1 00:00:00,120 --> 00:00:01,080 Speaker 1: I'm Emily Astor. 2 00:00:01,680 --> 00:00:07,560 Speaker 2: This is parent data, and today we're talking about peanuts. 3 00:00:06,440 --> 00:00:08,360 Speaker 3: Just a sort of snack you could eat by the 4 00:00:08,400 --> 00:00:12,520 Speaker 3: handful watching the Super Bowl, unless, that is, you're one 5 00:00:12,560 --> 00:00:15,480 Speaker 3: of the many people for whom the peanut poses a 6 00:00:15,560 --> 00:00:17,200 Speaker 3: serious threat to your health. 7 00:00:17,239 --> 00:00:20,520 Speaker 4: Picking out a tea time snack an innocent treat for Emily, 8 00:00:20,720 --> 00:00:22,599 Speaker 4: but one that once terrified her mother. 9 00:00:22,760 --> 00:00:26,120 Speaker 1: When Sarah Kureshi's daughter Zara was just nine months old, 10 00:00:26,440 --> 00:00:29,240 Speaker 1: she discovered she had a deadly peanut allergy. 11 00:00:29,480 --> 00:00:32,120 Speaker 2: The first thing I thought was, my child is gonna die. 12 00:00:34,120 --> 00:00:38,520 Speaker 5: We were constantly stressed watching for everything she acted. 13 00:00:38,880 --> 00:00:40,760 Speaker 1: We needed to make sure that not even a trace 14 00:00:40,800 --> 00:00:41,560 Speaker 1: of peanuts. 15 00:00:41,800 --> 00:00:44,440 Speaker 2: My standard school lunch as a kid, sent by my 16 00:00:44,520 --> 00:00:48,600 Speaker 2: mother was whole weight bread with natural peanut. 17 00:00:48,360 --> 00:00:48,919 Speaker 5: Butter on it. 18 00:00:49,520 --> 00:00:53,440 Speaker 2: No jam I swore when I was a parent that 19 00:00:53,520 --> 00:00:56,480 Speaker 2: I would give my kid jiff because the natural peanut 20 00:00:56,520 --> 00:01:00,280 Speaker 2: butter that I was served came in chunks. It became 21 00:01:00,280 --> 00:01:03,800 Speaker 2: an adult, two things happened. First, I immediately started using 22 00:01:03,840 --> 00:01:06,120 Speaker 2: natural peanut butter because in fact, of course, my mother 23 00:01:06,200 --> 00:01:11,120 Speaker 2: was right. And second, I actually couldn't use peanut butter 24 00:01:11,200 --> 00:01:12,399 Speaker 2: for my kids' school lunches. 25 00:01:13,680 --> 00:01:14,960 Speaker 1: That was true for two reasons. 26 00:01:15,640 --> 00:01:18,679 Speaker 2: One is an appropriately heightened sense of caution and respect 27 00:01:18,680 --> 00:01:21,840 Speaker 2: for kids with allergies, but the other is a substantial 28 00:01:21,840 --> 00:01:27,440 Speaker 2: increase in allergies among kids over time. Somewhere along the way, 29 00:01:27,920 --> 00:01:32,480 Speaker 2: along with these school restrictions, we also introduced cautions about 30 00:01:32,800 --> 00:01:36,360 Speaker 2: when kids could first have allergens. When my daughter was born, 31 00:01:36,440 --> 00:01:40,320 Speaker 2: I was told no peanut products until one, and it 32 00:01:40,400 --> 00:01:41,200 Speaker 2: turns out. 33 00:01:41,240 --> 00:01:42,880 Speaker 1: That this was precisely wrong. 34 00:01:44,080 --> 00:01:48,320 Speaker 2: It wasn't just not necessary, it was actually really harmful. 35 00:01:50,520 --> 00:01:54,600 Speaker 2: As we'll talk about today, randomized trial evidence conveniently occurring 36 00:01:54,600 --> 00:01:58,000 Speaker 2: between my two kids actually showed that you need to 37 00:01:58,000 --> 00:02:03,640 Speaker 2: give kids allergens early to prevent allergies. When I wrote Cripsheet, 38 00:02:03,760 --> 00:02:07,320 Speaker 2: my book about early parenting, people often ask me in interviews, 39 00:02:07,480 --> 00:02:09,240 Speaker 2: what is the one piece of advice you would give 40 00:02:09,280 --> 00:02:11,919 Speaker 2: to parents. The one piece of advice that I always 41 00:02:11,960 --> 00:02:14,800 Speaker 2: say is introduce allergens early. It's one of the few 42 00:02:14,840 --> 00:02:19,440 Speaker 2: things where we have concrete and actionable evidence about the 43 00:02:19,720 --> 00:02:23,560 Speaker 2: quote right thing to do. And one really big reason 44 00:02:23,600 --> 00:02:27,480 Speaker 2: for this is today's guest, doctor Gideon Lack, who actually 45 00:02:27,560 --> 00:02:32,520 Speaker 2: ran the trial that evaluated early introduction of peanuts. I 46 00:02:32,560 --> 00:02:34,919 Speaker 2: have wanted to talk to doctor Lac since I read 47 00:02:34,919 --> 00:02:37,880 Speaker 2: this paper, and I'm delighted to do so. Today we 48 00:02:38,000 --> 00:02:41,440 Speaker 2: talk about the trial, but also about the science of allergies, 49 00:02:41,720 --> 00:02:44,360 Speaker 2: and we get into some real practical advice about what 50 00:02:44,440 --> 00:02:48,919 Speaker 2: to do with peanuts and your baby. After the break, 51 00:02:49,320 --> 00:02:57,760 Speaker 2: Doctor Gideon Lack, Welcome Gideon. Thank you so much for 52 00:02:57,840 --> 00:03:00,680 Speaker 2: joining me. I'd love it if you could just interduce yourself. 