Peanut Allergy Prevention – Can You Prevent Peanut Allergies?
Allergies are on the rise – especially peanut allergies. In fact, every 3 minutes a food allergy reaction sends someone to the emergency room.
Food allergies have been rising rapidly around the world over the past 20 years and now affect an estimated 2 to 10 percent of children in the United States. Food allergies have become a major clinical and public health problem due to their increasing prevalence, their potential to be life-threatening and their enormous medical and economic impact.
Peanut allergy is among the most fatal food allergies and is often a lifelong allergy, unlike the milk or egg allergies that most children will grow out of.
And this isn’t something that has just come to light in 2019. In fact, in 2011 in an article titled The Peanut Puzzle in the New Yorker, Dr. Jerome Groopman wrote about something that has baffled food allergy researchers for the past 20 years – why are food allergies, particularly peanut allergies, on the rise when more and more mothers are aware of the problem and actively taking precautions to try to decrease their childs risk of developing food allergies.
So why are peanut allergies on the rise and what steps can you take to reduce your childs risk of developing a peanut allergy?
The Peanut Puzzle – Why Are Peanut Allergies Increasing?
In the article, Dr. Groopman starts with a story about Jill Mindlin who, like most mothers prides herself on being a good parent and one who actively tried to reduce her childs liklihood of developing a food allergy, discovered via an allergic reaction that her daughter was allergic to eggs, peanuts, tree nuts, milk, and sesame seeds.
Jill Mindlin followed the advice that most mothers do – avoidance. For years, mothers were told to breastfeed their child and avoid peanuts during pregancy and breastfeeding. The theory was that children were far less likely to become allergic to problematic foods if they are not exposed to them as infants.
Interestingly, 30 years ago doctors rarely saw patients with severe food allergies. Today, severe food allergies, especially peanut allergies, are a commonplace. In fact, peanut allergies are the leading cause of food allergy deaths in the United States.
While there is a genetic predisposition to food allergies, no one has identified specific genes and there is no biological explanation.
Dr. Scott Sicherer at Mount Sinai states:
From an evolutionary-biology point of view, food allergy amkes no sense at all. Hunters and gatherers who had potentially fatal reactions to tree nuts, peanuts, seeds and fish would be at a distinct evolutionary disadvantage and were less likely to pass on their DNA to a progeny. It seems pretty clear that food allergy is a condition that resulted from the environment we created.
While it doesn’t make sense from a biological standpoint that humans would develop an allergy to peanuts there are studies indicating that genes can play a role in the development of food allergies.
In their study, Wang and her colleagues analyzed DNA samples from 2,759 participants (1,315 children and 1,444 of their biological parents) enrolled in the Chicago Food Allergy Study. Most of the children had some kind of food allergy. They scanned approximately 1 million genetic markers across the human genome, searching for clues to which genes might contribute to increased risk of developing food allergies, including peanut. They found that a genomic region harboring genes such as HLA-DB and HLA-DR and located on chromosome six is linked to peanut allergy. This study suggests that the HLA-DR and -DQ gene region probably poses significant genetic risk for peanut allergy as it accounted for about 20 percent of peanut allergy in the study population.
It is important to note that not everyone with these mutations develops a peanut allergy.
Resetting Immune System
Due to the increase in vaccinations and antibiotics and reduction of infections in the first year or two of an infant’s life, we end up redirecting the immune system away from the infection-fighting mode and resetting it to battle against allergies. Instead of reducing allergies we are actually making them more problematic.
This theory is called the Hygiene Hypothesis which I originally discussed in my book, Dr. Dean Mitchell’s Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time, back in 2006.
The Hygiene Hypothesis makes the case that our “cleaner”, more antiseptic environment makes the immune system tilt in favor of developing allergic inflammation. The hypothesis attributes vaccines, antibiotics and our diets to causing allergic diseases.
Changes of lifestyle in industrialized countries have led to a decrease of the infectious burden and are associated with the rise of allergic and autoimmune diseases, according to the ‘hygiene hypothesis’. The best explanation for the lower incidence of asthma and allergies in rural and 3rd world countries vs. urban and Western countries is The Hygiene Hypothesis. 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.
