WSJ article about the rise in peanut allergies

[SKL]

I found this article interesting.  Not sure if you can all access it.  If you trust my quick read, it basically says that after a focus on peanut allergies in the 1990s (when these existed but were rare and usually mild), UK pediatrician groups started recommending that kids under 3 not be given peanuts, and the US pediatrician groups followed suit.  Fast forward and the US and UK have extremely high rates of peanut allergies compared to countries where no similar precautions were taken.  The article ends with what I read as a warning against all-or-nothing health advice when we actually aren't sure what's best.

This policy has various results, from removing an affordable, palatable, and pro-environment source of protein from many diets to creating a need for expensive pharmaceuticals.  The beneficiaries of these policies are not the children, and especially not poor children.

I think some of these concerns extend beyond peanuts.

What do y'all think?

https://www.wsj.com/health/how-pediatricians-created-the-peanut-allergy-epidemic-952831c4?mod=hp_trending_now_article_pos3

Edited Friday at 02:20 PM by SKL

[marbel]

Is this it? This is supposedly an unlocked gifted article.  I say "supposedly" as I am a subscriber and have access to it, and I'm too lazy to log out and check it. 

https://www.wsj.com/health/how-pediatricians-created-the-peanut-allergy-epidemic-952831c4?st=mbU9dU&reflink=desktopwebshare_permalink

Edited Friday at 02:20 PM by marbel

[SKL]

1 minute ago, marbel said:

Is this it? This is supposedly an unlocked gifted article.  

https://www.wsj.com/health/how-pediatricians-created-the-peanut-allergy-epidemic-952831c4?st=mbU9dU&reflink=desktopwebshare_permalink

Yes, thanks.

[TheReader]

I know that a friend of mine, with much younger children than mine, said that between her 1st and 2nd kiddo (2nd kiddo is turning 5 or 6), her pediatrician said "you know, actually, we think it's better you go ahead and feed peanut butter early, because it seems like the removal of it has maybe contributed to the rise in peanut allergies...." 

So, the info is definitely out there & getting out there. 

[YaelAldrich]

It's interesting because in Israel they introduce Bamba, a peanut butter based puff laced with vitamins and minerals, to even very small children and infants as a first food. Peanut allergies are extremely rare in Israel. But sesame allergies are pretty high. But I don't think any medical people said to not feed children sesame early in life in Israel. My daughter has a peanut allergy that was desensitized by oral immunotherapy when she was 7 years old. Homeschooling helped because I needed a full day to take her to her appointment an almost 5-hour drive away. She was unresponsive to peanuts with rare exceptions until about 4 months ago. She had a pretty good reaction to eating peanuts and then taking a fast walk in the heat in the summertime. Admittedly, she had been slacking off on eating peanuts, which is required by the desensitization process. She is supposed to eat peanuts at least three or four times a week. She doesn't like them so it's harder for her to eat them. The allergic reaction scared her into restarting to eat peanuts more frequently. She just moved out of the house and is in Israel on a gap year program and she's got to figure out when she's got at least 2 hours of down time because you're not allowed to get hot, sweaty or raise your pulse very high when you've eaten your allergen.

[scholastica]

Well, in our case, that would have likely resulted in death for our oldest child. Born late 90s, allergic at birth to peanuts, dairy and eggs. Anaphylactic for nuts. Pediatrician actually referred for allergy testing when he was 9 months because of all the foods I had to avoid while breastfeeding. She rarely referred a child under 5. Confirmation at that time. With vigilance on our part, he outgrew the dairy and egg allergies. He will never outgrow the nuts. He is now 26 and just had his first ever airborne  reaction. Every situation is different.

[KSera]

18 minutes ago, YaelAldrich said:

It's interesting because in Israel they introduce Bamba, a peanut butter based puff laced with vitamins and minerals, to even very small children and infants as a first food.

This idea was introduced to me by a lactation consultant about 13 years ago. When I had my first kids, they had thought avoiding peanuts would be the best way, but I guess then they discovered there was actually no way to do so, so early exposure was better. That was well-known and advised by eight years ago and my youngest had peanut puff type products as an early food (meaning after six months, but before 12). 
 

i’m not sure what you’re (eta: sorry, meaning OP, @SKL) getting at with the other part of your question. I feel like you have something specific in mind. 

