Our son is very allergic to peanuts and less so to cashew, and sesame. We went through oral immunotherapy and it's been absolutely life changing. He used to need an epi pen in case of chance encounter, but now he eats 2 whole peanut m&ms every day to keep his dosage up. It's been difficult finding an allergist in Germany that's willing to accept this and move forward
Obviously everyone's mileage will vary, but I'm happy to see this treatment being more widely adopted
In Israel this is done naturally by feeding children Bamba, a puffed peanut snack, at a very early age. Research shows significantly decreased levels of peanut allergy.
Bambas are recommended in the U.S. as well, but our kid entered anaphylaxis after eating just 5 bambas his first time, at about 6 months of age. It's certainly possible to have a peanut allergy despite early exposure. Recommendation in the U.S. is now for pregnant women to eat peanuts to expose the fetus in utero, but even this doesn't always work.
Kid is desensitized now after a year of oral immunotherapy, so add us to the chorus of voices saying "It works", but it can strike early and severely despite the parents' best efforts.
People mention this quite often to me because my toddler is on oral immunotherapy for peanuts, and there’s a small but important distinction here. It’s extra important when relatives start to think it’s okay to be casually leaving peanut products lying around within the toddler’s reach. (It’s not)
The general consensus among allergists is that early exposure reduces the chances of developing the allergy in the first place, but people on oral immunotherapy are still allergic, they just have a high tolerance and can still have anaphylactic reactions. Some will outgrow the allergy, but for peanuts most don’t and the data doesn’t yet exist for whether peanut oral immunotherapy increases the likelihood of outgrowing the allergy.
I thought there was a study that suggested the weapon of first resort should be breastfeeding mothers eating the allergen-triggering foods so the kids get exposed to them indirectly.
Makes me wonder if there is something we should be doing with baby formula.
Yeah, we hadn't heard of this when our son was born, but the allergist mentioned it. When our daughter was born, we gave her something like this at his recommendation. The ones we got were some puffs that have a whole pile of allergens in tiny doses. Causation vs correlation and all that, and a small sample size, but our daughter doesn't have any issues with any allergies.
We did this for our son (peanuts and cashews) and it was also life changing. He’s on a daily maintenance dose for life, but we no longer fear the possibility of either allergen being near him in public places or cross contamination in food. He still has to carry his epipen, but now the prognosis for “oops he ate something with peanut in it” is no reaction at all until he’s several peanuts in. He’s not cured and can still eat his way to anaphylaxis with a bag of peanuts, but he can take a few bites out of a PB&J sandwich and nothing will happen.
One detail in particular makes a huge difference: oral immunotherapy seems to be significantly more effective in babies (starting before age 2) with significantly better outcomes. Adults and young children have a much higher incidence of side effects (most common one is a constantly upset stomach) that makes avoidance potentially still better for overall quality of life, but our allergist told us that among their <2 year old cohorts they’ve seen zero out of [upper two digits] experience any of those side effects at all. We started our son when he was 1 year old.
In our case the kid started eating peanuts basically as soon as they started eating solid foods, so the allergy happened despite early exposure. Actually we caught the allergy early enough to start OIT early because of early exposure.
Our daughter too, she’s been on a maintenance dose equivalent to two peanuts, once a week.
It’s been life changing. She’s had several trips to A&E before the treatment but after a few years she was able to tolerate a dose equivalent to ten peanuts (although that still made her quite nauseous).
Wow that is really good to hear. I am on immunotherapy for a different type of allergy and can't stop talking about its effectiveness. It has been life changing.
I asked our allergist about oral immunotherapy for my daughter and he cited a study that found that avoidance was more effective in preventing severe reactions.
So there’s one factor that doesn’t get discussed much: adherence to a fairly draconian treatment regimen for “forever”. Our allergist screened us for whether they thought that as parents we had the resolve and diligence to figure out a way to get a baby/toddler to eat a full teaspoon of peanut and cashew every single day. And as any parent can tell you getting them to eat a specific thing every single day is non-trivial.
Oral immunotherapy seems to be very effective but sticking with it is nontrivially hard.
Even if they believe it, there's a list of treatments and procedures for each diagnosis that insurances are required to cover and oral immunatherapy might not be on said list.
They tend to be critical against immunotherapy in general, if it's not for those allergies where the therapy has a good chance of working and is without risk. Otherwise avoidance of the allergen is preached. We encountered that with a cat hair allergy, treatment was refused.
