and are even working to develop a “peanut vaccine” for allergies that is derived from peanut proteins.
“I think there’s a lot of interesting work happening right now. I’m excited to hear more about the study of Chinese herbs and immunotherapy, the studies of the immunotherapy patch and studies using combinations of immunotherapy with other medications,” says Dr. Corinne Keet, an assistant professor of pediatrics who specializes in the areas of allergies and immunology at Johns Hopkins.
Keet cautions that parents whose children have diagnosed food allergies shouldn’t view immunotherapy as a cure, or even an accessible treatment option, for every kid, though.
“I think that immunotherapy for food allergy is becoming more widely used, and more and more parents are looking for it,” she says. “However, I think that it’s very premature for it to be used in widespread clinical practice now. In our hands and others, the rates of adverse reactions are high for a disease of this kind. I’m not convinced that oral immunotherapy, as is currently being practiced, is safer than avoiding the food.”
But for babies who aren’t at increased risk for food allergies – because they have conditions including eczema or a sibling with food allergies, for example – a growing number of medical professionals are recommending parents introduce eggs, dairy products and nut products like peanut butter right along with other age-appropriate table foods. It’s advice that runs contrary to longstanding guidelines from organizations including the American Academy of Pediatrics, which recommended avoiding certain foods until babies were older, or even until they were toddlers. Educational material from the AAP now states that, “many pediatricians recommend against giving eggs and fish in the first year of life because of allergic reactions, but there is no evidence that introducing these nutrient-dense foods after 4 to 6 months of age determines whether your baby will be allergic to them.”
In fact, the results of a study published earlier this year in the New England Journal of Medicine showed that feeding infants as young as 4 to 11 months foods containing peanuts could help protect them from eventually developing peanut allergies.
“The recent LEAP [Learning Early About Peanut Allergy] study, which randomized babies to early peanut exposure versus later peanut exposure, showed a clear benefit to early peanut exposure. We think, but don’t know, that this may be the case for other potentially allergenic foods, like eggs,” says Keet, who recommends parents talk to their doctors to evaluate individual infants’ risk factors. “In general, introduction of these allergens with other table foods is what I advise. “
Turns out, the advice may save babies from developing allergies to those PB&J they’ll encounter later in life.
Charlene Oldham is a St. Louis-based freelancer and teacher. She blogs about writing and life at www.charleneoldham.com.
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