Edited Friday at 02:48 PM by KSera

[prairiewindmomma]

Our peanut allergy kid developed the allergy at 15 months, while still b-feeding from a peanut eating mom, and having had a few exposures to peanut butter at this point.

It is true that for some early low exposures make it less likely to develop reactions, and that our allergist does recommend now early exposure to peanut butter…..but also, our kids who had no exposure to peanut butter for years (peanut free house because of cross contamination risk) have not developed a peanut allergy now that they are exposed. 

Immune systems are weird and complex.

[KSera]

1 hour ago, KSera said:

i’m not sure what you’re (eta: sorry, meaning OP, @SKL) getting at with the other part of your question. I feel like you have something specific in mind. 

A different thread I just read here actually raised some examples that sounded like maybe the kind of thing you’re talking about? @Harriet Vane posted a link to this article about three medical practices that our thinking is changing on https://www.nytimes.com/2024/09/14/health/medical-practices-treatments-patients.html?unlocked_article_code=1.ME4.O2uR.bu9yi6ICogSZ&smid=nytcore-ios-share&referringSource=articleShare&sgrp=c-cb&ngrp=mnp (I thought I would be paywalled when I read it but perhaps she shared a gift gift link, so hopefully you can read it as well). In any case, I do think this happens pretty frequently in medicine where as they study more and learn more about some thing, they find certain treatments are not supported and maybe/hopefully they might discover better ones that are. It’s not uncommon to find out things they are doing in medicine aren’t just not helpful, but are actually harmful. This is more likely to happen with things that are not evidence based but just based on some notion of “common sense” someone had that turns out to not be valid. Childbirth practices are rife with this. Think episiotomy, shaving, enemas. Fortunately as things have become more evidence based, those things have increasingly been abandoned.
 

Edited Friday at 03:56 PM by KSera
Typos

[Carrie12345]

I’m not going to pretend to think there’s one answer for every instance, but I’ll share anecdotes.

My firstborn (1998) had a reaction (hives) to PB when he hit whatever the age was that we were told he could try it. Because we didn’t miss peanut butter at all, we actually FORGOT until #2 was a toddler and I handed them both pb&j sandwiches. That’s how much of a mush my brain was after having 2 and 3 back to back!

Anyway, he was fine and went on to eat peanut stuff to this day.

The two kids we know with the most severe anaphylactic allergies have both gone through exposure tests and passed as teens. (They still carry epis and we avoid peanuts around them, but the fear of accidental exposure is reduced.)

My #5 outgrew his MSPI, but not taking the proper precautions could have killed him as an infant. He was genuinely FTT when finally dx’ed.

I’m happy to go with the best science at the given time.

[wintermom]

I don't have the study to link, but I have heard some reports of early childhood exposure to farm animals being helpful to reduce allergies. This would be very interesting to explore, as perhaps you don't have to focus on just one or two very specific potential allergens. Rather, exposure to lots of different 'stuff on the farm' could have multiple positive affects. But how many city folks can get regular access to farm animals - and even then, what farm owners would allow strangers with little children access to their animals without risking law suits? Maybe research into what it is about being in contact with farm animals that may reduce allergies would be more useful. I'm all about somehow introducing more farm animals to a wider audience, though! Bring on the baby lambs! 😉 

 

[KSera]

4 minutes ago, wintermom said:

I don't have the study to link, but I have heard some reports of early childhood exposure to farm animals being helpful to reduce allergies. This would be very interesting to explore, as perhaps you don't have to focus on just one or two very specific potential allergens. Rather, exposure to lots of different 'stuff on the farm' could have multiple positive affects. But how many city folks can get regular access to farm animals - and even then, what farm owners would allow strangers with little children access to their animals without risking law suits? Maybe research into what it is about being in contact with farm animals that may reduce allergies would be more useful. I'm all about somehow introducing more farm animals to a wider audience, though! Bring on the baby lambs! 😉 

 

Just owning pets provides some of the same benefits. In general, not striving for a sterile (bacteria-wise) home environment. Playing outside in the dirt, etc.

[ikslo]

1 hour ago, scholastica said:

Well, in our case, that would have likely resulted in death for our oldest child. Born late 90s, allergic at birth to peanuts, dairy and eggs. Anaphylactic for nuts. Pediatrician actually referred for allergy testing when he was 9 months because of all the foods I had to avoid while breastfeeding. She rarely referred a child under 5. Confirmation at that time. With vigilance on our part, he outgrew the dairy and egg allergies. He will never outgrow the nuts. He is now 26 and just had his first ever airborne  reaction. Every situation is different.