With. First they did a blood test (instead of a scratch test) to identify possible allergy levels. Then the allergist had us come into the office to take e.g. a few micrograms of peanut powder and watch him for reactions. Then we maintained the dose at home every day for the next couple weeks, taking zyrtec with it to avoid hives, etc. Then we'd go back in, try doubling the dose as a challenge. If he had a bad reaction, we stayed on the same dose another few weeks, and if not, it became the new standard level. Rinse and repeat for about a year until we got to 2 peanuts, 1 cashew, and 1/4 tsp of tahini, which we maintained now for the past ~1.5y. We're due for another blood test and challenge here soon, as the allergist suggested there's a small chance that the immunotherapy could result in the allergies essentially receding
1. First three days: test the child with increasing amounts of cashew protein, until the child has a reaction. Use the amount ingested for that reaction, to determine the single highest tolerated dose (SHTD = the maximal amount of cashew protein each patient could tolerate).
2. Next 24 days: the child ingests the SHTD daily.
3. After that: every month, the dose was increased (I think at an in-person visit), and taken at home for the next 30 days.
For #1, I looked at the amounts of protein they gave the child. Table S2 (in one of the supporting documents) shows how much they gave on days 1, 2 and 3. Of course they stopped increasing once the child had a reaction. If you convert the amounts of protein into equivalent numbers of whole cashews, then you get:
- day 1: start with 1/1800th of a small cashew, increasing up to a fifth of a small cashew.
- day 2: 1/5th small cashew, up to 2 small cashews
- day 3: 2 small cashews, up to 22 small cashews
22 small cashews is about equivalent to what they want to achieve by the end of the therapy, i.e. if you don't have a reaction after eating that many, you won't have a reaction to a greater quantity.
It seems a bit hard to DIY it, because:
- The first three days requires very small amounts of cashew protein. At home we don't have either (i) isolated cashew protein, or (ii) tools to measure such small amounts (starting with 0.1mg cashew protein, or 0.5mg cashew).
- For the first three days, we'd need to be very vigilant to watch out for a reaction. I don't know whether, in a supervised setting, they'd observe or measure other factors than just an apparent reaction, to make sure the procedure is safe.
I AM NOT A DOCTOR OR OTHER HEALTHCARE PROFESSIONAL
Me too. My younger sibling, as a child, had (and still has) allergies (at the time, peanuts, tree nuts, eggs, sesame & sunflower). About a year, maybe 2, after starting to eat small amounts, they could do sesame, stovetop (!!) eggs, and nut butter. The problems went from 'allergic reaction' to 'won't eat the eggs and nuts'. (I think at one point the solution was pancakes with nut butters and sprinkles. Kid still had a hard time eating it.)
I don't know why it's taken so long for this to gain broader acceptance.
If you are willing to say, what was your son’s peanut allergy level?
One of our sons is 6/6 on peanuts and they were very hesitant to try oral immunotherapy, more or less saying they weren’t willing to given the risk of anaphylaxis.
I don't remember for sure, but I'm pretty sure it was 1 below the max level. I seem to recall it was on a scale of 5 with our test, but it might have been on a scale of 6
I visited my local allergist for this (in the USA). Basically the treatments available to me were either shots or eyedrops. The shots required visiting the office almost daily, then weekly, then less frequently. The eyedrops can be self administered. I was told both treatment options are not permanent and need to be basically done in perpetuity. The cost was a couple thousand dollars per year (basically no insurance coverage).
Seems like the treatment options are evolving pretty rapidly and these options aren't available everywhere. Or this is what I was told.
I heard that you can choose between pills every day for a prolonged period OR three injections over a year. Not sure how accurate this is, but every "allergologe" provides this in Germany.
My hayfever is mild. Since some years ago, I chew some grass ends, mostly at the beginning of the season. I do seem to get much reduced symptoms compared to what I used to get. But of course I can't be sure it's causal. I have completely stopped taking antihistamines.
Yes, my girlfriend gets allergy exposure shots for cat dander. It's stupid expensive and time consuming. You will meet your insurance deductible for several years. The outcome is only somewhat good as well.
My daughter took part in a large study that led to similar guidance being introduced in the UK. The was randomised into the early introduction group, which meant that she had to eat peanut, egg, cow's milk, fish, wheat and sesame on a regular schedule when she was a baby. It was interesting - though lots of work, and when she was old enough to understand why she was going up to London for the follow-up tests, she was very proud of her role as "scientist". It was very satisfying when the results were published many years later, proving the hypothesis.
and IIRC you need to maintain consistent exposure to the allergens throughout the first, idk, 18 months of life to have the best result. So don't just expose them once early on and stop.
It's the opposite. Usually babies don't eat any food at 4 months. They only get breastmilk or formula. The advice is to start early with peanutbutter and egg.