53 00:03:00,760 --> 00:03:03,800 Speaker 2: Tell us where you are today and what your job is. 54 00:03:04,880 --> 00:03:07,360 Speaker 5: My name is Gideon Lack. It's a pleasure to be 55 00:03:07,440 --> 00:03:12,600 Speaker 5: on this program. I'm a professor pediatric allergy and immunology. 56 00:03:13,440 --> 00:03:17,000 Speaker 5: My main area of interest is food allergies. I work 57 00:03:17,040 --> 00:03:20,720 Speaker 5: at King's College, London. I happen to be on vacation 58 00:03:20,840 --> 00:03:22,840 Speaker 5: in the mountains. 59 00:03:23,160 --> 00:03:25,400 Speaker 1: You have a very nice backdrop for this podcast. 60 00:03:27,080 --> 00:03:27,440 Speaker 6: Thank you. 61 00:03:27,600 --> 00:03:27,720 Speaker 3: So. 62 00:03:28,080 --> 00:03:31,080 Speaker 2: My first introduction to you is through the Leap Study, 63 00:03:31,680 --> 00:03:35,440 Speaker 2: which is a study about peanut allergies in particular, and 64 00:03:35,680 --> 00:03:37,560 Speaker 2: just to like set the stage for people who are 65 00:03:37,600 --> 00:03:42,640 Speaker 2: not pediatric allergy experts, peanuts are a very common allergen 66 00:03:42,920 --> 00:03:45,360 Speaker 2: and for many years. And I will say I have 67 00:03:45,400 --> 00:03:47,640 Speaker 2: a twelve year old and an eight year old, so 68 00:03:47,760 --> 00:03:51,280 Speaker 2: with my first child born in twenty eleven, I got 69 00:03:51,520 --> 00:03:54,880 Speaker 2: the advice that I should avoid giving my kid peanuts 70 00:03:54,960 --> 00:03:59,240 Speaker 2: until she was at least one, possibly even two. What 71 00:03:59,320 --> 00:04:01,600 Speaker 2: you show is in the Leap study is that this 72 00:04:01,680 --> 00:04:05,560 Speaker 2: is literally the opposite of the correct advice. And in 73 00:04:05,600 --> 00:04:09,080 Speaker 2: this paper there's a large ranomized trial with kids who 74 00:04:09,080 --> 00:04:12,560 Speaker 2: are relatively high risk of allergies and shows that exposing 75 00:04:12,600 --> 00:04:15,839 Speaker 2: them to peanuts at four months actually made them much 76 00:04:15,920 --> 00:04:19,600 Speaker 2: less likely, much much less likely to develop a peanut allergy. 77 00:04:20,279 --> 00:04:21,960 Speaker 2: So the result of this, and we're going to talk 78 00:04:22,000 --> 00:04:25,320 Speaker 2: about the shifts in recommendations and the smaller ships perhaps 79 00:04:25,320 --> 00:04:27,440 Speaker 2: in what people are actually doing and how parents should 80 00:04:27,480 --> 00:04:30,440 Speaker 2: operationalize this. But I actually want to start by asking 81 00:04:30,480 --> 00:04:33,919 Speaker 2: you where this idea came from, Because when I wrote 82 00:04:34,080 --> 00:04:36,000 Speaker 2: crib sheet and I wrote about this study, I had 83 00:04:36,000 --> 00:04:38,280 Speaker 2: a whole story about where you had come up with 84 00:04:38,320 --> 00:04:38,839 Speaker 2: this idea. 85 00:04:39,279 --> 00:04:40,440 Speaker 1: And I'm not going to tell you what it is, 86 00:04:40,480 --> 00:04:42,279 Speaker 1: because I'm sure it's not right. But can you tell 87 00:04:42,320 --> 00:04:44,120 Speaker 1: me how you came up with this idea? 88 00:04:45,120 --> 00:04:49,200 Speaker 5: Absolutely, Emily, So, as you say, for many decades and 89 00:04:49,240 --> 00:04:53,719 Speaker 5: for long periods of time, while food allergies became prevalent, 90 00:04:54,240 --> 00:04:59,680 Speaker 5: we mistakenly believed that eating peanuts was the cause of 91 00:04:59,720 --> 00:05:03,840 Speaker 5: divis peanut allergy, and that was a sort of intuitive 92 00:05:03,880 --> 00:05:06,680 Speaker 5: belief in terms of cause and effect. You give a 93 00:05:06,720 --> 00:05:11,320 Speaker 5: baby peanuts, the baby has peanut