Same. My DS had multiple allergies since birth. Would not have made a difference in our case.

[prairiewindmomma]

Farm life isnt a panacea either. I had to move off of the farm to breathe. I tested allergic to over 40 things despite growing up on a working farm, eating mostly organically from stuff we grew, and otherwise doing all of the “right” things. 
 

It’s kind of like our ped allergist who said, “Oh, with the severity of dd’s allergies, at least won’t ever get cancer. Her immune system is so robust!. “ (bad narrator voice: In fact, he was wrong. 3 months after this appointment, dd was diagnosed with terminal cancer)

Correlation and causation are two very different beasts. 

[Faith-manor]

The immune system is pretty complex and bizarre. While I can maybe see the value of introduction to PB early, it definitely is not a panacea. I have no evidence for this, but I suspect one factor is just how much we have in our environments now that children's immune systems must react to, ie. pollution and chemical sensitivity. Possibly we being in an immune state of constant hyperactivity could contribute. Of course, maybe not. I would like to see some research into this. Genetic factors too. So much is just simply coded into our DNA, and the mutations lurking in our bodies. 

[wintermom]

14 minutes ago, prairiewindmomma said:

Farm life isnt a panacea either. I had to move off of the farm to breathe. I tested allergic to over 40 things despite growing up on a working farm, eating mostly organically from stuff we grew, and otherwise doing all of the “right” things. 
 

It’s kind of like our ped allergist who said, “Oh, with the severity of dd’s allergies, at least won’t ever get cancer. Her immune system is so robust!. “ (bad narrator voice: In fact, he was wrong. 3 months after this appointment, dd was diagnosed with terminal cancer)

Correlation and causation are two very different beasts. 

So sorry about your dd. 😌

I hear ya with growing up with animals not necessarily being a deterant. I grew up with cats and dogs, and I'm allergic to cats and dogs. It's minor, though, and I still have cats and dogs. I grew up with trees, and am also allergic to a ton of trees. 

[historically accurate]

2 hours ago, KSera said:

A different thread I just read here actually raised some examples that sounded like maybe the kind of thing you’re talking about? @Harriet Vane posted a link to this article about three medical practices that our thinking is changing on https://www.nytimes.com/2024/09/14/health/medical-practices-treatments-patients.html?unlocked_article_code=1.ME4.O2uR.bu9yi6ICogSZ&smid=nytcore-ios-share&referringSource=articleShare&sgrp=c-cb&ngrp=mnp (I thought I would be paywalled when I read it but perhaps she shared a gift gift link, so hopefully you can read it as well). In any case, I do think this happens pretty frequently in medicine where as they study more and learn more about some thing, they find certain treatments are not supported and maybe/hopefully they might discover better ones that are. It’s not uncommon to find out things they are doing in medicine aren’t just not helpful, but are actually harmful. This is more likely to happen with things that are not evidence based but just based on some notion of “common sense” someone had that turns out to not be valid. Childbirth practices are rife with this. Think episiotomy, shaving, enemas. Fortunately as things have become more evidence based, those things have increasingly been abandoned.
 

We had to make our 19 yo dd wear her shoes on the wrong feet for years to correct in-toeing while walking. Very annoying as everywhere we went, people commented about her shoes. She still in-toes a little, and a recent doctor asked her about it. He chuckled when I said she wore her shoes wrong for years to correct it, and said, "We don't do that anymore; it can cause some serious foot problems." Fortunately, she doesn't have any foot problems due to it. 

[knitgrl]

I read an article online probably 12 years ago, so I will never be able to find it again. But the jist of it was that the American Pediatric Association came up with all those recommendations about allergens and infants, based on.....nothing. It just seemed like a good thing to do. And they thought it would probably help. But there were no studies that they used to come to these conclusions. Which is just wild, to say the least.

ETA - Maybe it was the American Academy of Pediatrics? Like I said, it was a long time ago.

Edited Friday at 06:04 PM by knitgrl

[kbutton]

1 hour ago, prairiewindmomma said:

Farm life isnt a panacea either. I had to move off of the farm to breathe. I tested allergic to over 40 things despite growing up on a working farm, eating mostly organically from stuff we grew, and otherwise doing all of the “right” things. 