In our case diary products were an issue instead of nuts. My daughter would get very sick from anything that had diary in it, even if my wife ate diary products while breastfeeding. But at about 1.5 years one she got over that and now at 4 she is completely fine drinking normal cow milk.
So allergies in kids are not a permanent set in stone thing. They can get over some, and early exposure makes a difference.
No, it's the opposite. The advice we were given was that it was very important that their first encounter with the allergens was to eat them, and not to allow skin contact or anything before that. This meant that with my youngest we had no peanuts in the house until she was old enough to eat solid food, and peanut butter was the first food she ate. It's still her favourite food!
I am not sure if you had a child or not, but you don't give the baby food before 4 to 6 months. So its not that you aren't exposing them at all, but not feeding them the food.
I'm assuming you're not a parent, but it's a valid question! No food before 4 months, babies can and should subsist on breastmilk or formula before that.
Where does the peanut and egg allergy come from? My understanding is that peanut oil and egg albumin are ingredients in many common medicines given early to infants.. is there any chance that could be contributing?
Egg albumin is also interesting because the vast majority of kids outgrow it. My toddler has a peanut allergy but has already outgrown his egg albumin allergy.
It does make you wonder if we shouldn’t vaccinate until exposing the children to solid foods in ordinary healthy cases. The mother’s antibodies from her milk do good work.
There are other commenters warning about skin exposure before dietary exposure. If that’s true then it would make sense.
It is not well known but this also works for adults too. I’m 28 and recently completed oral immunotherapy therapy for my extremely severe peanut allergy. I used to go anaphylactic from single milligram exposure and now I’m eating multiple peanuts a day. As an adult you have to go slower and be more careful but absolutely can be done and is life changing.
Wonderful to hear - my son took part in a milk desensitisation, which has been really successful - but he also has a good few other food allergies. We haven't yet been able to get him onto other trials, so I was worried that if we didn't do it while he was young, we'd miss the 'window'.
Brilliant to hear it still works well in adulthood - if we can get peanuts, sesame and egg under control - so that he can eat 'May Contain' food, that would be a huge change for him.
About a year overall but I started to have meaningful protection after about 6 months. There is no one in the UK currently offering it for adults so I had to travel to a specialist clinic Atlanta a few times.
Immunotherapy works. I run a company (YC w21) that wants to eliminate allergies forever. It's ancient medicine to manage symptoms with antihistamines when we can remove the root cause completely.
Right now, we fix cat, dog, pet, pollen, and dust allergies. In a few years, we'll be doing nuts.
I've done two rounds of sublingual drops over the past 8 years and both times I've seen no noticeable improvement. Once was directly through my doctor and the second time was through a service similar to this (Curex).
I don't doubt this works for some people, but I also don't think it works for everyone. I had much better results with shots.
How is this different or better compared to diagnostics and treatments available from allergists? At least one office in my area says they do immunotherapy and desensitization.
* The Royal Children's Hospital in Victoria
* Perth Children's Hospital
* Fiona Stanley Hospital in Western Australia
* Queensland Children's Hospital
* Women's and Children's Health Network in South Australia
* Sydney Children's Hospital, Randwick
* The Children's Hospital at Westmead
* John Hunter Children's Hospital
* Campbelltown Hospital
* Royal Prince Alfred Hospital in NSW
Nuts are a very good and healthy natural snack; it's a shame they are banned by most daycares and schools now. It would be great if this became so common they could be allowed again. Without nuts...what do we have instead? Chips. granola-bars. These are highly processed foods that have other issues. Raisins or apples maybe? but they are mostly sugar. None of these options have healthy fat & protein like nuts do. What healthy snacks do you feed your children?
Yep, the banning of normal foods from these spaces is a detriment to everyone else. I feel it is a bit unfair, in that everyone else has to “subsidize” the few rare people with allergies. Shouldn’t the burden be on them to avoid public spaces if they’re that sensitive?
Oh wow, are nuts banned from US schools? Never heard of that in NL or UK. The only food requests we get from daycare and primary school are to provide healthy snacks for birthday celebrations instead of sugary. And that's a friendly request not a rule.
I’d be curious to see statistics on this as well. If I were to hypothesize it would be a combination of 3 factors:
- Nut Allergies in particular seem to be reduced with early exposure [0]. Maybe dietary trends have changed in a way that causes less early exposure?
- Child mortality rate used to be much higher. Children with allergies used to be part of this mortality rate. This combined with parents with mild allergies that might have previously not survived to have children cause the incidence to increase.
- People today are exposed to many more types of food. Many people who might have a particular allergy may not have ever been exposed to that allergen.
Another one I’d throw out there would be nearsightedness. Of course a lot of people wear contacts, but I’d imagine incidence of glasses is higher than it used to be.
