Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / Introducing Allergens: What we've been getting precisely wrong

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Introducing Allergens: What we've been getting precisely wrong · Wellness, Actually with Emily Oster & Perry Wilson, MD

• 0:00
  Speaker 1: I'm Emily Astor.
• 0:01
  Speaker 2: This is parent data, and today we're talking about peanuts.
• 0:06
  Speaker 3: Just a sort of snack you could eat by the
• 0:08
  Speaker 3: handful watching the Super Bowl, unless, that is, you're one
• 0:12
  Speaker 3: of the many people for whom the peanut poses a
• 0:15
  Speaker 3: serious threat to your health.
• 0:17
  Speaker 4: Picking out a tea time snack an innocent treat for Emily,
• 0:20
  Speaker 4: but one that once terrified her mother.
• 0:22
  Speaker 1: When Sarah Kureshi's daughter Zara was just nine months old,
• 0:26
  Speaker 1: she discovered she had a deadly peanut allergy.
• 0:29
  Speaker 2: The first thing I thought was, my child is gonna die.
• 0:34
  Speaker 5: We were constantly stressed watching for everything she acted.
• 0:38
  Speaker 1: We needed to make sure that not even a trace
• 0:40
  Speaker 1: of peanuts.
• 0:41
  Speaker 2: My standard school lunch as a kid, sent by my
• 0:44
  Speaker 2: mother was whole weight bread with natural peanut.
• 0:48
  Speaker 5: Butter on it.
• 0:49
  Speaker 2: No jam I swore when I was a parent that
• 0:53
  Speaker 2: I would give my kid jiff because the natural peanut
• 0:56
  Speaker 2: butter that I was served came in chunks. It became
• 1:00
  Speaker 2: an adult, two things happened. First, I immediately started using
• 1:03
  Speaker 2: natural peanut butter because in fact, of course, my mother
• 1:06
  Speaker 2: was right. And second, I actually couldn't use peanut butter
• 1:11
  Speaker 2: for my kids' school lunches.
• 1:13
  Speaker 1: That was true for two reasons.
• 1:15
  Speaker 2: One is an appropriately heightened sense of caution and respect
• 1:18
  Speaker 2: for kids with allergies, but the other is a substantial
• 1:21
  Speaker 2: increase in allergies among kids over time. Somewhere along the way,
• 1:27
  Speaker 2: along with these school restrictions, we also introduced cautions about
• 1:32
  Speaker 2: when kids could first have allergens. When my daughter was born,
• 1:36
  Speaker 2: I was told no peanut products until one, and it
• 1:40
  Speaker 2: turns out.
• 1:41
  Speaker 1: That this was precisely wrong.
• 1:44
  Speaker 2: It wasn't just not necessary, it was actually really harmful.
• 1:50
  Speaker 2: As we'll talk about today, randomized trial evidence conveniently occurring
• 1:54
  Speaker 2: between my two kids actually showed that you need to
• 1:58
  Speaker 2: give kids allergens early to prevent allergies. When I wrote Cripsheet,
• 2:03
  Speaker 2: my book about early parenting, people often ask me in interviews,
• 2:07
  Speaker 2: what is the one piece of advice you would give
• 2:09
  Speaker 2: to parents. The one piece of advice that I always
• 2:11
  Speaker 2: say is introduce allergens early. It's one of the few
• 2:14
  Speaker 2: things where we have concrete and actionable evidence about the
• 2:19
  Speaker 2: quote right thing to do. And one really big reason
• 2:23
  Speaker 2: for this is today's guest, doctor Gideon Lack, who actually
• 2:27
  Speaker 2: ran the trial that evaluated early introduction of peanuts. I
• 2:32
  Speaker 2: have wanted to talk to doctor Lac since I read
• 2:34
  Speaker 2: this paper, and I'm delighted to do so. Today we
• 2:38
  Speaker 2: talk about the trial, but also about the science of allergies,
• 2:41
  Speaker 2: and we get into some real practical advice about what
• 2:44
  Speaker 2: to do with peanuts and your baby. After the break,
• 2:49
  Speaker 2: Doctor Gideon Lack, Welcome Gideon. Thank you so much for
• 2:57
  Speaker 2: joining me. I'd love it if you could just interduce yourself.
• 3:00
  Speaker 2: Tell us where you are today and what your job is.
• 3:04
  Speaker 5: My name is Gideon Lack. It's a pleasure to be
• 3:07
  Speaker 5: on this program. I'm a professor pediatric allergy and immunology.
• 3:13
  Speaker 5: My main area of interest is food allergies. I work
• 3:17
  Speaker 5: at King's College, London. I happen to be on vacation
• 3:20
  Speaker 5: in the mountains.
• 3:23
  Speaker 1: You have a very nice backdrop for this podcast.
• 3:27
  Speaker 6: Thank you.
• 3:27
  Speaker 3: So.
• 3:28
  Speaker 2: My first introduction to you is through the Leap Study,
• 3:31
  Speaker 2: which is a study about peanut allergies in particular, and
• 3:35
  Speaker 2: just to like set the stage for people who are
• 3:37
  Speaker 2: not pediatric allergy experts, peanuts are a very common allergen
• 3:42
  Speaker 2: and for many years. And I will say I have
• 3:45
  Speaker 2: a twelve year old and an eight year old, so
• 3:47
  Speaker 2: with my first child born in twenty eleven, I got
• 3:51
  Speaker 2: the advice that I should avoid giving my kid peanuts
• 3:54
  Speaker 2: until she was at least one, possibly even two. What
• 3:59
  Speaker 2: you show is in the Leap study is that this
• 4:01
  Speaker 2: is literally the opposite of the correct advice. And in
• 4:05
  Speaker 2: this paper there's a large ranomized trial with kids who
• 4:09
  Speaker 2: are relatively high risk of allergies and shows that exposing
• 4:12
  Speaker 2: them to peanuts at four months actually made them much
• 4:15
  Speaker 2: less likely, much much less likely to develop a peanut allergy.
• 4:20
  Speaker 2: So the result of this, and we're going to talk
• 4:22
  Speaker 2: about the shifts in recommendations and the smaller ships perhaps
• 4:25
  Speaker 2: in what people are actually doing and how parents should
• 4:27
  Speaker 2: operationalize this. But I actually want to start by asking
• 4:30
  Speaker 2: you where this idea came from, Because when I wrote
• 4:34
  Speaker 2: crib sheet and I wrote about this study, I had
• 4:36
  Speaker 2: a whole story about where you had come up with
• 4:38
  Speaker 2: this idea.
• 4:39
  Speaker 1: And I'm not going to tell you what it is,
• 4:40
  Speaker 1: because I'm sure it's not right. But can you tell
• 4:42
  Speaker 1: me how you came up with this idea?