allergy, they develop hives. Therefore, 94 00:05:11,360 --> 00:05:14,640 Speaker 5: by virtue of giving the baby the peanut, you must 95 00:05:14,680 --> 00:05:18,240 Speaker 5: have caused the problem. That's a bit though as simplistic 96 00:05:18,279 --> 00:05:23,240 Speaker 5: as saying that exercise causes angina or heart pain and 97 00:05:23,360 --> 00:05:28,039 Speaker 5: coronary artery disease. Therefore, exercise causes heart disease, therefore we 98 00:05:28,040 --> 00:05:31,520 Speaker 5: shouldn't exercise. And there was that sort of paradox that 99 00:05:31,839 --> 00:05:36,279 Speaker 5: was going on. And while I trained in the nineties 100 00:05:37,360 --> 00:05:42,000 Speaker 5: in Denver at National Jewish Pediatric Allergy, I was working 101 00:05:42,040 --> 00:05:46,599 Speaker 5: on mouse models, and it was very apparent that in mice, 102 00:05:46,680 --> 00:05:50,800 Speaker 5: in order to provoke allergic responses to foods, they had 103 00:05:50,839 --> 00:05:54,760 Speaker 5: to be exposed through a braided skin or inflamed skin. 104 00:05:55,360 --> 00:05:58,120 Speaker 5: And the most interesting thing to me at the time, 105 00:05:58,200 --> 00:06:02,920 Speaker 5: and I remember asking my teachers this was that if 106 00:06:02,960 --> 00:06:07,719 Speaker 5: you've fed a young mice pop, peanut, or egg or 107 00:06:08,600 --> 00:06:12,039 Speaker 5: milk protein by gavage very early on in life, in 108 00:06:12,120 --> 00:06:17,320 Speaker 5: high amounts, it was almost impossible to artificially cause the 109 00:06:17,360 --> 00:06:20,680 Speaker 5: development of food allergy in that mouse. And in fact, 110 00:06:20,760 --> 00:06:25,160 Speaker 5: that is a long, long, well known phenomenon called oral 111 00:06:25,240 --> 00:06:28,800 Speaker 5: tolerance induction that people have known about going back to 112 00:06:28,880 --> 00:06:33,279 Speaker 5: the beginning of the twentieth century. Actually HG. Wells, the author, 113 00:06:33,320 --> 00:06:37,200 Speaker 5: actually wrote about this using animal models. He was a scientist, 114 00:06:37,680 --> 00:06:41,680 Speaker 5: and we've known about this for decades and decades, And 115 00:06:42,120 --> 00:06:45,080 Speaker 5: simultaneously to all of this we were saying, well, let's 116 00:06:45,120 --> 00:06:51,360 Speaker 5: avoid allergenic foods and babies to prevent the development of 117 00:06:51,400 --> 00:06:54,479 Speaker 5: food allergies, where in fact we believed it should have 118 00:06:54,480 --> 00:06:55,440 Speaker 5: been the opposite. 119 00:06:55,640 --> 00:06:58,920 Speaker 2: It's interesting because so much in science, so often I 120 00:06:58,960 --> 00:07:02,120 Speaker 2: see people say, have some result in mice, it must 121 00:07:02,120 --> 00:07:04,400 Speaker 2: also be true in people. But it sounds like here 122 00:07:04,600 --> 00:07:06,800 Speaker 2: was we have some result in mice, but we think 123 00:07:06,839 --> 00:07:08,200 Speaker 2: the opposite is true in people. 124 00:07:09,560 --> 00:07:14,600 Speaker 5: Exactly. But of course these animal models were not developed 125 00:07:15,040 --> 00:07:20,080 Speaker 5: with a view to testing food allergy. The observations that 126 00:07:19,080 --> 00:07:23,440 Speaker 5: were made it actually applies in a variety in a 127 00:07:23,520 --> 00:07:27,120 Speaker 5: number of diseases. But yes, I mean, not all that 128 00:07:27,240 --> 00:07:31,360 Speaker 5: happens in mice happens in humans. But here is a 129 00:07:31,400 --> 00:07:34,280 Speaker 5: good example. You are, You're absolutely right, But even in mice, 130 00:07:34,320 --> 00:07:37,960 Speaker 5: a critical thing is that it had to be early, right, 131 00:07:38,240 --> 00:07:42,120 Speaker 5: And we had this idea for a long period of 132 00:07:42,160 --> 00:07:45,680 Speaker 5: time that we could sort of wrap up babies in 133 00:07:45,760 --> 00:07:51,640 Speaker 5: an immunological cocoon, avoid exposure to peanut proteins and to 134 00:07:51,720 --> 00:07:56,040 Speaker 5: other food proteins, and let the baby's immune system mature 135 00:07:56,240 --> 00:08:00,320 Speaker 5: to one two three years of age. The American I mean, 136 00:08:00,360 --> 00:08:02,920 Speaker 5: pediatric guidelines used to be avoid p nuts still three 137 00:08:03,000 --> 00:08:05,600 Speaker 5: years of age. That will change in two thousand and eight. 