Reported rates of nut allergies rates have definitely increased though. [1]
Multiple newer parents I've met (in Australia) have practiced complete avoidance of such serious potential allergens. The idea seems to be that a very young child may have a reaction, but not be able to tell you and just cry or go red - as per usual at that age, so you probably don't realise it's serious until it's too late.
They gradually introduce these foods later. Maybe too late, if the idea of early exposure is accurate, but it's very much a case of "can't be too safe" when I asked them.
"Children with allergies used to be part of this mortality rate."
Perhaps so, but I had a mother who was particularly fussy that we kids had good fresh food—I reckon she was a bit obsessed with it, yummy things like potato chips, sweets, etc. were discouraged and not a part of our normal diet—and at no time was anything ever mentioned about nuts, peanut butter, etc. being bad or 'suspect'.
In fact, I was encouraged to eat nuts instead of sweets as they were considered wholesome whereas sweets were not. We always had peanut butter at home (mother encouraged it over jam).
When we did have sweets it was often peanut brittle (and peanut toffee) which I and most kids loved.
Moreover, my mother always thought of herself as up to date, every week she read women's magazines such as the Women's Weekly, if nut allergies were a big deal back then she would have heard of it. But there was nothing said.
Likewise, I'd love to know the statistics. What I do know is that these days something has changed for the worse. If peanut allergies had been so prevalent when I was a kid then there'd have been no way that it could have been covered up so completely that no one would have been aware of it.
Incidentally, it's not as if allergies were unknown back then, we occasionally heard of some unfortunate people who were allergic to shellfish, or occasionally egg, or being near cats or horses—but never peanuts or other nuts.
> When I was a kid in Australia decades ago we'd never heard of peanut allergies and swapping peanut butter sandwiches at school was the norm.
Recognition of severe peanut allergies plus a common false hypothesis that early exposure increased the risk of such allergies developing led lots of parents in lots of places for a few decades to avoid their children having early exposure, leading to a huge increase in severe allergies (because it turns out, early exposure actually reduces the risk, which was recognized in large part because Israel, where the avoidance thing not only didn't catch on but where peanut-based puffed snacks remained a popular snack for kids from pretty much when they could eat solid food, was conspicuously left out of the major upswing in peanut allergies). Since the recognition that avoidance is counterproductive has worked its way into general advice in the last few years, we should see a noticeable drop in the incidence.
> Same with asthma. Something has gone terribly wrong.
Lots of stuff going on with asthma, I think: It's got a genetic component and treatment getting better probably increases the incidence, all other things being equal, there's a lot of known environmental factors, some of which are probably increasing in probability of exposure, and it’s also made more noticeable and more likely to be diagnosed by allergies and other co-occurring inflammatory conditions, which gets back to the allergy discussion...
"…Israel, where the avoidance thing not only didn't catch on but where peanut-based puffed snacks remained a popular snack for kids from pretty much when they could eat solid food, was conspicuously left out of the major upswing in peanut allergies)."
Seems that common sense prevailed there.
"Lots of stuff going on with asthma,…"
I grew up in a cold, damp mountain environment where mists and rain were commonplace (by the time Ventolin/salbutamol came onto the market in the late '60s I'd have left school), and I recall no kids that I knew who had asthma. I'm not saying that asthma was unknown, I'm just saying it wasn't as common as it seems to be these days.
Again, I'd like to know the stats, population versus reported incidents by year etc., so we had a handle on what's actually happened over this timeframe.
I saw a show several years ago that said Australia (I think specifically Melbourne?) and a city in Finland are the epicentre of research for food allergies, because of how prevalent they are. The Finnish two was basically split in two decades ago so that half of it is in Russia and half in Finland. The Finnish side has made significantly better economic progress since then, but also has a much higher rate of allergies. In Australia it seemed to affect first generation descendants of immigrants (I vaguely recall SE Asia and South America being over represented in those impacted?). They had a doctor from Malaysia on the show that had 7 kids, the latter 2 both born in Australia and both had peanut allergies. I remember him saying how hard it is to travel home with them “you tell someone in Malaysia your kids are allergic to satay and they just don’t understand”.
I’m like you re lunches as a kid. I never liked peanut butter as a kid, but it was a staple option among kids alongside Nutella and Vegemite. Now peanut butter and Nutella is banned in a lot of classrooms.
"The Finnish side has made significantly better economic progress since then, but also has a much higher rate of allergies."
To me, that's very significant. It's almost a quintessential model. Splitting a population down the middle and changing the circumstances of one and not the other has to be pretty much the ideal situation for researchers. So what's the research say?