• 4:45
  Speaker 5: Absolutely, Emily, So, as you say, for many decades and
• 4:49
  Speaker 5: for long periods of time, while food allergies became prevalent,
• 4:54
  Speaker 5: we mistakenly believed that eating peanuts was the cause of
• 4:59
  Speaker 5: divis peanut allergy, and that was a sort of intuitive
• 5:03
  Speaker 5: belief in terms of cause and effect. You give a
• 5:06
  Speaker 5: baby peanuts, the baby has peanut allergy, they develop hives. Therefore,
• 5:11
  Speaker 5: by virtue of giving the baby the peanut, you must
• 5:14
  Speaker 5: have caused the problem. That's a bit though as simplistic
• 5:18
  Speaker 5: as saying that exercise causes angina or heart pain and
• 5:23
  Speaker 5: coronary artery disease. Therefore, exercise causes heart disease, therefore we
• 5:28
  Speaker 5: shouldn't exercise. And there was that sort of paradox that
• 5:31
  Speaker 5: was going on. And while I trained in the nineties
• 5:37
  Speaker 5: in Denver at National Jewish Pediatric Allergy, I was working
• 5:42
  Speaker 5: on mouse models, and it was very apparent that in mice,
• 5:46
  Speaker 5: in order to provoke allergic responses to foods, they had
• 5:50
  Speaker 5: to be exposed through a braided skin or inflamed skin.
• 5:55
  Speaker 5: And the most interesting thing to me at the time,
• 5:58
  Speaker 5: and I remember asking my teachers this was that if
• 6:02
  Speaker 5: you've fed a young mice pop, peanut, or egg or
• 6:08
  Speaker 5: milk protein by gavage very early on in life, in
• 6:12
  Speaker 5: high amounts, it was almost impossible to artificially cause the
• 6:17
  Speaker 5: development of food allergy in that mouse. And in fact,
• 6:20
  Speaker 5: that is a long, long, well known phenomenon called oral
• 6:25
  Speaker 5: tolerance induction that people have known about going back to
• 6:28
  Speaker 5: the beginning of the twentieth century. Actually HG. Wells, the author,
• 6:33
  Speaker 5: actually wrote about this using animal models. He was a scientist,
• 6:37
  Speaker 5: and we've known about this for decades and decades, And
• 6:42
  Speaker 5: simultaneously to all of this we were saying, well, let's
• 6:45
  Speaker 5: avoid allergenic foods and babies to prevent the development of
• 6:51
  Speaker 5: food allergies, where in fact we believed it should have
• 6:54
  Speaker 5: been the opposite.
• 6:55
  Speaker 2: It's interesting because so much in science, so often I
• 6:58
  Speaker 2: see people say, have some result in mice, it must
• 7:02
  Speaker 2: also be true in people. But it sounds like here
• 7:04
  Speaker 2: was we have some result in mice, but we think
• 7:06
  Speaker 2: the opposite is true in people.
• 7:09
  Speaker 5: Exactly. But of course these animal models were not developed
• 7:15
  Speaker 5: with a view to testing food allergy. The observations that
• 7:19
  Speaker 5: were made it actually applies in a variety in a
• 7:23
  Speaker 5: number of diseases. But yes, I mean, not all that
• 7:27
  Speaker 5: happens in mice happens in humans. But here is a
• 7:31
  Speaker 5: good example. You are, You're absolutely right, But even in mice,
• 7:34
  Speaker 5: a critical thing is that it had to be early, right,
• 7:38
  Speaker 5: And we had this idea for a long period of
• 7:42
  Speaker 5: time that we could sort of wrap up babies in
• 7:45
  Speaker 5: an immunological cocoon, avoid exposure to peanut proteins and to
• 7:51
  Speaker 5: other food proteins, and let the baby's immune system mature
• 7:56
  Speaker 5: to one two three years of age. The American I mean,
• 8:00
  Speaker 5: pediatric guidelines used to be avoid p nuts still three
• 8:03
  Speaker 5: years of age. That will change in two thousand and eight.
• 8:06
  Speaker 5: And this idea was that by protecting that baby during
• 8:09
  Speaker 5: its early formation, the formation development of its immune system,
• 8:13
  Speaker 5: you would be protecting against panut allergy. And of course
• 8:18
  Speaker 5: that's not the case, and personally I believe that's a
• 8:21
  Speaker 5: reason for the increase in food allergies.
• 8:24
  Speaker 1: That seems likely to meet.
• 8:25
  Speaker 2: So you have, before you even got to the randomized
• 8:28
  Speaker 2: trial where you tested this in kids, you actually have
• 8:30
  Speaker 2: an earlier two thousand and eight paper which just compares
• 8:34
  Speaker 2: peanut allergy rates for kids in Israel and the UK.
• 8:37
  Speaker 2: It shows that allergen rates are lower in Israel, and
• 8:39
  Speaker 2: then you talk about peanuts next. I'm right that that's
• 8:42
  Speaker 2: your paper, right.
• 8:43
  Speaker 5: That is right, Yes, that's the Israel UK paper, And
• 8:46
  Speaker 5: that all came as a result of a lecture I
• 8:49
  Speaker 5: gave in Tel Aviv to a group of pediatricians and allergists.
• 8:55
  Speaker 5: Probably it must have been in the late nineteen nineties,
• 8:59
  Speaker 5: and they are to come and talk about peanut allergy
• 9:02
  Speaker 5: because with a lot more literature coming out in p
• 9:05
  Speaker 5: nut allergy in the UK specialist journals, particularly in the
• 9:10
  Speaker 5: US specialist journals, and they weren't seeing much in Israel,
• 9:15
  Speaker 5: but they wanted to be informed about it. So when
• 9:19
  Speaker 5: I gave this ection, there were about two hundred pediatricians.
• 9:22
  Speaker 5: I asked, how many of you have seen a case
• 9:24
  Speaker 5: of peanut allergy in the last year, and only two
• 9:27
  Speaker 5: or three in the audience put up their hand. Was
• 9:31
  Speaker 5: in the UK or US, My guess it would have
• 9:33
  Speaker 5: been one hundred percent virtually or close to that number.
• 9:37
  Speaker 5: And actually many of the specialists there had been trained
• 9:41
  Speaker 5: in the US, so don't I didn't think this was
• 9:44
  Speaker 5: an underdiagnosis or lack of recognition, and you know, not
• 9:49
  Speaker 5: wishing to belittle my specialty. Diagnosing p nut allergy isn't
• 9:53
  Speaker 5: that difficult. It's pretty obvious to the parent the first
• 9:57
  Speaker 5: time it happens. So I wondered, what what's going on here?
• 10:01
  Speaker 5: And then I spoke to the pediatricians and to some
• 10:05
  Speaker 5: friends who had babies, and they all told me they
• 10:07
  Speaker 5: were giving this snack called bumba, which contains peanut protein,
• 10:12
  Speaker 5: and it's a puff that babies start very early, at
• 10:16
  Speaker 5: about four months of age. It dissolves on the tongue,
• 10:19
  Speaker 5: and in fact the whole population eats it. And I
• 10:22
  Speaker 5: wondered a whether, first of all, there really is a
• 10:26
  Speaker 5: lower rate of peanut allergy in Israel compared to the UK,
• 10:30
  Speaker 5: and whether they really were eating peanuts to that extent.
• 10:33
  Speaker 5: We did a survey looking at five thousand babies in
• 10:39
  Speaker 5: Israel who would largely Jewish, and chose five thousand children
• 10:43
  Speaker 5: from Jewish day schools in the UK, comparing them so
• 10:47
  Speaker 5: that they would have similar ancestral origin and any differences
• 10:51
  Speaker 5: would be due to environment and behavior rather than genetics.