138 00:08:06,120 --> 00:08:09,280 Speaker 5: And this idea was that by protecting that baby during 139 00:08:09,320 --> 00:08:13,440 Speaker 5: its early formation, the formation development of its immune system, 140 00:08:13,880 --> 00:08:18,320 Speaker 5: you would be protecting against panut allergy. And of course 141 00:08:18,520 --> 00:08:21,400 Speaker 5: that's not the case, and personally I believe that's a 142 00:08:21,480 --> 00:08:24,720 Speaker 5: reason for the increase in food allergies. 143 00:08:24,440 --> 00:08:25,400 Speaker 1: That seems likely to meet. 144 00:08:25,520 --> 00:08:28,480 Speaker 2: So you have, before you even got to the randomized 145 00:08:28,520 --> 00:08:30,480 Speaker 2: trial where you tested this in kids, you actually have 146 00:08:30,480 --> 00:08:33,760 Speaker 2: an earlier two thousand and eight paper which just compares 147 00:08:34,160 --> 00:08:36,880 Speaker 2: peanut allergy rates for kids in Israel and the UK. 148 00:08:37,679 --> 00:08:39,920 Speaker 2: It shows that allergen rates are lower in Israel, and 149 00:08:39,960 --> 00:08:42,439 Speaker 2: then you talk about peanuts next. I'm right that that's 150 00:08:42,480 --> 00:08:43,319 Speaker 2: your paper, right. 151 00:08:43,679 --> 00:08:46,520 Speaker 5: That is right, Yes, that's the Israel UK paper, And 152 00:08:46,559 --> 00:08:49,480 Speaker 5: that all came as a result of a lecture I 153 00:08:49,600 --> 00:08:55,280 Speaker 5: gave in Tel Aviv to a group of pediatricians and allergists. 154 00:08:55,679 --> 00:08:58,640 Speaker 5: Probably it must have been in the late nineteen nineties, 155 00:08:59,280 --> 00:09:02,120 Speaker 5: and they are to come and talk about peanut allergy 156 00:09:02,480 --> 00:09:05,559 Speaker 5: because with a lot more literature coming out in p 157 00:09:05,720 --> 00:09:10,320 Speaker 5: nut allergy in the UK specialist journals, particularly in the 158 00:09:10,440 --> 00:09:15,520 Speaker 5: US specialist journals, and they weren't seeing much in Israel, 159 00:09:15,520 --> 00:09:19,080 Speaker 5: but they wanted to be informed about it. So when 160 00:09:19,080 --> 00:09:22,240 Speaker 5: I gave this ection, there were about two hundred pediatricians. 161 00:09:22,720 --> 00:09:24,440 Speaker 5: I asked, how many of you have seen a case 162 00:09:24,480 --> 00:09:27,800 Speaker 5: of peanut allergy in the last year, and only two 163 00:09:27,840 --> 00:09:30,960 Speaker 5: or three in the audience put up their hand. Was 164 00:09:31,320 --> 00:09:33,719 Speaker 5: in the UK or US, My guess it would have 165 00:09:33,720 --> 00:09:37,040 Speaker 5: been one hundred percent virtually or close to that number. 166 00:09:37,920 --> 00:09:41,160 Speaker 5: And actually many of the specialists there had been trained 167 00:09:41,160 --> 00:09:43,960 Speaker 5: in the US, so don't I didn't think this was 168 00:09:44,000 --> 00:09:48,719 Speaker 5: an underdiagnosis or lack of recognition, and you know, not 169 00:09:49,160 --> 00:09:53,439 Speaker 5: wishing to belittle my specialty. Diagnosing p nut allergy isn't 170 00:09:53,480 --> 00:09:57,000 Speaker 5: that difficult. It's pretty obvious to the parent the first 171 00:09:57,000 --> 00:10:01,000 Speaker 5: time it happens. So I wondered, what what's going on here? 172 00:10:01,480 --> 00:10:04,600 Speaker 5: And then I spoke to the pediatricians and to some 173 00:10:05,080 --> 00:10:07,280 Speaker 5: friends who had babies, and they all told me they 174 00:10:07,280 --> 00:10:12,520 Speaker 5: were giving this snack called bumba, which contains peanut protein, 175 00:10:12,840 --> 00:10:16,080 Speaker 5: and it's a puff that babies start very early, at 176 00:10:16,120 --> 00:10:18,640 Speaker 5: about four months of age. It dissolves on the tongue, 177 00:10:19,080 --> 00:10:22,560 Speaker 5: and in fact the whole population eats it. And I 178 00:10:22,679 --> 00:10:26,000 Speaker 5: wondered a whether, first of all, there really is a 179 00:10:26,040 --> 00:10:29,480 Speaker 5: lower rate of peanut allergy in Israel compared to the UK, 180 00:10:30,000 --> 00:10:32,760 Speaker 5: and whether they really were eating peanuts to that extent. 