"In Australia it seemed to affect first generation descendants!… …
“you tell someone in Malaysia your kids are allergic to satay and they just don’t understand”."
Reckon that'd be pretty disturbing for parents who'd consider satay a staple food. Again, I can only say that Australian kids of my generation who came of age in the late '60s—mid '70s and who were exposed to Asian foods including satay for the first time and loved it, never seemed to have problematic allergies with peanut sauces.
BTW, re swapping sandwiches, the trade at school often occurred with peanut butter and honey (or jam) with Vegemite and lettuce (sometimes cheese). I always preferred the latter, the former being a bit too sweet (perhaps I was a bit unusual). :-)
Well there's that theory that a reduced exposure to infections during the first few years of life causes the immune system to overreact to harmless things. Modern sterile environments are quite the opposite of kids playing in the dirt a century ago. Not sure if that theory still holds though.
Then there's the genetic component, if you had allergies before epipens and ambulances it was pretty likely that you just, well, died, the first time you got exposed to the allergen. Today people with dozens of deadly allergies live relatively normal lives, and are able to make those genes propagate further. This goes for most genetic problems really, any ones we can treat will eventually become massively more prevalent than before.
I always think about the low incidence of peanut allergies in developing countries and wonder if the mother's diet during pregnancy has an effect on allergies in children? Has this been researched? Because instead of introducing peanuts and eggs to babies, introducing it to mothers is almost a no brainer.
Allergies are weird and our understanding of them is very incomplete. My son has/had a peanut allergy (very successful oral immunotherapy, knock on wood) and I ended up doing a lot of research. One study that is particular interesting is this one: https://pubmed.ncbi.nlm.nih.gov/26728850/
It shows that east asian children, who very rarely have nut allergies in their home countries, develop nut allergies at a higher rate than non-asian children when born in Australia while east asian children who immigrate to Australia after their early infancy continue to maintain very low rates of nut allergies.
This is what our allergist said. Living in Australia wife and I are both asian both eat peanuts. No peanut allergies in either families. Wife ate peanuts while pregnant but son has peanut allergy.
No link because I'm on mobile, but I remember reading about how peanut allergy in Israel is nearly non-existent. This is notable because:
1) Israelis come from all over the world, and the incidence of peanut allergies are lower in, say, Sephardic Jews living in Israel compared to Sephardic Jews living in Spain.
2) a very popular snack there for kids(but also adults) are these peanut butter corn-puffs called "Bambas"(like, literally 25% of the snack market is this one snack)
Strictly speaking, if all babies eat peanuts, you'll get to "nearly non-existent" peanut allergy one way or another. But you need better data than that to conclude that the change comes from allergy prevention, rather than... allergy "removal".
Edit: I guess I was just trying to say "surprising data needs detail." I should have just said that, instead of making light of how dangerous allergies are. Downvotes deserved, lesson learned.
It most likely has to do with how bored our immune systems are.
We evolved to be constantly dirty, and we live in an extremely clean society. When your immune system has a lot to fight, it doesn't worry to much about dumb shit like pollen and peanuts.
Clean vs. dirty isn't even the right way to think about it. We used to be immersed in an environment full of life, and now we live in mostly sterile environments free of life except for maybe some of the first wave colonizer specialist microorganisms. You are filled and covered with life that isn't from your own genes, and that microbiome is now mostly disconnected from the biosphere.
I get some weird skin issues sometimes which are almost magically fixed if I visit a natural body of water... it's clearly an issue of my immune system interacting unfavorably with a microbiome which is out of whack.
About 20 years a doctor told me that this was a theory that wasn't widely accepted YET, but it deserved to be taken seriously. Now it's much more mainstream.
How do you see reactivity to house dust, air pollution, stuff like asbestos and adjacent construction materials etc. ? Then I'd assume the living ecosystem also shifted from mostly open air to indoor insects, i.e. "life finds a way"
We sure aren't exposed to the same things as 4 centuries ago, but I can't imagine we're living a what anyone would call a "clean" environment.
This checks out. After moving to a state with a lot of greenery I developed a rather severe allergy to grass and pollen. Literally the entire face would get swollen and stuffy for several months in any given year. Not life threatening, thankfully, but very unpleasant. It went away within a year after I started mowing my own lawn and working in the garden without gloves.
I am the parent of twins. Their mother ate multitudes of peanut M&M's and similar items when pregnant. One twin has zero peanut allergies, the other one has deadly allergies and we are at the ER at least once a year from food contamination.
I am kinda of curious about populations where peanuts aren’t common at all. I certainly didn’t have many fancy nuts (i know peanuts aren’t nuts) until well into adulthood. Why were there not wide spread peanut allergies among migratory populations?