Side comment…We had pets, and I was regularly exposed to farm animals. I developed “allergies” to just about everything but food as an adult and got shots, which helped. Then I started having food sensitivities and got diagnosed with MCAS. My MCAS allergist is a different doctor (my first one retired), and he said that testing positive for a ton of allergies at one time (especially as an adult) is a red flag for MCAS or another global problem.

And weirdly, my SIL who has some MCAS symptoms too, would test as allergic to “everything” even when she knew something wasn’t a problem! Her doctor switched to testing her for one thing at a time, and she didn’t react to nearly as many allergens.

I think we’re just scratching the surface (pun intended) on some of this stuff.

[Alice]

As a pediatrician I have some thoughts...

-There are tons of instances in medicine where we give advice based on the best knowledge at the time and then turn out to be wrong. The author is right that often the medical world gets entrenched in beliefs and doesn't want to change long held dogma. 

-I do think that there are a few misleading things in the article and a similar one from the NYT I was sent (I think he just wrote a book so is promoting it everywhere). Peanut allergies started to rise in the 90's. He makes it sound like they were rare, and they were rare but it was still an exponential rise. All kinds of alleriges/asthma rose. Here is a great article : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617537/ with some cool graphs showing the rise of allergies/asthma. We still don't really know why. This is important to underline....we really do not know why the increase and it is probably multifactorial and not one simple reason.  There are lots of hypotheses but to say "pediatricians caused the peanut allergy epidemic" is a bit of a click-bait headline. Did we contribute to it? Yes. But the advice to avoid peanuts came after the rise in allergies (which was not just a media fueled hysteria as he seems to imply). There wasn't evidence for why but it there was some early evidence that babies who delayed allergy exposure did not have as many allergies. I don't have the time to go back and find those articles but it was anecdotal and in retrospect incorrect, but it was the best thought at the time. 

-The advice to avoid early allergen exposure came out in 2000. In 2007-2008 there were reports that the delayed introduction seemed to be making things worse. At that time (2008)  the AAP came out with a statement saying that there was no evidence to support delaying introduction and that introducing allergens early might be beneficial. But there wasn't strong evidence for early introduction...this article makes it sound like Dr. Lack's article was conclusive. It was suggestive that early introduction was helpful based on a population based study in Israel. And it itself concluded by saying that. Most pediatricians I know (including my own practice) at that time started telling people exactly that "we don't really know but it seems to be that delaying is not helpful" and our recommendation was that when solids were introduced allergens could be given. 

-There was a very large study done (the LEAP study) that came out in 2015 that showed that there was strong evidence that early introduction was protective. The AAP followed up with recommendations reflecting that study and since that time the recommendation has been to introduce allergens, in particular peanuts early (between 4-6 months). 

-There is a difference between what an individual doctor recommends and what the AAP recommends. The AAP by design is a very large organization and it is going to make recommendations that are based on scientific evidence (the best available) and be slow to adopt new statements/policies. It also is more of a public-healthy/community based organization so it is going to make recommendations that might be the best for most people most of the time but not necessarily the best for a specific patient. An individual pediatrician can read the latest evidence and make changes more quickly and can tailor their advice to a specific patient. The best current example I have of this is the stupid sleep guidelines that the AAP puts out that are horrible. They might be based on the best population evidence to prevent SIDS but when I see individual patients who are struggling or who have individual needs...my advice often goes against the guidelines. But that's because I can have a conversation with an individual parent and explain the nuance. Big organizations putting out policy statements aren't really about nuance. 

[YaelAldrich]

4 hours ago, KSera said:

Just owning pets provides some of the same benefits. In general, not striving for a sterile (bacteria-wise) home environment. Playing outside in the dirt, etc.

My house ain't never been clean, much less sterile! 😉

My peanut allergic DD touched a OB covered knife when she was less than 6 months old and got hives all over her neck and torso. 

We are a ton of PB back in those days. The day we got the go ahead to bring PB back in the house during oral immunotherapy was a joyous day I tell you. 

[scholastica]

1 hour ago, Alice said:

As a pediatrician I have some thoughts...

-There are tons of instances in medicine where we give advice based on the best knowledge at the time and then turn out to be wrong. The author is right that often the medical world gets entrenched in beliefs and doesn't want to change long held dogma. 