• 10:55
  Speaker 5: And indeed we found that we found that the rate
• 10:58
  Speaker 5: in the UK children was just over two percent, and
• 11:02
  Speaker 5: it was well below zero point two percent in the
• 11:07
  Speaker 5: Israeli babies. There was essentially a tenfold high rate in
• 11:13
  Speaker 5: the UK. We found the UK babies using questionnaires were
• 11:17
  Speaker 5: not eating peanuts. Actile median consumption was zero grams of
• 11:22
  Speaker 5: peanut per week in Israel on average, and the majority
• 11:27
  Speaker 5: of babies actually were eating two grams plus of peanut
• 11:31
  Speaker 5: protein per week, which is about two teaspoons of peanut
• 11:34
  Speaker 5: butter a week. But that was observational data and that
• 11:38
  Speaker 5: didn't prove anything.
• 11:40
  Speaker 2: But I mean, I will say what I absolutely love,
• 11:42
  Speaker 2: and I use this all the time as an example,
• 11:44
  Speaker 2: is like, that's observational data, and you could easily say
• 11:47
  Speaker 2: Israel UK differences in diagnoses. I mean, what makes this
• 11:51
  Speaker 2: so powerful, obviously, in such a great example of how
• 11:53
  Speaker 2: science evolves, is that you then did a trial, that
• 11:57
  Speaker 2: you did a randomized trial where you could be more
• 12:00
  Speaker 2: confident about the causality exactly.
• 12:03
  Speaker 5: And I'm delighted, and you know, very grateful that we
• 12:07
  Speaker 5: were funded by the NIH and other bodies for that.
• 12:11
  Speaker 5: I would say that we had been trying to get
• 12:14
  Speaker 5: funding for study like this for a while. We were
• 12:18
  Speaker 5: lucky to be able to do it because there was
• 12:20
  Speaker 5: such a strongly entrenched belief that exposing babies to peanuts
• 12:25
  Speaker 5: would be dangerous, that it was an obstacle. And you know,
• 12:28
  Speaker 5: we went through a lot of ethical discussions and view
• 12:31
  Speaker 5: committees as well as to whether this was the right
• 12:35
  Speaker 5: thing to do. But anyway, that study took off.
• 12:38
  Speaker 2: The study took off, and the effects are very large,
• 12:41
  Speaker 2: But I actually I think in some ways the study
• 12:43
  Speaker 2: is very easy to describe and the reductions are very big,
• 12:48
  Speaker 2: but it has not had I think, as much affect
• 12:52
  Speaker 2: as it should have on behavior. So I'm going to
• 12:55
  Speaker 2: read you a question which is sort of emblematic of
• 12:58
  Speaker 2: some of the questions that I get from people. So
• 13:02
  Speaker 2: this person asks, is there any flexibility regarding the recommendation
• 13:06
  Speaker 2: to introduce allergens at six months? I've been dragging my
• 13:09
  Speaker 2: feet on this because I'm worried my son will have
• 13:11
  Speaker 2: a reaction. I'm also worried that the dragging of the
• 13:13
  Speaker 2: feet will end up being the thing that causes the allergy.
• 13:16
  Speaker 1: Is there any wiggle room?
• 13:18
  Speaker 2: Is there a specific reason why the recommendation is to
• 13:21
  Speaker 2: do it when they're young? And this person isn't expressing
• 13:24
  Speaker 2: as much fear, although there's some anxiety, But people also
• 13:27
  Speaker 2: tell me just I'm afraid to do this. I want
• 13:29
  Speaker 2: to wait longer because I'm afraid even when they know
• 13:31
  Speaker 2: the recommendation, let alone not knowing. So I think the
• 13:34
  Speaker 2: first thing I want to talk about is what exactly
• 13:37
  Speaker 2: do you do in the trial. It's not just you
• 13:39
  Speaker 2: gave them one peanut at six months. It's a much
• 13:41
  Speaker 2: deeper thing than that. So can we just like for people,
• 13:43
  Speaker 2: tell them what is the treatment that is delivering the
• 13:46
  Speaker 2: results in the LEAP study?
• 13:49
  Speaker 5: Absolutely, I mean the although I like to think of
• 13:51
  Speaker 5: this not so much as a treatment but a behavior.
• 13:55
  Speaker 1: A lifestyle choice.
• 13:57
  Speaker 5: It's a life it's exactly, it's a lifestyle. Will to
• 14:00
  Speaker 5: demedicalize this, it's about basically eating the foods that are
• 14:06
  Speaker 5: eaten in your environment. Essentially, what we did in this
• 14:11
  Speaker 5: study was we took a high risk population by high
• 14:15
  Speaker 5: risk mean children with exama or egg galergy between four
• 14:19
  Speaker 5: to eleven months of age. We selected six hundred and
• 14:22
  Speaker 5: forty such children who had severe exzemin egg galergy. Why
• 14:26
  Speaker 5: because such children we estimated would have about a fifteen
• 14:31
  Speaker 5: percent risk of developing peanut allergy. Was the background risk
• 14:35
  Speaker 5: in the general population is two percent. So we took
• 14:39
  Speaker 5: a population where the disease was very likely to develop,
• 14:44
  Speaker 5: and we randomized six hundred and forty babies at that
• 14:48
  Speaker 5: age into either consumption of peanuts or avoidance of peanuts
• 14:54
  Speaker 5: all the way through until five years of age. So,
• 14:57
  Speaker 5: as you point out Emily. It was not just why peanut,
• 15:01
  Speaker 5: It was recurrent, consistent consumption of peanuts right from the
• 15:08
  Speaker 5: word go.
• 15:09
  Speaker 1: So what's the age you guys started at?
• 15:11
  Speaker 5: So we started between four and eleven months of age.
• 15:15
  Speaker 5: That is a really critical thing, and this is perhaps
• 15:19
  Speaker 5: whoever asked that question gets right to really the essence
• 15:23
  Speaker 5: of the problem here is their wiggle room, and disappointingly,
• 15:27
  Speaker 5: there isn't a lot of wiggle room, especially in the
• 15:31
  Speaker 5: high risk babies who have egzema. But what we showed
• 15:35
  Speaker 5: in the LEAP study was that those babies who continually
• 15:39
  Speaker 5: ate peanut, the majority till five years and the per
• 15:44
  Speaker 5: protocol definition, what we're meant to do was eat regularly
• 15:48
  Speaker 5: until two years of age, had a marked reduction in
• 15:52
  Speaker 5: peanut allergy. And these babies were eating six grams of
• 15:55
  Speaker 5: peanut protein per week, which is the equivalent of about
• 16:00
  Speaker 5: twenty to twenty five grams of peanut butter one to
• 16:03
  Speaker 5: two tablespoons or about sixty spoons of peanut butter a week.