181 00:10:33,160 --> 00:10:37,880 Speaker 5: We did a survey looking at five thousand babies in 182 00:10:39,120 --> 00:10:43,760 Speaker 5: Israel who would largely Jewish, and chose five thousand children 183 00:10:43,760 --> 00:10:47,560 Speaker 5: from Jewish day schools in the UK, comparing them so 184 00:10:47,640 --> 00:10:51,360 Speaker 5: that they would have similar ancestral origin and any differences 185 00:10:51,480 --> 00:10:55,520 Speaker 5: would be due to environment and behavior rather than genetics. 186 00:10:55,800 --> 00:10:58,120 Speaker 5: And indeed we found that we found that the rate 187 00:10:58,400 --> 00:11:02,280 Speaker 5: in the UK children was just over two percent, and 188 00:11:02,960 --> 00:11:07,040 Speaker 5: it was well below zero point two percent in the 189 00:11:07,120 --> 00:11:13,200 Speaker 5: Israeli babies. There was essentially a tenfold high rate in 190 00:11:13,240 --> 00:11:17,720 Speaker 5: the UK. We found the UK babies using questionnaires were 191 00:11:17,720 --> 00:11:22,280 Speaker 5: not eating peanuts. Actile median consumption was zero grams of 192 00:11:22,360 --> 00:11:27,520 Speaker 5: peanut per week in Israel on average, and the majority 193 00:11:27,520 --> 00:11:31,520 Speaker 5: of babies actually were eating two grams plus of peanut 194 00:11:31,520 --> 00:11:34,760 Speaker 5: protein per week, which is about two teaspoons of peanut 195 00:11:34,840 --> 00:11:38,400 Speaker 5: butter a week. But that was observational data and that 196 00:11:38,679 --> 00:11:40,120 Speaker 5: didn't prove anything. 197 00:11:40,480 --> 00:11:42,640 Speaker 2: But I mean, I will say what I absolutely love, 198 00:11:42,679 --> 00:11:44,520 Speaker 2: and I use this all the time as an example, 199 00:11:44,640 --> 00:11:47,480 Speaker 2: is like, that's observational data, and you could easily say 200 00:11:47,600 --> 00:11:50,920 Speaker 2: Israel UK differences in diagnoses. I mean, what makes this 201 00:11:51,040 --> 00:11:53,520 Speaker 2: so powerful, obviously, in such a great example of how 202 00:11:53,559 --> 00:11:57,440 Speaker 2: science evolves, is that you then did a trial, that 203 00:11:57,480 --> 00:11:59,920 Speaker 2: you did a randomized trial where you could be more 204 00:12:00,040 --> 00:12:03,280 Speaker 2: confident about the causality exactly. 205 00:12:03,320 --> 00:12:07,480 Speaker 5: And I'm delighted, and you know, very grateful that we 206 00:12:07,480 --> 00:12:10,679 Speaker 5: were funded by the NIH and other bodies for that. 207 00:12:11,280 --> 00:12:14,400 Speaker 5: I would say that we had been trying to get 208 00:12:14,440 --> 00:12:18,079 Speaker 5: funding for study like this for a while. We were 209 00:12:18,120 --> 00:12:19,920 Speaker 5: lucky to be able to do it because there was 210 00:12:20,000 --> 00:12:25,439 Speaker 5: such a strongly entrenched belief that exposing babies to peanuts 211 00:12:25,440 --> 00:12:28,680 Speaker 5: would be dangerous, that it was an obstacle. And you know, 212 00:12:28,720 --> 00:12:31,800 Speaker 5: we went through a lot of ethical discussions and view 213 00:12:31,800 --> 00:12:34,760 Speaker 5: committees as well as to whether this was the right 214 00:12:35,040 --> 00:12:38,280 Speaker 5: thing to do. But anyway, that study took off. 215 00:12:38,640 --> 00:12:41,040 Speaker 2: The study took off, and the effects are very large, 216 00:12:41,360 --> 00:12:43,720 Speaker 2: But I actually I think in some ways the study 217 00:12:43,760 --> 00:12:47,720 Speaker 2: is very easy to describe and the reductions are very big, 218 00:12:48,160 --> 00:12:52,400 Speaker 2: but it has not had I think, as much affect 219 00:12:52,480 --> 00:12:55,520 Speaker 2: as it should have on behavior. So I'm going to 220 00:12:55,559 --> 00:12:58,920 Speaker 2: read you a question which is sort of emblematic of 221 00:12:58,960 --> 00:13:01,000 Speaker 2: some of the questions that I get from people. So 222 00:13:02,080 --> 00:13:06,040 Speaker 2: this person asks, is there any flexibility regarding the recommendation 223 00:13:06,120 --> 00:13:09,560 Speaker 2: to introduce allergens at six months? I've been dragging my 224 00:13:09,600 --> 00:13:11,480 Speaker 2: feet on this because I'm worried my son will have 225 00:13:11,559 --> 00:13:13,840 Speaker 2: a reaction. I'm also worried that the dragging of the 226 00:13:13,840 --> 00:13:16,280 Speaker 2: feet will end up being the thing that causes the allergy. 