I have a suspicious that apparent elevated rates of allergies are caused by overzealous preemptive testing. The tests are very sensitive and trigger for people that have only slight allergies which, in the past or in developing countries, could have been simply unknown and naturally diminished with subsequent exposure.
The human genome didn't evolve in a sterile environment, it evolved in an incredibly hostile environment and developed some nasty defenses as a result. If you don't expose children to pathogenic microbes at an early age to train the immune system on what to attack, it will find other things to attack. Allergies are the result. Stop the constant use of antibacterial hand gels and surface sanitizers and for bonus points get a dog.
Is it possible that in developing nations having more limited dietary options and/or the risk of allergic reaction makes a child less likely to survive and therefore makes it appear that allergies are less common?
This is just speculation, I don't know of any evidence one way or the other.
Readit News
Obviously everyone's mileage will vary, but I'm happy to see this treatment being more widely adopted
https://www.npr.org/sections/thesalt/2015/02/23/388450621/fe...
The original studies on peanut allergy and bamba in Israel came out many years ago.
It’s taken people so long in the US to learn about the value of introducing small amount to babies at a young age to protect them.
I can only think of the many families and children who have been negatively impacted due to the lack of awareness and understanding in America.
Kid is desensitized now after a year of oral immunotherapy, so add us to the chorus of voices saying "It works", but it can strike early and severely despite the parents' best efforts.
The general consensus among allergists is that early exposure reduces the chances of developing the allergy in the first place, but people on oral immunotherapy are still allergic, they just have a high tolerance and can still have anaphylactic reactions. Some will outgrow the allergy, but for peanuts most don’t and the data doesn’t yet exist for whether peanut oral immunotherapy increases the likelihood of outgrowing the allergy.
Or you can order it from amazon:
https://www.amazon.com/Smoki-Peanuts-Flavored-Snack-Pack/dp/...
Makes me wonder if there is something we should be doing with baby formula.
One detail in particular makes a huge difference: oral immunotherapy seems to be significantly more effective in babies (starting before age 2) with significantly better outcomes. Adults and young children have a much higher incidence of side effects (most common one is a constantly upset stomach) that makes avoidance potentially still better for overall quality of life, but our allergist told us that among their <2 year old cohorts they’ve seen zero out of [upper two digits] experience any of those side effects at all. We started our son when he was 1 year old.
In our case the kid started eating peanuts basically as soon as they started eating solid foods, so the allergy happened despite early exposure. Actually we caught the allergy early enough to start OIT early because of early exposure.
I've been wondering if there's something else causing me to be allergic to them, like something I eat or so, idk. But I'll have to get tested again
Oral immunotherapy seems to be very effective but sticking with it is nontrivially hard.
What are they saying? They don't believe in oral immunotherapy?
I looked into oral immunotherapy for tree nut allergies. There's a paper from 2022: https://onlinelibrary.wiley.com/doi/10.1111/all.15212
They did it in a few stages:
1. First three days: test the child with increasing amounts of cashew protein, until the child has a reaction. Use the amount ingested for that reaction, to determine the single highest tolerated dose (SHTD = the maximal amount of cashew protein each patient could tolerate).
2. Next 24 days: the child ingests the SHTD daily.
3. After that: every month, the dose was increased (I think at an in-person visit), and taken at home for the next 30 days.
For #1, I looked at the amounts of protein they gave the child. Table S2 (in one of the supporting documents) shows how much they gave on days 1, 2 and 3. Of course they stopped increasing once the child had a reaction. If you convert the amounts of protein into equivalent numbers of whole cashews, then you get:
- day 1: start with 1/1800th of a small cashew, increasing up to a fifth of a small cashew.
- day 2: 1/5th small cashew, up to 2 small cashews
- day 3: 2 small cashews, up to 22 small cashews
22 small cashews is about equivalent to what they want to achieve by the end of the therapy, i.e. if you don't have a reaction after eating that many, you won't have a reaction to a greater quantity.
It seems a bit hard to DIY it, because:
- The first three days requires very small amounts of cashew protein. At home we don't have either (i) isolated cashew protein, or (ii) tools to measure such small amounts (starting with 0.1mg cashew protein, or 0.5mg cashew).
- For the first three days, we'd need to be very vigilant to watch out for a reaction. I don't know whether, in a supervised setting, they'd observe or measure other factors than just an apparent reaction, to make sure the procedure is safe.
I AM NOT A DOCTOR OR OTHER HEALTHCARE PROFESSIONAL
I don't know why it's taken so long for this to gain broader acceptance.
One of our sons is 6/6 on peanuts and they were very hesitant to try oral immunotherapy, more or less saying they weren’t willing to given the risk of anaphylaxis.