-I do think that there are a few misleading things in the article and a similar one from the NYT I was sent (I think he just wrote a book so is promoting it everywhere). Peanut allergies started to rise in the 90's. He makes it sound like they were rare, and they were rare but it was still an exponential rise. All kinds of alleriges/asthma rose. Here is a great article : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617537/ with some cool graphs showing the rise of allergies/asthma. We still don't really know why. This is important to underline....we really do not know why the increase and it is probably multifactorial and not one simple reason.  There are lots of hypotheses but to say "pediatricians caused the peanut allergy epidemic" is a bit of a click-bait headline. Did we contribute to it? Yes. But the advice to avoid peanuts came after the rise in allergies (which was not just a media fueled hysteria as he seems to imply). There wasn't evidence for why but it there was some early evidence that babies who delayed allergy exposure did not have as many allergies. I don't have the time to go back and find those articles but it was anecdotal and in retrospect incorrect, but it was the best thought at the time. 

-The advice to avoid early allergen exposure came out in 2000. In 2007-2008 there were reports that the delayed introduction seemed to be making things worse. At that time (2008)  the AAP came out with a statement saying that there was no evidence to support delaying introduction and that introducing allergens early might be beneficial. But there wasn't strong evidence for early introduction...this article makes it sound like Dr. Lack's article was conclusive. It was suggestive that early introduction was helpful based on a population based study in Israel. And it itself concluded by saying that. Most pediatricians I know (including my own practice) at that time started telling people exactly that "we don't really know but it seems to be that delaying is not helpful" and our recommendation was that when solids were introduced allergens could be given. 

-There was a very large study done (the LEAP study) that came out in 2015 that showed that there was strong evidence that early introduction was protective. The AAP followed up with recommendations reflecting that study and since that time the recommendation has been to introduce allergens, in particular peanuts early (between 4-6 months). 

-There is a difference between what an individual doctor recommends and what the AAP recommends. The AAP by design is a very large organization and it is going to make recommendations that are based on scientific evidence (the best available) and be slow to adopt new statements/policies. It also is more of a public-healthy/community based organization so it is going to make recommendations that might be the best for most people most of the time but not necessarily the best for a specific patient. An individual pediatrician can read the latest evidence and make changes more quickly and can tailor their advice to a specific patient. The best current example I have of this is the stupid sleep guidelines that the AAP puts out that are horrible. They might be based on the best population evidence to prevent SIDS but when I see individual patients who are struggling or who have individual needs...my advice often goes against the guidelines. But that's because I can have a conversation with an individual parent and explain the nuance. Big organizations putting out policy statements aren't really about nuance. 

 

Thank you for your thoughts. This is helpful.

Do you as a pediatrician educate families on what an anaphylactic reaction would look like? I had no education about food allergies and anaphylaxis until my son was diagnosed. I don’t know that I would have known what was going on if he’d had one as a toddler. I hope this has changed and when doctors talk about introducing foods, they also educate about food allergies and what to watch for. 
 

 

[wathe]

2 hours ago, Alice said:

As a pediatrician I have some thoughts...

-There are tons of instances in medicine where we give advice based on the best knowledge at the time and then turn out to be wrong. The author is right that often the medical world gets entrenched in beliefs and doesn't want to change long held dogma. 

-I do think that there are a few misleading things in the article and a similar one from the NYT I was sent (I think he just wrote a book so is promoting it everywhere). Peanut allergies started to rise in the 90's. He makes it sound like they were rare, and they were rare but it was still an exponential rise. All kinds of alleriges/asthma rose. Here is a great article : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617537/ with some cool graphs showing the rise of allergies/asthma. We still don't really know why. This is important to underline....we really do not know why the increase and it is probably multifactorial and not one simple reason.  There are lots of hypotheses but to say "pediatricians caused the peanut allergy epidemic" is a bit of a click-bait headline. Did we contribute to it? Yes. But the advice to avoid peanuts came after the rise in allergies (which was not just a media fueled hysteria as he seems to imply). There wasn't evidence for why but it there was some early evidence that babies who delayed allergy exposure did not have as many allergies. I don't have the time to go back and find those articles but it was anecdotal and in retrospect incorrect, but it was the best thought at the time. 