In 1998, one of the first allergists to question the theory on avoiding foods in order to avoid developing allergies was Dr. Gideon Lack at St. Mary’s Hospital in London. Dr. Lack stated:
If eating eggs or eating peanuts in an allergic sufferer causes a reaction, then clearly the way to prevent a reaction from occurring is by not eating egg or peanut. That makes sense. But that’s different from saying that clearly the way to not become allergic in the first place is not to eat egg or peanut.
Yet in 2000, the American Academy of Pediatrics was still recommending that parents not feed peanuts to their children until they were at least 3 years old. The thinking was that this would reduce the risk of developing a peanut allergy.
Recent studies are concluding otherwise so it is becoming conclusive that the avoidance of peanuts actually caused more children to develop allergies to peanuts.
The New England Journal of Medicine published results from Randomized Trial of Peanut Consumption in Infacts at Risk for Peanut Allergy which concluded
The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts.
The study above tracked babies that had a high risk of developing peanut allergies, from infancy to the age of 5. Some of the babies were given peanut butter or peanut-based foods from an early age, and some were told to stay completely away from these products. Those babies that were given peanut-based food were found to be a lot less likely to develop peanut allergies than those who were told to stay away from these products.
In an article by Irene Mikhail, MD titled Implementation of Early Peanut Introduction Guidelines: It Takes a Village advocates that early peanut introduction around 6 months of age is now thought to prevent the development of peanut allergy in high-risk infacts.
Based on recent research, it’s becoming evident that avoiding foods like peanuts actually caused more children developing allergies to these foods.
So, how do you prevent peanut allergies?
While genetics play a role in peanut allergy development, the main causes of increases in peanut allergies is due to resetting the immune systems of infants by reducing their exposure to infection and by reducing the contact babies and young children have with foods commonly associated with allergies like peanuts.
These findings could be an indication that parents should consider introducing their child to peanut or peanut based foods. Clearly an early introduction and exposure to peanuts could trigger an immune tolerance where their body gets used to the allergen and doesn’t over-react to it in the form of a peanut allergy.
The thinking seems to be that the first year of life is probably very critical for the immune system. It may be in this first year that the immune system determines whether it develops a tolerance to allergies or whether allergies will be exacerbated.
What is really coming to light is the hygiene hypothesis. I believe that a lot of the increase in allergies in western societies is due to the fact that we are sheltering our children from a lot of the environmental immune stimulants that would make a huge improvement in their overall immune system.
Overall our children may be better off if they are exposed to an allergen in their first of year of life. It is possible that there is a critical time in their immune system where introducing and exposing them to an allergen can make them immune tolerant.
What to do if You or Your Child Already Has a Peanut Allergy?
For people who have developed food allergies and live under a constant threat there is hope. We have recently started treating patients at our practice who have severe food allergies with sublingual allergy drops. The goal is to desensitize individuals with a peanut allergy so that, at the very least, you will have enough of a tolerance to not suffer from a severe allergic reaction when in contact with peanuts.
Ultimately, we want to help children and adults with life-threatening peanut allergies achieve true food freedom – the ability to eat whatever they want, whenever they want, in unlimited quantities – without fear of reaction.
Dr. Dean Mitchell, M.D. is a Board Certified Allergist and Immunologist based out of NYC. He graduated from the Sackler School of Medicine and completed training at the Robert Cooke Allergy Institute in New York City. He is also a Clinical Assistant Professor at Touro College of Osteopathic Medicine, a fellow of the American Academy of Allergy, Asthma, and Immunology, and the author of Dr. Dean Mitchell’s Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time. Dr. Dean Mitchell, M.D. has also been featured in The New York Times, The Huffington Post, Fitness Magazine, Dr. Oz and News NY 1. Dr. Mitchell also hosts the podcast The Smartest Doctor in the Room – a combination of a lively, personal and in-depth interview with top healthcare specialists.
Abrams MD, Elissa, Chan MD, Edmond. It’s Not Mom’s Fault: Prenatal and Early Life Exposures that Do and Do Not Contribute to Food Allergy Development. Immunology and Allergy Clinics of North America, Volume 39, Issue 4, November 2019 – pages 447-457.
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