Allergies are on the rise – especially peanut allergies
I just read a great article in The New Yorker magazine by one of my favorite science writers, Dr. Jerome Groopman. The February 7th issue is titled: The Peanut Puzzle. The article discusses what has baffled Food Allergy researchers for the past twenty years: Why are food allergies, particularly peanut allergies, on the rise when more and more mothers aware of this problem are taking specific precautions to try and decrease the risk that their child will have a food allergy? For years, mothers were told to breastfeed their child, and avoid peanuts during pregnancy and breastfeeding. None of this now seems to make a difference. And in fact, in the future, the opposite advice might be given. Why?
The first theory – Play with dirt
There are a few interesting and plausible theories now circulating that may explain this conundrum: First, The Hygiene Hypothesis, which I discuss in my book, Dr. Dean Mitchell’sAllergy and Asthma Solution (Marlowe 2006). The hypothesis makes the case that with advances in medical practice, such as vaccinations and increased use of antibiotics in the first year or two of an infant’s life, that we are re-directing the immune system away from the infection-fighting mode and resetting it to battle against allergies. Their data shows that children growing up on farms, surrounded by dirt and animal manure, seemed to have fewer allergies. It was part of the “play with dirt” theory of exposing children to certain endotoxins that may actually strengthen the immune system.
The second theory – The sunshine vitamin
The 2nd and newer theory revolve around the “Sunshine Vitamin”, Vitamin D. Researchers are finding that geographical areas – typically in the U.S. below Atlanta on the east coast and out west in Arizona and Southern California that allergies are less prevalent. Studies have shown that Epinephrine, the injectable medication for a severe allergy attack, (anaphylaxis) is more commonly written in these areas of the country. Vitamin D is also being found to help decrease allergic dermatitis, specifically atopic dermatitis (eczema) because it blocks certain proteins in the skin that cause the inflammation. I am now routinely recommending Vitamin D to my patients with eczema.
The third theory – Give babies peanuts
The 3rd and final new theory are fascinating because it goes against everything we think is logical. An infant at risk for food allergies, specifically peanut allergy, should be given peanuts early in life. Dr. Gideon Lack, a pediatric allergist at St. Mary’s Hospital in London, has published letters in British medical journals drawing attention to the disparity between peanut allergy in the U.K. and U.S.A vs. Israel. He found that the risk in the U.K. among Jewish children was 11X higher than the Jewish children in Israel – this was astonishing. I know families in my New York practice that have children with peanut allergy and have cousins in Israel without any food allergies. One interesting, but not proven theory, is that Israeli infants are givenBamba, a peanut concoction early in life, which may cause the immune system to build an early tolerance from the exposure.
Hopefully, over the next few years we physicians will better understand the causes of peanut and other food allergies. In the meantime, our best options are careful avoidance through education, being prepared with an EpiPen and awaiting new desensitization treatments.
Dr. Dean Mitchell M.D.
Mitchell Medical Group, NYC & Long Island