227 00:13:16,679 --> 00:13:18,280 Speaker 1: Is there any wiggle room? 228 00:13:18,480 --> 00:13:21,240 Speaker 2: Is there a specific reason why the recommendation is to 229 00:13:21,240 --> 00:13:24,000 Speaker 2: do it when they're young? And this person isn't expressing 230 00:13:24,000 --> 00:13:27,000 Speaker 2: as much fear, although there's some anxiety, But people also 231 00:13:27,080 --> 00:13:29,000 Speaker 2: tell me just I'm afraid to do this. I want 232 00:13:29,040 --> 00:13:31,400 Speaker 2: to wait longer because I'm afraid even when they know 233 00:13:31,520 --> 00:13:34,920 Speaker 2: the recommendation, let alone not knowing. So I think the 234 00:13:34,920 --> 00:13:37,160 Speaker 2: first thing I want to talk about is what exactly 235 00:13:37,200 --> 00:13:39,040 Speaker 2: do you do in the trial. It's not just you 236 00:13:39,080 --> 00:13:41,200 Speaker 2: gave them one peanut at six months. It's a much 237 00:13:41,240 --> 00:13:43,520 Speaker 2: deeper thing than that. So can we just like for people, 238 00:13:43,679 --> 00:13:46,680 Speaker 2: tell them what is the treatment that is delivering the 239 00:13:46,720 --> 00:13:48,040 Speaker 2: results in the LEAP study? 240 00:13:49,200 --> 00:13:51,920 Speaker 5: Absolutely, I mean the although I like to think of 241 00:13:51,960 --> 00:13:56,160 Speaker 5: this not so much as a treatment but a behavior. 242 00:13:55,840 --> 00:13:57,320 Speaker 1: A lifestyle choice. 243 00:13:57,640 --> 00:14:00,320 Speaker 5: It's a life it's exactly, it's a lifestyle. Will to 244 00:14:00,840 --> 00:14:06,840 Speaker 5: demedicalize this, it's about basically eating the foods that are 245 00:14:06,920 --> 00:14:10,920 Speaker 5: eaten in your environment. Essentially, what we did in this 246 00:14:11,080 --> 00:14:15,000 Speaker 5: study was we took a high risk population by high 247 00:14:15,080 --> 00:14:19,240 Speaker 5: risk mean children with exama or egg galergy between four 248 00:14:19,280 --> 00:14:22,560 Speaker 5: to eleven months of age. We selected six hundred and 249 00:14:22,600 --> 00:14:26,680 Speaker 5: forty such children who had severe exzemin egg galergy. Why 250 00:14:26,720 --> 00:14:31,280 Speaker 5: because such children we estimated would have about a fifteen 251 00:14:31,320 --> 00:14:35,880 Speaker 5: percent risk of developing peanut allergy. Was the background risk 252 00:14:35,920 --> 00:14:38,680 Speaker 5: in the general population is two percent. So we took 253 00:14:39,280 --> 00:14:43,400 Speaker 5: a population where the disease was very likely to develop, 254 00:14:44,160 --> 00:14:48,640 Speaker 5: and we randomized six hundred and forty babies at that 255 00:14:48,760 --> 00:14:54,440 Speaker 5: age into either consumption of peanuts or avoidance of peanuts 256 00:14:54,760 --> 00:14:57,680 Speaker 5: all the way through until five years of age. So, 257 00:14:57,800 --> 00:15:00,600 Speaker 5: as you point out Emily. It was not just why peanut, 258 00:15:01,200 --> 00:15:08,400 Speaker 5: It was recurrent, consistent consumption of peanuts right from the 259 00:15:08,440 --> 00:15:09,000 Speaker 5: word go. 260 00:15:09,400 --> 00:15:11,160 Speaker 1: So what's the age you guys started at? 261 00:15:11,280 --> 00:15:14,600 Speaker 5: So we started between four and eleven months of age. 262 00:15:15,360 --> 00:15:18,880 Speaker 5: That is a really critical thing, and this is perhaps 263 00:15:19,160 --> 00:15:22,960 Speaker 5: whoever asked that question gets right to really the essence 264 00:15:23,000 --> 00:15:27,240 Speaker 5: of the problem here is their wiggle room, and disappointingly, 265 00:15:27,880 --> 00:15:31,520 Speaker 5: there isn't a lot of wiggle room, especially in the 266 00:15:31,600 --> 00:15:34,960 Speaker 5: high risk babies who have egzema. But what we showed 267 00:15:35,000 --> 00:15:39,440 Speaker 5: in the LEAP study was that those babies who continually 268 00:15:39,600 --> 00:15:44,520 Speaker 5: ate peanut, the majority till five years and the per 269 00:15:44,560 --> 00:15:47,920 Speaker 5: protocol definition, what we're meant to do was eat regularly 270 00:15:48,040 --> 00:15:51,960 Speaker 5: until two years of age, had a marked reduction in 271 00:15:52,000 --> 00:15:55,840 