• 16:09
  Speaker 5: And at the end of this five year study, we
• 16:13
  Speaker 5: compared the avoidant group with the consuming group, and we
• 16:17
  Speaker 5: found that the rate of peanut allergy in the children
• 16:23
  Speaker 5: who were avoiding was thirteen point seven percent, very close
• 16:27
  Speaker 5: to the fifteen percent we'd projected, and in the consuming
• 16:31
  Speaker 5: group it was one point nine percent, which represents about
• 16:35
  Speaker 5: an eighty six percent reduction in peanut allergy. But there's
• 16:40
  Speaker 5: a butt here is that there is so far, okay,
• 16:45
  Speaker 5: all good, so far, But seventy six babies out of
• 16:49
  Speaker 5: the eight hundred or so babies we evaluated, we enrolled
• 16:54
  Speaker 5: six hundred and forty seventy six were excluded because already
• 16:58
  Speaker 5: at baseline between four and eleven months of age, they
• 17:02
  Speaker 5: had peanut allergy. And we found that the majority of
• 17:06
  Speaker 5: these children had peanut allergy between the age of seven
• 17:11
  Speaker 5: and eleven months is when they developed it if you
• 17:14
  Speaker 5: looked on a month by month basis. And we actually
• 17:18
  Speaker 5: combined our LEAP data with another study, the EAT Study,
• 17:23
  Speaker 5: very similar designed to LEAP, but that was a low
• 17:25
  Speaker 5: risk population of one thousand, three hundred babies, and there
• 17:30
  Speaker 5: we recommend introducing peanuts between three and six months of age.
• 17:34
  Speaker 5: But the bottom line was when we did the modeling,
• 17:37
  Speaker 5: and even looking at the raw data without modeling, it
• 17:41
  Speaker 5: became eminently clear that after six seven months of age,
• 17:46
  Speaker 5: especially in babies with exzema. It was getting too late.
• 17:50
  Speaker 5: And if you had brought a baby into the study
• 17:54
  Speaker 5: at ten months of age, they already had about a
• 17:57
  Speaker 5: forty percent chance of having peanutsalogy and having to be excluded.
• 18:03
  Speaker 5: So especially if you're a high risk, there isn't much
• 18:06
  Speaker 5: wiggle room you've got into being really early.
• 18:10
  Speaker 2: So I think then the question people have when you
• 18:12
  Speaker 2: say not only did you intervene early, but also that
• 18:16
  Speaker 2: it's it's not I mean, two tablespoons of peanut butter
• 18:19
  Speaker 2: a week is not, you know, an unbelievable I certainly
• 18:21
  Speaker 2: eat far more than two tablespons of peanut butter a week,
• 18:24
  Speaker 2: but it's not you know, remembering to do it once.
• 18:28
  Speaker 2: It's just a food you should have in the rotation
• 18:29
  Speaker 2: for your kids, starting at a young age. And this
• 18:32
  Speaker 2: is where I think we get into the second piece
• 18:34
  Speaker 2: that holds some people back beyond the kind of the
• 18:37
  Speaker 2: information issues, the kind of I'm afraid issue. Then there's like,
• 18:42
  Speaker 2: well what do I give them? And so one answer
• 18:45
  Speaker 2: maybe bamba, you know, we should all be importing the
• 18:48
  Speaker 2: Israeli peanuts next.
• 18:50
  Speaker 1: But this is something you.
• 18:51
  Speaker 2: Have thought about, and you have thought about sort of
• 18:54
  Speaker 2: the questions of access and I think it's an interesting
• 18:56
  Speaker 2: one because I'm an economist. I think a lot about
• 18:58
  Speaker 2: the market and the ways in which sometimes the market
• 19:01
  Speaker 2: is underproviding what we need.
• 19:04
  Speaker 5: Yeah, absolutely so for years, and you know, behind this
• 19:09
  Speaker 5: picture too lie the World Health Organization recommendations that babies
• 19:14
  Speaker 5: should be exclusively breastfed for the first six months of life.
• 19:18
  Speaker 5: So with all of this together, there's been a belief
• 19:22
  Speaker 5: that babies shouldn't have any solids before six months of age. So,
• 19:27
  Speaker 5: not surprisingly, they're not many natural home recipes and they're
• 19:31
  Speaker 5: not many products on shelves that are geared towards giving
• 19:36
  Speaker 5: babies peanuts.
• 19:37
  Speaker 2: And indeed, to be clear, you cannot give a baby
• 19:41
  Speaker 2: just a peanut. Obviously they will choke, and giving them
• 19:44
  Speaker 2: peanut butter alone is actually not a super baby friendly food.
• 19:48
  Speaker 5: It can be mixed and diluted with puread food, but
• 19:52
  Speaker 5: that's a bit of work. Whole peanuts is an absolute
• 19:55
  Speaker 5: no no, because that's a major cause of choking and
• 20:00
  Speaker 5: and aspiration, like with any sort of small piece of
• 20:04
  Speaker 5: solid food at that age. And the remarkable success story
• 20:08
  Speaker 5: of the Israel puff was that it's a puff that
• 20:12
  Speaker 5: is readily apart from being nutritious and tasty. It dissolves
• 20:17
  Speaker 5: and is very easy for the baby as early as
• 20:20
  Speaker 5: four months to have it, especially if mixed with a
• 20:23
  Speaker 5: bit of water or milk. And in fact, it's really
• 20:26
  Speaker 5: interesting because you talk about what's happened to the industry since,
• 20:30
  Speaker 5: and there have been moves in the industry. So one
• 20:33
  Speaker 5: which I was asked to be involved, and I personally
• 20:36
  Speaker 5: don't like that direction was to medicalize this and create
• 20:42
  Speaker 5: formulae with or powders rather containing x amounts of peanut
• 20:49
  Speaker 5: other food allergens. Problem with that, as I said, is
• 20:53
  Speaker 5: it's medicalizing this. And again babies aren't going to drink
• 20:59
  Speaker 5: milk with formula with powder for the first few years
• 21:03
  Speaker 5: of life. They'll do it for a few months in transition.
• 21:07
  Speaker 5: So in fact, I against, you know what, my earlier beliefs,
• 21:12
  Speaker 5: I decided to become involved in this sort of venture
• 21:17
  Speaker 5: with some colleagues and we founded a company called Mission
• 21:21
  Speaker 5: Mighty Me. And in fact, although there isn't evidence for
• 21:25
  Speaker 5: other nuts, there is now moderate to high level evidence
• 21:29
  Speaker 5: that multi allergen introduction will prevent multiple food allergies. And
• 21:36
  Speaker 5: we've created puffs, dissolvable puffs that babies can as early
• 21:43
  Speaker 5: as four months start having either. I mean, that is
• 21:47
  Speaker 5: one way of doing it. It's proven to be highly
• 21:51
  Speaker 5: successful in Israel, and that's why we chose that. And
• 21:55
  Speaker 5: by the way, it should be said, Israeli babies are
• 21:58
  Speaker 5: not protected against food food allergies in general. They have
• 22:02
  Speaker 5: the same rates of milk and egg and other food
• 22:04
  Speaker 5: allergies as in the UK. So this really seems to
• 22:08
  Speaker 5: work well at a population level in Israel. And we
• 22:12
  Speaker 5: went down the puff roots, but the other ways that
• 22:14
  Speaker 5: can be done as well, pouches. As I said, I'm
• 22:18
  Speaker 5: not keen on tablets or powders or.
• 22:21
  Speaker 1: You know, like a mix in.
• 22:23
  Speaker 5: Well, well, the problem with the mix ins is there's
• 22:26
  Speaker 5: a few problems with that, Emily, one real, very real,
• 22:31
  Speaker 5: and the other theoretical. So the real problem with a
• 22:35
  Speaker 5: mix in and a powder is getting enough of the
• 22:38
  Speaker 5: food proteins in. And there have been products out there
• 22:42
  Speaker 5: that contain milligram quantities of peanut is we know that
• 22:48
  Speaker 5: you need gram quantities, and we've done modeling showing the
• 22:51
  Speaker 5: minimum you really require is two grams of peanut protein
• 22:55
  Speaker 5: two grams of egg white protein. So the powders usually
• 22:59
  Speaker 5: not all but usually contain lower amounts. My other concern
• 23:04
  Speaker 5: about the powder is that it comes in mixed with formula.