-The advice to avoid early allergen exposure came out in 2000. In 2007-2008 there were reports that the delayed introduction seemed to be making things worse. At that time (2008)  the AAP came out with a statement saying that there was no evidence to support delaying introduction and that introducing allergens early might be beneficial. But there wasn't strong evidence for early introduction...this article makes it sound like Dr. Lack's article was conclusive. It was suggestive that early introduction was helpful based on a population based study in Israel. And it itself concluded by saying that. Most pediatricians I know (including my own practice) at that time started telling people exactly that "we don't really know but it seems to be that delaying is not helpful" and our recommendation was that when solids were introduced allergens could be given. 

-There was a very large study done (the LEAP study) that came out in 2015 that showed that there was strong evidence that early introduction was protective. The AAP followed up with recommendations reflecting that study and since that time the recommendation has been to introduce allergens, in particular peanuts early (between 4-6 months). 

-There is a difference between what an individual doctor recommends and what the AAP recommends. The AAP by design is a very large organization and it is going to make recommendations that are based on scientific evidence (the best available) and be slow to adopt new statements/policies. It also is more of a public-healthy/community based organization so it is going to make recommendations that might be the best for most people most of the time but not necessarily the best for a specific patient. An individual pediatrician can read the latest evidence and make changes more quickly and can tailor their advice to a specific patient. The best current example I have of this is the stupid sleep guidelines that the AAP puts out that are horrible. They might be based on the best population evidence to prevent SIDS but when I see individual patients who are struggling or who have individual needs...my advice often goes against the guidelines. But that's because I can have a conversation with an individual parent and explain the nuance. Big organizations putting out policy statements aren't really about nuance. 

That is how I remember it, also.

(And I clearly remember a shift locally  in 2009, reversing previous advice on allergen avoidance in infants.   That was the year that our allergist advised "early and often" allergen exposure for peanut, and cited this 2008 paper to support his advice.)

[prairiewindmomma]

I remember that timeline also.  I was advised to start taking my other children out of the house and feeding them peanut stuff in 2009. I was to feed them,  wash their hands thoroughly, check their clothes and make them drink a lot of water to wash away stuff in our mouth before coming home to our highly anaphylactic peanut allergy daughter.  I was to try to regularly eat peanuts as well so that the proteins would pass through my milk to my infant.

 

[Clarita]

What I was told when I had children is that at one point pediatricians/medical community were telling parents to delay nut introduction because some children had severe allergies to nuts and severe reactions to them. The delay was to try and avoid severe reactions during babydom. After having made that suggestion they discovered more kids became allergic to nuts. So now the recommendation is introduce early but be vigilant for reactions when you introduce, and this really goes for all foods (hence the one food introduction at a time). Some people are going to have severe allergy to certain things no matter what. 

I don't think they did us some sort of evil disservice or is there a lesson to really be learned for the future (aside from the obvious introduce nuts early but be vigilant lesson). Sometimes you just have to learn from your mistakes because the outcome is unforeseeable.  

[Spryte]

17 hours ago, prairiewindmomma said:

I remember that timeline also.  I was advised to start taking my other children out of the house and feeding them peanut stuff in 2009. I was to feed them,  wash their hands thoroughly, check their clothes and make them drink a lot of water to wash away stuff in our mouth before coming home to our highly anaphylactic peanut allergy daughter.  I was to try to regularly eat peanuts as well so that the proteins would pass through my milk to my infant.

 

This is what we were advised as well, same time line.

DS arrived on this planet with multiple severe allergies, way past peanut, and we knew within 14 days so this whole debate doesn’t apply to our allergy experience. His first exposures to lots of foods caused traumatic moments. But when the next kid arrived — around the time mentioned above — we followed the same advice, giving peanut out of the house, carefully.

(Of course, DD developed anaphylaxis to dairy very suddenly at 7 yrs old, after eating dairy every day of her life, so really — I can’t claim to understand allergies at all. She was our easy, non-allergic kid and it came out of the blue.)

I did once have a hairstylist tell me it’s all because I keep our house too clean. To my credit, I did not laugh hysterically, but yeh, between two dogs, a cat, and turtles, and me not being the best housekeeper — I can definitely say it wasn’t my perfect housekeeping that caused our kids’ allergies. We were regular visitors at a farm, but also did not have our newborn infant exposed to farm-whatever before two weeks old. In our case, DS’s allergies are probably genetic, but we don’t know his complete history.

 

[scholastica]

1 hour ago, Spryte said:

This is what we were advised as well, same time line.