Speaker 5: peanut allergy. And these babies were eating six grams of 272 00:15:55,880 --> 00:15:59,960 Speaker 5: peanut protein per week, which is the equivalent of about 273 00:16:00,360 --> 00:16:03,480 Speaker 5: twenty to twenty five grams of peanut butter one to 274 00:16:03,560 --> 00:16:08,600 Speaker 5: two tablespoons or about sixty spoons of peanut butter a week. 275 00:16:09,480 --> 00:16:12,760 Speaker 5: And at the end of this five year study, we 276 00:16:13,160 --> 00:16:17,720 Speaker 5: compared the avoidant group with the consuming group, and we 277 00:16:17,840 --> 00:16:23,680 Speaker 5: found that the rate of peanut allergy in the children 278 00:16:23,680 --> 00:16:27,640 Speaker 5: who were avoiding was thirteen point seven percent, very close 279 00:16:27,680 --> 00:16:31,480 Speaker 5: to the fifteen percent we'd projected, and in the consuming 280 00:16:31,520 --> 00:16:35,080 Speaker 5: group it was one point nine percent, which represents about 281 00:16:35,080 --> 00:16:40,640 Speaker 5: an eighty six percent reduction in peanut allergy. But there's 282 00:16:40,640 --> 00:16:44,440 Speaker 5: a butt here is that there is so far, okay, 283 00:16:45,560 --> 00:16:49,840 Speaker 5: all good, so far, But seventy six babies out of 284 00:16:49,880 --> 00:16:54,120 Speaker 5: the eight hundred or so babies we evaluated, we enrolled 285 00:16:54,120 --> 00:16:58,880 Speaker 5: six hundred and forty seventy six were excluded because already 286 00:16:58,960 --> 00:17:02,560 Speaker 5: at baseline between four and eleven months of age, they 287 00:17:02,680 --> 00:17:06,560 Speaker 5: had peanut allergy. And we found that the majority of 288 00:17:06,600 --> 00:17:11,240 Speaker 5: these children had peanut allergy between the age of seven 289 00:17:11,280 --> 00:17:14,199 Speaker 5: and eleven months is when they developed it if you 290 00:17:14,240 --> 00:17:18,440 Speaker 5: looked on a month by month basis. And we actually 291 00:17:18,480 --> 00:17:22,880 Speaker 5: combined our LEAP data with another study, the EAT Study, 292 00:17:23,320 --> 00:17:25,640 Speaker 5: very similar designed to LEAP, but that was a low 293 00:17:25,760 --> 00:17:30,440 Speaker 5: risk population of one thousand, three hundred babies, and there 294 00:17:30,480 --> 00:17:34,000 Speaker 5: we recommend introducing peanuts between three and six months of age. 295 00:17:34,520 --> 00:17:37,600 Speaker 5: But the bottom line was when we did the modeling, 296 00:17:37,760 --> 00:17:41,280 Speaker 5: and even looking at the raw data without modeling, it 297 00:17:41,359 --> 00:17:46,240 Speaker 5: became eminently clear that after six seven months of age, 298 00:17:46,440 --> 00:17:49,960 Speaker 5: especially in babies with exzema. It was getting too late. 299 00:17:50,560 --> 00:17:53,880 Speaker 5: And if you had brought a baby into the study 300 00:17:54,480 --> 00:17:57,879 Speaker 5: at ten months of age, they already had about a 301 00:17:57,920 --> 00:18:02,880 Speaker 5: forty percent chance of having peanutsalogy and having to be excluded. 302 00:18:03,480 --> 00:18:06,480 Speaker 5: So especially if you're a high risk, there isn't much 303 00:18:06,520 --> 00:18:09,119 Speaker 5: wiggle room you've got into being really early. 304 00:18:10,080 --> 00:18:12,840 Speaker 2: So I think then the question people have when you 305 00:18:12,880 --> 00:18:16,000 Speaker 2: say not only did you intervene early, but also that 306 00:18:16,080 --> 00:18:18,960 Speaker 2: it's it's not I mean, two tablespoons of peanut butter 307 00:18:19,000 --> 00:18:21,560 Speaker 2: a week is not, you know, an unbelievable I certainly 308 00:18:21,600 --> 00:18:23,840 Speaker 2: eat far more than two tablespons of peanut butter a week, 309 00:18:24,240 --> 00:18:27,880 Speaker 2: but it's not you know, remembering to do it once. 310 00:18:28,000 --> 00:18:29,760 Speaker 2: It's just a food you should have in the rotation 311 00:18:29,880 --> 00:18:32,360 Speaker 2: for your kids, starting at a young age. And this 312 00:18:32,440 --> 00:18:34,760 Speaker 2: is where I think we get into the second piece 313 00:18:34,800 --> 00:18:37,760 Speaker 2: that holds some people back beyond the kind of the 314 00:18:37,800 --> 00:18:41,800 Speaker 2: information issues, the kind of I'm afraid issue. Then