• 23:08
  Speaker 5: And I'm afraid you didn't want to get to the
• 23:11
  Speaker 5: dualalagen exposure hypothesis.
• 23:13
  Speaker 1: I do. I do.
• 23:14
  Speaker 5: Yeah, that sort of ties in because we believe in
• 23:17
  Speaker 5: there's strong evidence for that that babies develop peanut and
• 23:22
  Speaker 5: other food allergies through their skin. Why through their skins well,
• 23:26
  Speaker 5: in general, babies have a thinner skin, a less effective
• 23:30
  Speaker 5: skin barrier, and that is particularly the case in babies
• 23:34
  Speaker 5: who have exama or dry skin.
• 23:37
  Speaker 2: So I want to turn a little bit to something
• 23:39
  Speaker 2: else that we've talked about a bit, which for me
• 23:43
  Speaker 2: was some of the most surprising things I heard from you.
• 23:45
  Speaker 2: And we toashed on a little bit early on. We're
• 23:47
  Speaker 2: talking about your work in mice. But one of the
• 23:50
  Speaker 2: things that parents hear quite a lot and has come
• 23:53
  Speaker 2: up in this conversation is that allergies and ezema are linked.
• 23:56
  Speaker 2: If your child has eggzma, they're at a higher risk
• 23:58
  Speaker 2: of allergies. And that's just that's act is just true
• 24:01
  Speaker 2: in the data. There's a strong correlation there. And I
• 24:04
  Speaker 2: had always interpreted this as reflecting some underlying shared cause
• 24:08
  Speaker 2: that Basically, some people's immune system reacts differently to things,
• 24:12
  Speaker 2: and so it is it is that underlying cause that
• 24:15
  Speaker 2: is both the exzema and the allergies. But my sense
• 24:18
  Speaker 2: from you is that there's another school of thought that.
• 24:21
  Speaker 1: You think is correct.
• 24:22
  Speaker 2: Is effectively that the exzema is causing the allergies or
• 24:26
  Speaker 2: it's contributing to the allergies.
• 24:27
  Speaker 1: Is that the right way to say that? Or am
• 24:29
  Speaker 1: I getting that wrong?
• 24:30
  Speaker 5: Well, you're saying it absolutely the way I mean logically.
• 24:33
  Speaker 5: The three possibilities if two things are strongly associated. One
• 24:38
  Speaker 5: is there's an underlying shared cause, and I think to
• 24:41
  Speaker 5: some extent that is true for peanut energy and exzema,
• 24:46
  Speaker 5: or food energies and exzema. The other is that food
• 24:50
  Speaker 5: allergies cause exzema. And the third is that exzema causes
• 24:53
  Speaker 5: food allergies. And this is a perfect example where correlation
• 24:58
  Speaker 5: does not prove cause. Out we saw this very high
• 25:02
  Speaker 5: correlation in pediatrics amongst babies with eggzema and saw they
• 25:07
  Speaker 5: had food allergies, and we said, well, it must be
• 25:10
  Speaker 5: the food allergies. Thats causing their eggzema. Remove the milk,
• 25:13
  Speaker 5: remove the eggs, remove the peanuts, and that's the worst
• 25:17
  Speaker 5: thing you can do. Why Because it's the eggzema that
• 25:21
  Speaker 5: leads to the food allergies. And that's the second part
• 25:24
  Speaker 5: of the dual allergen exposure hypothesis. You can be exposed
• 25:28
  Speaker 5: to foods in two ways, one by eating it or
• 25:32
  Speaker 5: through the skin. If you've got ezema all over your cheeks,
• 25:36
  Speaker 5: you've got dry skin over your cheeks as an infant,
• 25:39
  Speaker 5: and foods get on that skin. Your parent has eaten
• 25:43
  Speaker 5: a peanut butter sandwich or had an on egg omelet
• 25:46
  Speaker 5: and touches your face, kisses your face. The baby is
• 25:50
  Speaker 5: exposed to foods through their skin from the parents' hands,
• 25:54
  Speaker 5: and those food molecules can penetrate the skin and be
• 25:58
  Speaker 5: taken up by are called antigen presenting cells under the skin.
• 26:03
  Speaker 5: And we know that we know already from house models
• 26:06
  Speaker 5: previously that if you're exposed to proteins through the skin,
• 26:10
  Speaker 5: especially an inflamed skin, that leads to an allergic type response.
• 26:15
  Speaker 5: And we believe that we don't have strong but we
• 26:18
  Speaker 5: have good reason to believe that from an evolutionary perspective.
• 26:22
  Speaker 5: That's because helminthic parasites would burrow their way through the
• 26:26
  Speaker 5: skin worms and that's a worm, absolutely, and the body
• 26:32
  Speaker 5: to reject it would mount ig allergic antibodies. So really
• 26:37
  Speaker 5: what this is is a rejection response. So we believe
• 26:42
  Speaker 5: that we misinterpreted this association to mean food allergies called exzema,
• 26:49
  Speaker 5: whereas I believe it's small and a lot of colleagues
• 26:52
  Speaker 5: believe now that exzema leads to food allergies. But as
• 26:56
  Speaker 5: you say, there may well be an underlying shared genetic
• 26:59
  Speaker 5: or other factors involved.
• 27:01
  Speaker 2: But I mean, it's an extremely interesting idea, and it
• 27:03
  Speaker 2: just to sort of recap in slightly more lay terms. Effectively,
• 27:08
  Speaker 2: the idea is that the allergens are going through the
• 27:10
  Speaker 2: through the window, and they should have gone through the door,
• 27:13
  Speaker 2: and when they come in through the window, there's a
• 27:16
  Speaker 2: response mounted and your body says, hey, this is something
• 27:19
  Speaker 2: we don't like.
• 27:20
  Speaker 1: This is a problematic entrant of some type.
• 27:23
  Speaker 2: And then when you see it again, even coming in
• 27:25
  Speaker 2: the right way, your body is already sensitized to.
• 27:28
  Speaker 5: This absolutely, And I like your window door analogy, only
• 27:32
  Speaker 5: I would flip the other way round. Okay, just if
• 27:35
  Speaker 5: you take a day to day scenario, someone knocks at
• 27:38
  Speaker 5: your front door and politely asks you directions or something.
• 27:42
  Speaker 5: You'll be civil to that person. But if that person
• 27:46
  Speaker 5: sort of knocks through your bedroom window and tries to
• 27:49
  Speaker 5: break into your house, that way, you'll you know, you
• 27:52
  Speaker 5: won't be quite as friendly in your greetings. And the
• 27:55
  Speaker 5: body is like that. It depends on the root of entry.