Seems like the treatment options are evolving pretty rapidly and these options aren't available everywhere. Or this is what I was told.
[1] https://www.honeyshoney.co.uk/blogs/news/local-honey-and-hay...
I heard that you can choose between pills every day for a prolonged period OR three injections over a year. Not sure how accurate this is, but every "allergologe" provides this in Germany.
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More information (in Dutch): https://www.voedingscentrum.nl/nl/service/vraag-en-antwoord/...
https://www.food.gov.uk/research/food-allergy-and-intoleranc...
How is that proving the hypothesis?
https://mana.md/peanut-allergies-may-affect-your-child/
What goes wrong if they're exposed before that? If the mother eats peanuts and eggs while breast feeding, does that confer desensitisation?
In our case diary products were an issue instead of nuts. My daughter would get very sick from anything that had diary in it, even if my wife ate diary products while breastfeeding. But at about 1.5 years one she got over that and now at 4 she is completely fine drinking normal cow milk.
So allergies in kids are not a permanent set in stone thing. They can get over some, and early exposure makes a difference.
Egg albumin is also interesting because the vast majority of kids outgrow it. My toddler has a peanut allergy but has already outgrown his egg albumin allergy.
There are other commenters warning about skin exposure before dietary exposure. If that’s true then it would make sense.
Brilliant to hear it still works well in adulthood - if we can get peanuts, sesame and egg under control - so that he can eat 'May Contain' food, that would be a huge change for him.
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Right now, we fix cat, dog, pet, pollen, and dust allergies. In a few years, we'll be doing nuts.
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book a visit with a doc: https://www.wyndly.com/products/allergy-doctor-consult-onlin...
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I don't doubt this works for some people, but I also don't think it works for everyone. I had much better results with shots.
The big question for me is whether this is a permanent fix or if you have to keep taking their tablets (at $99-ish a month, it looks like?)
Unfortunately this doesn't look to be covered by my insurance as the at-home test is not administered by a doctor.
Also, what about things like gluten and dairy sensitivity?
It’s similar enough to an allergy, though
Depends how emphatic you are to your fellow human being. Peanuts aren't as important in most people's lives as actual people.
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One set being small is all it takes for the intersection to be small.
…although I do have some sympathy for those with such severe allergies. ‘The burden be[ing] on them’ does seem a bit harsh.
No doubt there were allergies back then but what on earth has made them so much more common these days?
Same with asthma. Something has gone terribly wrong.
- Nut Allergies in particular seem to be reduced with early exposure [0]. Maybe dietary trends have changed in a way that causes less early exposure? - Child mortality rate used to be much higher. Children with allergies used to be part of this mortality rate. This combined with parents with mild allergies that might have previously not survived to have children cause the incidence to increase. - People today are exposed to many more types of food. Many people who might have a particular allergy may not have ever been exposed to that allergen.
Another one I’d throw out there would be nearsightedness. Of course a lot of people wear contacts, but I’d imagine incidence of glasses is higher than it used to be.
Reported rates of nut allergies rates have definitely increased though. [1]
[0] https://www.nih.gov/news-events/news-releases/introducing-pe... [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477625/
They gradually introduce these foods later. Maybe too late, if the idea of early exposure is accurate, but it's very much a case of "can't be too safe" when I asked them.
Perhaps so, but I had a mother who was particularly fussy that we kids had good fresh food—I reckon she was a bit obsessed with it, yummy things like potato chips, sweets, etc. were discouraged and not a part of our normal diet—and at no time was anything ever mentioned about nuts, peanut butter, etc. being bad or 'suspect'.
In fact, I was encouraged to eat nuts instead of sweets as they were considered wholesome whereas sweets were not. We always had peanut butter at home (mother encouraged it over jam).
When we did have sweets it was often peanut brittle (and peanut toffee) which I and most kids loved.
Moreover, my mother always thought of herself as up to date, every week she read women's magazines such as the Women's Weekly, if nut allergies were a big deal back then she would have heard of it. But there was nothing said.
Likewise, I'd love to know the statistics. What I do know is that these days something has changed for the worse. If peanut allergies had been so prevalent when I was a kid then there'd have been no way that it could have been covered up so completely that no one would have been aware of it.
Incidentally, it's not as if allergies were unknown back then, we occasionally heard of some unfortunate people who were allergic to shellfish, or occasionally egg, or being near cats or horses—but never peanuts or other nuts.
