Why Allergists Are Eating “Humble Pie”
In honor of our exhibit Allergy: Game On in The Studio at Wellbody Academy, we spoke with Dr. Kevin Dooms, an expert in allergy and pediatrics at Allergy & Asthma Associates in Bellevue. Dr. Dooms helped demystify a few aspects of this fast-changing field and explained how allergists’ earlier advice to keep babies away from peanuts might have led to more peanut allergies. Allergy: Game On is on display through June 2015.
Changing Advice: Feed Your Baby Peanut Butter?
Fifteen years ago, in an effort to stem the rising tide of childhood food allergies, food allergy experts advised many parents to delay feeding their babies foods high at risk for causing allergies (dairy, eggs, nuts and seafood, for example). Some foods were reserved until a year of age, and other not introduced until toddlers were 3 years old.
Trouble is, the doctors were following guidelines based on “expert consensus” — expert opinion rather than solid data, Dr. Dooms says. Over the years, their advice didn’t appear to affect the trend; rates of childhood food allergies continued to increase at an alarming rate.
However, a new trend is developing in the world of food allergy. Instead of keeping infants and toddlers away from high-risk foods, food allergy experts wonder if the exact opposite is true: deliberately expose babies to high-risk foods as a way of preventing allergies. Recently, a landmark study was published in the New England Journal of Medicine that found children in Israel had one-tenth the rate of peanut allergies compared to children in the United Kingdom. The reason? Babies in Israel commonly eat a popular peanut-coated snack food. (Visit The Studio in Wellbody Academy to see the peanut snack food that upended the allergy world.)
“Allergy experts may have inadvertently medicalized food, causing unnecessary fear and confusion for many families,” Dr. Dooms says. “Now, allergy experts can say what grandparents have been telling us all along: Feed the baby! It was a BIG step forward for the medical community to eat humble pie and admit we may have been wrong in our earlier recommendations. The change will help young children and families, and will hopefully reduce the rate of food allergy in coming years.”
(Children allergic to peanuts and other foods should continue to avoid those foods. Visit our allergy exhibit to learn how local researchers are desensitizing kids who have food allergies.)
The Hygiene Hypothesis: Ultra-Clean Lives Might Lead To Allergies
Children who grow up on farms appear to have fewer allergies. The same may also be true of children in developing countries. In America, about 15 million people suffer from food allergies, including life-threatening anaphylaxis.
Why is the rate of allergies in the developed world so much higher? A simplified explanation is that the immune system is bored, says Dr. Dooms. “Our lives may be too clean.” Since an underused immune system can’t find something appropriate to attack, it attacks inappropriate targets in the environment (like food or pollen) or it attacks the body itself (think of autoimmune diseases such as lupus and multiple sclerosis).
In some studies, patients who ingested parasitic helminth worms or helminth eggs reduced the severity of allergies and autoimmune diseases. The worms “acted like a chew toy for the immune system,” Dr. Dooms says, distracting the immune system from environmental or autoimmune targets.
The immune landscape is quite complex and could also involve pesticides, GMO foods, chemical pollutants, social problems and many other factors that are not fully understood, Dr. Dooms says. “We do know that something is happening in the developed world” that contributes to such high allergy rates.
EpiPens®: Don’t Be Afraid To Use Them
EpiPens and Auvi-Q are “auto-injectors” that dispense pre-measured dose of epinephrine to help stop life-threatening reactions to allergens. If your child has been diagnosed with a food allergy, they probably carry an EpiPen and keep one at school.
As an allergist, Dr. Dooms sees a lot of EpiPens get prescribed, but very few ever get used. He urges people with allergies not to be afraid of using their EpiPen because it could save their life.
Epinephrine is another name for adrenaline, a hormone naturally produced by the body. During an allergic reaction, a burst of epinephrine will help keep the heart pumping. It’s the first and same medicine emergency room doctors would use, Dr. Dooms says. Experience has shown it’s generally a safe medicine, he says, with few side effects beyond a faster heart rate and sometimes tremors that will soon go away.
The real risk, he says, is not using your EpiPen when you need it. “Experts agree the benefits of epinephrine far outweigh the risks of an unnecessary dose.”
Among children who have food allergies, those who are allergic to nuts and seafood are at highest risk for severe reaction. What’s tricky is that there’s not a way to predict the severity of the next reaction. Kids who had a few hives and upset stomach last year could have a life-threatening whole-body reaction when exposed to the same allergy again.
Here are some classic signs of a severe allergic reaction:
- Whole body hives and swelling
- Breathing problems like coughing or wheezing
- If you experience any of these, Dr. Dooms says, use your EpiPen and call 911!
Food allergy testing is not always 100% reliable, so it is important for an expert to interpret the results and make a correct diagnosis. For example, some children may have been diagnosed with a food allergy based on testing, but may not be allergic at all. Many children with a true food allergy will outgrow the problem over time, and should be retested.
If a child appears not to be allergic, or to have lost their allergy, they may be a candidate for an oral food challenge, which can be performed by a board-certified allergy specialist. Food challenges may give some patients the opportunity to “un-diagnose” a food allergy. No longer having a food allergy diagnosis can lead to significant improvements in a patient or family’s quality of life.