• 27:59
  Speaker 5: If it comes in through the mouth very early on,
• 28:02
  Speaker 5: well that must be a food. It must be a
• 28:04
  Speaker 5: good protein antigen, and we mount what's called a tolerogenic
• 28:10
  Speaker 5: response with the immune system goes in a direction that
• 28:14
  Speaker 5: will prevent the development of food anergies. If you're exposed
• 28:18
  Speaker 5: very early on through a broken down skin, the immune
• 28:22
  Speaker 5: system and the cell sitting in that skin issue out
• 28:25
  Speaker 5: an alarm. Hey there's an invader coming in. Let's mount
• 28:29
  Speaker 5: an allergic response to repel it.
• 28:31
  Speaker 2: So would you, I mean sort of taking the logical
• 28:34
  Speaker 2: step I think for parents, And I understand this is
• 28:38
  Speaker 2: still not something where we have large Randomez trial evidence,
• 28:41
  Speaker 2: and I want to talk about how we get that.
• 28:42
  Speaker 2: But say, if this is true, then one thing I
• 28:45
  Speaker 2: might conclude as a parent is that if I have
• 28:49
  Speaker 2: a baby with egzima and I did have two of those,
• 28:53
  Speaker 2: that the best way to prevent allergies is initially when
• 28:57
  Speaker 2: they are infants before they are having solid food, for
• 29:00
  Speaker 2: me to avoid allergens in my household and then to
• 29:06
  Speaker 2: introduce allergens to them more or less as soon as
• 29:09
  Speaker 2: is they are having solid food. So I avoid this
• 29:14
  Speaker 2: other alternative exposure approach.
• 29:17
  Speaker 5: Yes, I mean, and logically that makes sense. In countries
• 29:23
  Speaker 5: where peanuts are not consumed, you don't see peanut allergy.
• 29:27
  Speaker 5: So you could argue in households where peanuts and other
• 29:30
  Speaker 5: allergens are not consumed, you won't see those food allergies.
• 29:34
  Speaker 5: But bear in mind there's not just peanuts. There's eggs, milk, tree, nuts, sesame, weed, fish,
• 29:39
  Speaker 5: et cetera. And that would mean you'd need to avoid
• 29:42
  Speaker 5: all these foods in your household. And even so, it
• 29:45
  Speaker 5: wouldn't be a guarantee, first of all, because peanut is
• 29:49
  Speaker 5: a very tenacious, persistent protein that hangs around for long
• 29:53
  Speaker 5: periods of time. Secondly, there's going to be so called
• 29:58
  Speaker 5: contamination people who are eating peanut entering your home environment, friends, relatives.
• 30:05
  Speaker 5: So although it may be a strategy that.
• 30:08
  Speaker 1: Is it's a lot of work, very.
• 30:09
  Speaker 5: Difficult to put to the test. As you say, it's
• 30:11
  Speaker 5: a lot of work, it's a lot of work and
• 30:13
  Speaker 5: may not work in our view now myself and mine
• 30:18
  Speaker 5: and that of many got my colleagues, is introduce babies
• 30:21
  Speaker 5: to those foods much earlier on orally. And we do
• 30:26
  Speaker 5: believe that the oral root trumps the skin root. So
• 30:31
  Speaker 5: if a baby's exposed both through the skin where and
• 30:35
  Speaker 5: it takes tiny doses. This is the interesting thing. It
• 30:38
  Speaker 5: only takes tiny doses less than microgram doses to cause
• 30:43
  Speaker 5: the development of food allergy through the skin where is
• 30:46
  Speaker 5: to protect orally, you need gram doses. So get the
• 30:50
  Speaker 5: baby onto good amounts of these foods the same way
• 30:53
  Speaker 5: the rest of the family is eating them, and that
• 30:55
  Speaker 5: ought to protect against peanut and we believe other food
• 30:59
  Speaker 5: allergies as well well.
• 31:00
  Speaker 2: Are their efforts to test these sort of dual allergen
• 31:03
  Speaker 2: eggma hypotheses in randomized trials, so.
• 31:06
  Speaker 5: There's observational data. For example, we did a case controlled
• 31:11
  Speaker 5: study where we Adam Fox, colleague of mine when he
• 31:15
  Speaker 5: did his PhD thesis equivalent in the UK, looked at
• 31:20
  Speaker 5: environmental peanut consumption in the home and found there was
• 31:24
  Speaker 5: a strong association between that and the risk of developing
• 31:28
  Speaker 5: peanut allergy. It was almost like a dose response curve.
• 31:31
  Speaker 5: The more peanut there was around in these babies with
• 31:34
  Speaker 5: the higher chance of developing peanut allergy. But when, and
• 31:37
  Speaker 5: although this wasn't a randomized controlled study, when you looked
• 31:40
  Speaker 5: at the babies who'd eaten significant quantities of peanut early
• 31:45
  Speaker 5: on in the first year of life, that relationship was destroyed.
• 31:48
  Speaker 5: The line was flat, so you saw both oral versus
• 31:53
  Speaker 5: skin interacting. The same has been shown very interestingly for
• 31:58
  Speaker 5: people who like to win jewelry and can't afford the
• 32:02
  Speaker 5: very expensive jewelry. Nickel is a very common ingredient and
• 32:05
  Speaker 5: in many people that causes a form of exemer called
• 32:09
  Speaker 5: contact dermatitis, and we know especially there've been studies showing
• 32:15
  Speaker 5: that young girls and teenage girls who'd had their ears
• 32:19
  Speaker 5: pierced had a higher chance of developing allergies to nickel.
• 32:24
  Speaker 5: But if they had orthodontic braces in the mouth applied
• 32:29
  Speaker 5: several years before that contained nickel, they seem to be
• 32:33
  Speaker 5: almost completely protected against developing nickel allergy, which means a
• 32:37
  Speaker 5: beautiful non allergic example of the dual allergen exposure hypothesis.
• 32:44
  Speaker 5: But they've been studies that have been a bit disappointing
• 32:47
  Speaker 5: using emollients, so those are moisturizers essentially to try and
• 32:54
  Speaker 5: protect the skin barrier in babies with dry skin and exoma. Regrettably,
• 33:00
  Speaker 5: so far we have not seen a reduction in peanut allergy.
• 33:03
  Speaker 5: It may take more than that. But also the use
• 33:07
  Speaker 5: of topical steroids chatty reduce the inflammation that is already present,
• 33:12
  Speaker 5: so there is definitely an In fact, I'm involved in
• 33:16
  Speaker 5: a multi center study with my colleagues in the UK
• 33:20
  Speaker 5: and in the US called the Seals Study, where we
• 33:23
  Speaker 5: are taking very young babies in the first week's couple
• 33:26
  Speaker 5: of months of life at high risk who have already
• 33:31
  Speaker 5: very early onset exama or dry skin, and we are
• 33:35
  Speaker 5: regularly moisturizing them and as soon as they develop any
• 33:39
  Speaker 5: hint of redness of the skin the beginnings of inflammatory ezema,
• 33:43
  Speaker 5: we treat proactively with topical steroids. So that may be
• 33:47
  Speaker 5: an approach that is promising. There are some new, very
• 33:53
  Speaker 5: interesting new products today that are used the monoclone lantibodies
• 33:59
  Speaker 5: that are used to treat exzema now an asthma that
• 34:04
  Speaker 5: target the inflammatory pathway in the skin, in the immune
• 34:09
  Speaker 5: system that lead to exemer asthma and food allergies and
• 34:14
  Speaker 5: really very successfully we'll switch off exzema, and you are
• 34:20
  Speaker 5: one of the questions. These molecules seem to be very
• 34:23
  Speaker 5: safe if you gave them to high risk babies very
• 34:26
  Speaker 5: early on. Could you prevent peanut allergy by preventing the
• 34:30
  Speaker 5: development of ezema? So that's partway that remains, And actually
• 34:34
  Speaker 5: it's a part way I like because I spoke to
• 34:38
  Speaker 5: you about the food we've developed, and we have been
• 34:40
  Speaker 5: able to produce foods that contain five allergens five nuts,
• 34:45
  Speaker 5: including peanuts. But you still have a lot of foods
• 34:48
  Speaker 5: to consider sixteen potential allergens, and to eat all of
• 34:52
  Speaker 5: these insufficient amounts early enough in life to prevent all
• 34:57
  Speaker 5: these food aalergies maybe a challenge. And one way forward,
• 35:01
  Speaker 5: which would be really wonderful, would be just to prevent
• 35:04
  Speaker 5: the development of exzema, which is.