Recognition of severe peanut allergies plus a common false hypothesis that early exposure increased the risk of such allergies developing led lots of parents in lots of places for a few decades to avoid their children having early exposure, leading to a huge increase in severe allergies (because it turns out, early exposure actually reduces the risk, which was recognized in large part because Israel, where the avoidance thing not only didn't catch on but where peanut-based puffed snacks remained a popular snack for kids from pretty much when they could eat solid food, was conspicuously left out of the major upswing in peanut allergies). Since the recognition that avoidance is counterproductive has worked its way into general advice in the last few years, we should see a noticeable drop in the incidence.
> Same with asthma. Something has gone terribly wrong.
Lots of stuff going on with asthma, I think: It's got a genetic component and treatment getting better probably increases the incidence, all other things being equal, there's a lot of known environmental factors, some of which are probably increasing in probability of exposure, and it’s also made more noticeable and more likely to be diagnosed by allergies and other co-occurring inflammatory conditions, which gets back to the allergy discussion...
Seems that common sense prevailed there.
"Lots of stuff going on with asthma,…"
I grew up in a cold, damp mountain environment where mists and rain were commonplace (by the time Ventolin/salbutamol came onto the market in the late '60s I'd have left school), and I recall no kids that I knew who had asthma. I'm not saying that asthma was unknown, I'm just saying it wasn't as common as it seems to be these days.
Again, I'd like to know the stats, population versus reported incidents by year etc., so we had a handle on what's actually happened over this timeframe.
I’m like you re lunches as a kid. I never liked peanut butter as a kid, but it was a staple option among kids alongside Nutella and Vegemite. Now peanut butter and Nutella is banned in a lot of classrooms.
To me, that's very significant. It's almost a quintessential model. Splitting a population down the middle and changing the circumstances of one and not the other has to be pretty much the ideal situation for researchers. So what's the research say?
"In Australia it seemed to affect first generation descendants!… … “you tell someone in Malaysia your kids are allergic to satay and they just don’t understand”."
Reckon that'd be pretty disturbing for parents who'd consider satay a staple food. Again, I can only say that Australian kids of my generation who came of age in the late '60s—mid '70s and who were exposed to Asian foods including satay for the first time and loved it, never seemed to have problematic allergies with peanut sauces.
BTW, re swapping sandwiches, the trade at school often occurred with peanut butter and honey (or jam) with Vegemite and lettuce (sometimes cheese). I always preferred the latter, the former being a bit too sweet (perhaps I was a bit unusual). :-)
Then there's the genetic component, if you had allergies before epipens and ambulances it was pretty likely that you just, well, died, the first time you got exposed to the allergen. Today people with dozens of deadly allergies live relatively normal lives, and are able to make those genes propagate further. This goes for most genetic problems really, any ones we can treat will eventually become massively more prevalent than before.
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It shows that east asian children, who very rarely have nut allergies in their home countries, develop nut allergies at a higher rate than non-asian children when born in Australia while east asian children who immigrate to Australia after their early infancy continue to maintain very low rates of nut allergies.
1) Israelis come from all over the world, and the incidence of peanut allergies are lower in, say, Sephardic Jews living in Israel compared to Sephardic Jews living in Spain.
2) a very popular snack there for kids(but also adults) are these peanut butter corn-puffs called "Bambas"(like, literally 25% of the snack market is this one snack)
Edit: I guess I was just trying to say "surprising data needs detail." I should have just said that, instead of making light of how dangerous allergies are. Downvotes deserved, lesson learned.
We evolved to be constantly dirty, and we live in an extremely clean society. When your immune system has a lot to fight, it doesn't worry to much about dumb shit like pollen and peanuts.
I get some weird skin issues sometimes which are almost magically fixed if I visit a natural body of water... it's clearly an issue of my immune system interacting unfavorably with a microbiome which is out of whack.
And infested with worms. Most allergies are caused by the antibody we evolved to fight worms (and venom) [1].
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010491/
We sure aren't exposed to the same things as 4 centuries ago, but I can't imagine we're living a what anyone would call a "clean" environment.
So if it runs out of intruders to fight, it will attack the body itself.
I know this sounds extremely insensitive, but I genuinely think the answer is simply that the vulnerable die.
I spent 3 years moving through 35 different African countries and 2 years through Latin America.
I honestly believe it is simply the harsh reality of life that many more infants and young children die than in developed countries.
https://en.wikipedia.org/wiki/Hygiene_hypothesis
The human genome didn't evolve in a sterile environment, it evolved in an incredibly hostile environment and developed some nasty defenses as a result. If you don't expose children to pathogenic microbes at an early age to train the immune system on what to attack, it will find other things to attack. Allergies are the result. Stop the constant use of antibacterial hand gels and surface sanitizers and for bonus points get a dog.
This is just speculation, I don't know of any evidence one way or the other.