DS arrived on this planet with multiple severe allergies, way past peanut, and we knew within 14 days so this whole debate doesn’t apply to our allergy experience. His first exposures to lots of foods caused traumatic moments. But when the next kid arrived — around the time mentioned above — we followed the same advice, giving peanut out of the house, carefully.

(Of course, DD developed anaphylaxis to dairy very suddenly at 7 yrs old, after eating dairy every day of her life, so really — I can’t claim to understand allergies at all. She was our easy, non-allergic kid and it came out of the blue.)

I did once have a hairstylist tell me it’s all because I keep our house too clean. To my credit, I did not laugh hysterically, but yeh, between two dogs, a cat, and turtles, and me not being the best housekeeper — I can definitely say it wasn’t my perfect housekeeping that caused our kids’ allergies. We were regular visitors at a farm, but also did not have our newborn infant exposed to farm-whatever before two weeks old. In our case, DS’s allergies are probably genetic, but we don’t know his complete history.

 

Our youngest hit seven and developed nut allergies, as well. Also out of the blue after consuming them without incident her whole life. 

[Brittany1116]

My dad was in his 20s when he developed a shellfish allergy seemingly overnight. ER trip for the same meal he ate weekly. Allergies are weird. 

 

I also seem to remember something about disparity in PB allergies among income levels. Kids who would qualify for WIC were less likely to be allergic because they were more likely to have early/repeat exposure? Can't recall when or where I read this. 

[Terabith]

Peanut butter has always been one of my "safe foods," and I had nightmares about having a kid with an allergy to peanuts.  My kids were born in 2003 and 2005, and frankly, I did NOT delay peanut introduction, even though it was recommended at the time, because I just couldn't find it in myself to keep peanut butter out of the house.  I mean, if I had had a kid with a peanut allergy, we'd have done it, but man, that would have been rough.  

However, we also ate a ton of salmon, and my oldest had some scary reactions (although at first we thought it was mango and not salmon) that involved more than two body systems, and nobody had educated us on anaphylaxis enough to know that that was what it was.  I dumped the kid in the bathtub to wash off anything that might be on their body and gave them a bunch of milk (because I knew they'd drink it) and gave them benadryl.  Eventually, I figured out that it was the salmon and not the mango and we stopped eating salmon at home (sigh - this is sad and because my youngest was never introduced to seafood, they hate it and the smell of it so even tho oldest is at college, we don't really get to eat it), but I still fed them tuna on the regular even tho oldest hated it.  It wasn't till I took them to an allergist for random rashes after playing outside, thinking it was a grass allergy, but allergist said it was a viral induced rash after a cold but while we were there said, "Oh?  They're allergic to salmon?  Let's do a skin prick test" that we found out that they were allergic to all fish, but salmon and perch were at anaphylaxis levels.  That was also the first time I learned what anaphylaxis really was.  I had thought it involved throat closing but didn't realize hives plus upset stomach could indicate it. 

But no, pediatricians didn't cause the rise in allergies.  They were going with what their best advice was based on the evidence at the time.  

[Happy2BaMom]

Well, I can't access the article, but the title deliberately feeds the 'lets-blame/not trust-physicians' mindset that is being deliberately cultivated in certain circles.

[SKL]

I guess the title could have been better.  I don't think the blame is on individual pediatricians, but on whoever provided a guideline without any scientific basis.

It seems to me that the better choice would have been to do a limited study with a control group and see if it supported a recommendation.  Instead, they essentially used a whole generation of US and UK babies to test their hypothesis, which turned out to be wrong - with big consequences.

I'm not a doctor, but if I were a pediatrician, I think I would assume that AAP guidelines were backed by more than just someone's thought that XYZ might help.

So how many other medical guidelines are like this?  Has this been fixed?  Should there be accountability?

 

[regentrude]

5 minutes ago, SKL said:

So how many other medical guidelines are like this?  Has this been fixed?  Should there be accountability?

Probably a huge number of medical guidelines are nothing more than best guesses. We know very little about how the human body works, and many studies merely indicate correlations, not causality (albeit there is a striking degree of conflating these two very different things). 

Medical advice, given to the best of that time's understanding, has constantly been changed based on new findings and understanding. 

How do you envision "accountability"? Who do you want to blame for not having perfect answers? Science is a method, not an infallible truth. Upon new evidence, ideas and approaches are corrected. In the absence of proven facts, medicine does the best it can with incomplete information and understanding. Who do you want to hold accountable for what?