• 35:06
  Speaker 1: Also very unpleasant to begin with.
• 35:09
  Speaker 5: Yes, not a pleasant, so yeah, sleepless nights and everything.
• 35:14
  Speaker 5: So that based on the dual allergen exposure hypothis, you
• 35:17
  Speaker 5: can make a number of predictions. One is that oral
• 35:20
  Speaker 5: consumption will prevent food allergies.
• 35:23
  Speaker 2: That's the actionable I mean, I think if we had
• 35:25
  Speaker 2: to say, like, what's the actionable takeaway. I think that's
• 35:28
  Speaker 2: that is for parents. The actionable takeaway is really that
• 35:33
  Speaker 2: oral exposure in a consistent manner to these allergens, starting
• 35:39
  Speaker 2: as soon as you introduce foods, is the best way
• 35:43
  Speaker 2: we know to prevent allergens at the moment.
• 35:45
  Speaker 5: Yeah, and early on you'd ask me about putting my
• 35:49
  Speaker 5: concerns about putting powder in formula. I mentioned two concerns.
• 35:54
  Speaker 5: One is that there's not enough of the allergen getting
• 35:58
  Speaker 5: into the baby because it's difficult to put this in
• 36:02
  Speaker 5: a bout the film already mixed with milk, which but
• 36:06
  Speaker 5: the other is that exema occurs and dry skin occurs
• 36:11
  Speaker 5: mainly primarily initially on the cheeks of babies, and if
• 36:14
  Speaker 5: they are being exposed to low dose microgram or milligram
• 36:19
  Speaker 5: exposure through the skin, they're inflamed skin and they're not
• 36:23
  Speaker 5: having sufficient quantities going down the gastric intestinal room because
• 36:28
  Speaker 5: one of that face it milk does tend to spill,
• 36:30
  Speaker 5: as do all foods, but particularly milk and liquid on
• 36:34
  Speaker 5: the baby's cheek. There's a theoretical concern by giving low
• 36:38
  Speaker 5: dose allergen or foreign proteins that cause allergies through the
• 36:43
  Speaker 5: skin and not sufficient through the gut, as this is
• 36:46
  Speaker 5: a potential set up for paradoxically increasing food allergies. Of
• 36:51
  Speaker 5: course that remains to be broken and very difficult to
• 36:56
  Speaker 5: prove that is theory. But what we do know is
• 36:58
  Speaker 5: that low dose exposure through the skin does lead to food,
• 37:03
  Speaker 5: especially peanuts, allergies.
• 37:06
  Speaker 2: Okay, So here are a couple lightning round questions about
• 37:09
  Speaker 2: allergies that I've gotten from readers over the years. Allergens
• 37:13
  Speaker 2: and the exposure allergens through breast milk so and through pregnancy.
• 37:16
  Speaker 2: So I think a lot of a question we get
• 37:17
  Speaker 2: a lot from people is if I consume a lot
• 37:20
  Speaker 2: of some allergen peanuts, eggs, et cetera while I'm pregnant
• 37:25
  Speaker 2: or while I'm breastfeeding, is that going to make my
• 37:28
  Speaker 2: kid less likely to be allergic or likely to be allergic?
• 37:30
  Speaker 1: Does it not matter?
• 37:32
  Speaker 5: So people have looked at this, obviously not in a
• 37:34
  Speaker 5: randomized controlled trial, but observational studies go both ways. So
• 37:39
  Speaker 5: though some studies showing that mothers who eat more peanuts
• 37:43
  Speaker 5: while breastfeeding the babies are protected, others that show the
• 37:47
  Speaker 5: exact opposite. This study that I mentioned to you, where
• 37:50
  Speaker 5: we showed the dose response curve between environmental exposure, which
• 37:55
  Speaker 5: basically was based on total family consumption. Each family unit member,
• 38:01
  Speaker 5: we calculate the amount of peanut they were eating and
• 38:04
  Speaker 5: came up with a total family consumption and that was
• 38:09
  Speaker 5: the environmental exposure that the young babies had. And we
• 38:12
  Speaker 5: did find that maternal consumption of peanut during both pregnancy
• 38:18
  Speaker 5: and the breastfeeding period was slightly correlated with developing peanut allergy.
• 38:24
  Speaker 5: But when you put into a regression analysis where you
• 38:29
  Speaker 5: look at all the variables and you looked at family consumption,
• 38:34
  Speaker 5: family consumption trumped all and the association between maternal consumption
• 38:41
  Speaker 5: and the development of peanut allergy, that association disappeared. And
• 38:46
  Speaker 5: we believe that simply a mother eating a lot of
• 38:49
  Speaker 5: peanut while breastfeeding simply is a marker of the rest
• 38:53
  Speaker 5: of the family eating a lot of peanut. There happens
• 38:56
  Speaker 5: to be a lot of peanut butter in that household,
• 38:58
  Speaker 5: the family's eating it, and the baby has a higher risk. Again,
• 39:04
  Speaker 5: this is where it's so difficult, you know, when you've
• 39:07
  Speaker 5: got multiple possible causes making spurious or wrong wrong correlations.
• 39:14
  Speaker 2: Okay, second question, Let's imagine that my kid does develop
• 39:18
  Speaker 2: an allergy. Is that necessarily an allergy forever or do
• 39:23
  Speaker 2: allergies pass and does that differ across different allergens.
• 39:27
  Speaker 5: So egg and milk allergy go away in the majority
• 39:31
  Speaker 5: of babies, usually between one and three years of life,
• 39:37
  Speaker 5: but a not insignificant minority, about ten to twenty percent,
• 39:44
  Speaker 5: will have persistent egg and milk allergy. With peanuts, knots seeds,
• 39:51
  Speaker 5: we see the reverse. These food allergies develop very early
• 39:55
  Speaker 5: on but tend to persist later into adelaie essence and
• 40:01
  Speaker 5: young adulthood. No one has actually followed up people with
• 40:04
  Speaker 5: peanut allergy for fifty years, but we know that bar
• 40:08
  Speaker 5: the twenty to twenty five percent of children with peanut
• 40:12
  Speaker 5: allergy who outgrow it, because about a quarter a fifth
• 40:15
  Speaker 5: to a quarter will outgrow it, the vast majority will
• 40:18
  Speaker 5: have life long pe nut allergy. Same seems to apply
• 40:22
  Speaker 5: to tree, nuts and seeds. But that's one of the
• 40:25
  Speaker 5: reasons too, by the way, that pe nut and nuts
• 40:29
  Speaker 5: are such an important one group, because you want to
• 40:32
  Speaker 5: prevent You don't want something. Okay, if it's a problem
• 40:35
  Speaker 5: that's there for a year or two, you can live
• 40:38
  Speaker 5: with it, adapt to it. But if it's going to
• 40:40
  Speaker 5: be there for the duration of that person's life. It
• 40:43
  Speaker 5: becomes a huge burden and affects all sorts of things,
• 40:47
  Speaker 5: quality of life, et cetera.
