By Henry Ehrlich
The new study “Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy” has burst like fireworks over the food allergy world and beyond. Now that the crowds have gone home, we are struggling to figure out its significance for those with peanut allergy, those who are at risk, and of course those on the fringes who don’t live with the issues every day of their lives, some of whom are quite sympathetic and some who are not. We were thrilled to have the lively, expert, instant analysis of Dr. David Stukus, which has been widely distributed.
Overnight, another of our contributors, Food Allergy Sleuth Jessica Martin, weighed in with her invaluable insights based on her dual perspectives as a food allergy mom and a PhD neuroscientist. She says, “Refrain from reading any and all article commentary from non-experts to avoid the ‘I told you so’ and ‘stupid, fearful parents for not feeding your kid our nation’s best, right-to-eat it anywhere, delicious, nutritious snack.’ These comments are examples of ignorant people wrongfully interpreting scientific findings through a way too generalized media filter to support what they already ‘believe’ to be true.”
She cautions, “This study was aimed at preventing peanut allergy in infants at high risk of developing food allergies. If you are already dealing with a food allergy, this study does not apply to your situation.”
Thank you, Jessica.
Both commentators warn against do-it-yourself inoculation and medical intervention without consulting allergists. I know the temptations to do so must be enormous given the small window in a child’s life described by the study. But are there any precautions anxious parents can take? Maybe. I recommend that you listen to the podcast of the February 25th Diane Rehm Show on public radio. She interviews Dr. Gideon Lack, one of the study authors as well as two American allergists.
(Be forewarned: Lack presents his point of view with an air of certainty that many will find disconcerting, particularly if you think you think your parenting and housekeeping skills would preclude this kind of exposure.)
Dr. Lack points out that because so many children react to peanut when they first eat it, there must be an alternative route of sensitization and that the circumstantial evidence points to the skin. (Loyal readers of this website know that we have covered this hypothesis for some time thanks to the contributions of dermatologist Dr. Peter Lio here and here.)
Lack says that there is a rising incidence of eczema, particularly in the first year of life. He asserts that peanut allergy doesn’t result from eating, and 80-90% of reactions are manifest on first known exposure. “So where does the young body first meet peanut?” When a family member who has been eating peanut and touches or kisses a child with dry, porous, oozy, itchy skin. The immune system reacts as if it were encountering a parasite.
Dr. Lack also questions the theory that peanuts in the gestational diet and during breastfeeding are responsible for an allergy but says instead that large amounts of peanut in the family diet will result in the allergen being distributed in the home where it can encounter eczematous skin. He pointed out that one of the co-authors of the LEAP study, Helen A. Brough, is very prominent in research about the connection between household peanut consumption and the persistence of peanut protein as a stubborn, biologically active component of household dust.
Dr. Lack further points out that the evidence is not as good for other allergens, but there just hasn’t been as much research. He says that it may well be the case for egg and milk, which are associated with “early, aggressive eczema” but different allergens have different characteristics.
So the big actionable takeaway in advance of new guidelines is to be vigilant about eczema.