• 40:54
  Speaker 2: This has been amazing. I feel like for me, this
• 40:56
  Speaker 2: is such a treat because I really am an enormous
• 40:59
  Speaker 2: fan of your work and I think it is such
• 41:03
  Speaker 2: a great example of how science evolves.
• 41:06
  Speaker 5: Well, it's been a pleasure talking to you, Emily. I'm
• 41:09
  Speaker 5: a big fan of your work, and you're good at
• 41:12
  Speaker 5: debunking a lot of science myths, so it was good
• 41:16
  Speaker 5: to talk to you.
• 41:16
  Speaker 1: It was great to talk to you. Thank you so much.
• 41:19
  Speaker 5: Bye bye.
• 41:26
  Speaker 2: Thank you again to doctor Gideon Lack for joining me
• 41:29
  Speaker 2: and for his tremendous work in this field. You can
• 41:32
  Speaker 2: read his paper on the Leap study, as well as
• 41:34
  Speaker 2: the American Academy and Pediatrics response to its recommendations, on
• 41:38
  Speaker 2: our episode website and in the show notes more apparent data,
• 41:42
  Speaker 2: including your own stories about introducing allergens after the break.
• 42:06
  Speaker 6: Hi, Emily, Hi, my name is Haley Goodwin.
• 42:09
  Speaker 7: This is Dana Johnson.
• 42:10
  Speaker 8: Hello, my name is Amy.
• 42:11
  Speaker 4: Timpy and this is a story about allergen introduction.
• 42:18
  Speaker 8: My story regarding allergens pertains to how different. The recommendations
• 42:24
  Speaker 8: can be depending on where you bring your child.
• 42:28
  Speaker 1: For pediatric visits.
• 42:29
  Speaker 7: When our first daughter turned six months old, I made
• 42:31
  Speaker 7: her a peanut butter, egg and banana pancake, just like
• 42:34
  Speaker 7: everyone else on Instagram, and of course she developed a
• 42:37
  Speaker 7: red rash around her face and my husband was like, darn,
• 42:40
  Speaker 7: guess she has an egg allergy. Continue on with the
• 42:43
  Speaker 7: peanut butter.
• 42:44
  Speaker 8: When my firstborn was an infant, we lived in a
• 42:49
  Speaker 8: university city. The pediatrician educated us on the risk for
• 42:54
  Speaker 8: allergies and at six months told us that my daughter
• 42:57
  Speaker 8: was moderate at risk and that she should begin introducing
• 43:00
  Speaker 8: peanut products.
• 43:01
  Speaker 7: Little did we know she also had peanut, walnut, and
• 43:04
  Speaker 7: pecan allergies, and so as we continue to introduce these nuts,
• 43:08
  Speaker 7: she continued to get this red rash, and so we
• 43:11
  Speaker 7: saw the allergist who was fairly out of date and
• 43:14
  Speaker 7: said no nuts of any type until she's five.
• 43:18
  Speaker 8: Flashed forward a few years and we moved to a
• 43:20
  Speaker 8: different city, and my second born, at her nine month visit,
• 43:26
  Speaker 8: was told not to introduce peanuts, eggs, or other allergens,
• 43:31
  Speaker 8: and when I told her, well, we've actually already introduced
• 43:35
  Speaker 8: them because she's moderate risk. She looked at me like
• 43:39
  Speaker 8: I was crazy. I then ended up informing the pediatrician
• 43:46
  Speaker 8: and she said that yes, it should have been corrected,
• 43:50
  Speaker 8: and that their binders the nurses were educating parents on
• 43:54
  Speaker 8: were outdated.
• 43:55
  Speaker 7: Thankfully, we chose not to follow that advice and sought
• 43:59
  Speaker 7: the advice of ad for an allergist who introduced us
• 44:02
  Speaker 7: to oral immunotherapy or OIT. We started OIT for our
• 44:07
  Speaker 7: daughter at two and a half and did weekly visits
• 44:10
  Speaker 7: to the allergists who lived about three hours away. And
• 44:14
  Speaker 7: now she is in first grade with no benadryl, no EpiPen.
• 44:19
  Speaker 7: She regularly eats peanuts freely and enjoys them. She still
• 44:24
  Speaker 7: doesn't like eggs, but she no longer is allergic to them.
• 44:30
  Speaker 4: So with my first super anxious BOUTE introducing allergens, and
• 44:35
  Speaker 4: I was.
• 44:35
  Speaker 6: Told, with eggs, mix it with breast milk. Boom, you're good.
• 44:40
  Speaker 4: So, you know, I hardboiled the egg, took the yolk,
• 44:43
  Speaker 4: mashed it up, mixed it with breast milk.
• 44:45
  Speaker 6: Baby loved it great. You know.
• 44:48
  Speaker 4: Then a month later have scrambled eggs again, and this
• 44:52
  Speaker 4: time we're at a park and his ears start swelling up,
• 44:56
  Speaker 4: and you know, I stopped feeding the egg right away,
• 44:59
  Speaker 4: realized it was an allergic reaction. But you know, book
• 45:03
  Speaker 4: an allergist appointment and find out that you know, the
• 45:06
  Speaker 4: actual allergen for.
• 45:07
  Speaker 6: Egg is usually in the whites, not the yoke.
• 45:12
  Speaker 4: So by introducing him to this yolk and breast milk,
• 45:17
  Speaker 4: which is what everyone says to do, I actually wasn't
• 45:20
  Speaker 4: exposing him to the allergen and didn't catch it. But anyways,
• 45:25
  Speaker 4: I always share that anecdote with people because I think
• 45:27
  Speaker 4: it's important to know where the allergen lies.
• 45:32
  Speaker 7: And that's our story of having an allergic reaction at
• 45:35
  Speaker 7: six months old.
• 45:36
  Speaker 6: Thanks for listening.
• 45:45
  Speaker 2: Thank you so much for sharing your stories with me.
• 45:48
  Speaker 2: Please keep an eye out for our calls for more
• 45:50
  Speaker 2: stories like these. Parent Data is produced by Tamar Avishai
• 45:54
  Speaker 2: with support from the parent Data team and pr Rex.
• 45:58
  Speaker 2: Also special thanks to our house violinist, my daughter Penelope.
• 46:01
  Speaker 4: No problem mom.
• 46:03
  Speaker 2: If you have thoughts on this episode, please join the
• 46:05
  Speaker 2: conversation on my Instagram at prof Emily Oster and if
• 46:09
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• 46:12
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• 46:15
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• 46:18
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• 46:41
  Speaker 6: Write Penelope, write Mom.
• 46:44
  Speaker 1: We'll see you next time.