there's like, 315 00:18:42,200 --> 00:18:44,920 Speaker 2: well what do I give them? And so one answer 316 00:18:45,080 --> 00:18:48,240 Speaker 2: maybe bamba, you know, we should all be importing the 317 00:18:48,440 --> 00:18:50,000 Speaker 2: Israeli peanuts next. 318 00:18:50,560 --> 00:18:51,840 Speaker 1: But this is something you. 319 00:18:51,840 --> 00:18:54,040 Speaker 2: Have thought about, and you have thought about sort of 320 00:18:54,080 --> 00:18:56,359 Speaker 2: the questions of access and I think it's an interesting 321 00:18:56,400 --> 00:18:58,240 Speaker 2: one because I'm an economist. I think a lot about 322 00:18:58,240 --> 00:19:01,760 Speaker 2: the market and the ways in which sometimes the market 323 00:19:01,800 --> 00:19:04,080 Speaker 2: is underproviding what we need. 324 00:19:04,840 --> 00:19:09,600 Speaker 5: Yeah, absolutely so for years, and you know, behind this 325 00:19:09,720 --> 00:19:14,639 Speaker 5: picture too lie the World Health Organization recommendations that babies 326 00:19:14,680 --> 00:19:18,679 Speaker 5: should be exclusively breastfed for the first six months of life. 327 00:19:18,920 --> 00:19:22,080 Speaker 5: So with all of this together, there's been a belief 328 00:19:22,160 --> 00:19:26,760 Speaker 5: that babies shouldn't have any solids before six months of age. So, 329 00:19:27,040 --> 00:19:31,359 Speaker 5: not surprisingly, they're not many natural home recipes and they're 330 00:19:31,359 --> 00:19:36,600 Speaker 5: not many products on shelves that are geared towards giving 331 00:19:36,680 --> 00:19:37,680 Speaker 5: babies peanuts. 332 00:19:37,720 --> 00:19:41,000 Speaker 2: And indeed, to be clear, you cannot give a baby 333 00:19:41,200 --> 00:19:44,040 Speaker 2: just a peanut. Obviously they will choke, and giving them 334 00:19:44,080 --> 00:19:48,560 Speaker 2: peanut butter alone is actually not a super baby friendly food. 335 00:19:48,800 --> 00:19:52,000 Speaker 5: It can be mixed and diluted with puread food, but 336 00:19:52,040 --> 00:19:55,760 Speaker 5: that's a bit of work. Whole peanuts is an absolute 337 00:19:55,880 --> 00:19:59,840 Speaker 5: no no, because that's a major cause of choking and 338 00:20:00,119 --> 00:20:04,000 Speaker 5: and aspiration, like with any sort of small piece of 339 00:20:04,040 --> 00:20:08,280 Speaker 5: solid food at that age. And the remarkable success story 340 00:20:08,560 --> 00:20:12,600 Speaker 5: of the Israel puff was that it's a puff that 341 00:20:12,760 --> 00:20:17,760 Speaker 5: is readily apart from being nutritious and tasty. It dissolves 342 00:20:17,800 --> 00:20:20,880 Speaker 5: and is very easy for the baby as early as 343 00:20:20,880 --> 00:20:23,399 Speaker 5: four months to have it, especially if mixed with a 344 00:20:23,400 --> 00:20:26,560 Speaker 5: bit of water or milk. And in fact, it's really 345 00:20:26,560 --> 00:20:29,959 Speaker 5: interesting because you talk about what's happened to the industry since, 346 00:20:30,400 --> 00:20:33,480 Speaker 5: and there have been moves in the industry. So one 347 00:20:33,600 --> 00:20:36,440 Speaker 5: which I was asked to be involved, and I personally 348 00:20:36,720 --> 00:20:41,639 Speaker 5: don't like that direction was to medicalize this and create 349 00:20:42,080 --> 00:20:49,480 Speaker 5: formulae with or powders rather containing x amounts of peanut 350 00:20:49,720 --> 00:20:53,679 Speaker 5: other food allergens. Problem with that, as I said, is 351 00:20:53,680 --> 00:20:58,159 Speaker 5: it's medicalizing this. And again babies aren't going to drink 352 00:20:59,040 --> 00:21:03,879 Speaker 5: milk with formula with powder for the first few years 353 00:21:03,920 --> 00:21:06,440 Speaker 5: of life. They'll do it for a few months in transition. 354 00:21:07,280 --> 00:21:12,720 Speaker 5: So in fact, I against, you know what, my earlier beliefs, 355 00:21:12,840 --> 00:21:16,960 Speaker 5: I decided to become involved in this sort of venture 356 00:21:17,640 --> 00:21:20,879 Speaker 5: with some colleagues and we founded a company called Mission 357 00:21:21,000 --> 00:21:25,000 Speaker 5: Mighty Me. And in fact, although there isn't evidence for 358 00:21:25,240 --> 00:21:29,760 Speaker 5: other nuts, there is now moderate to high level evidence 359 00:21:29,840 --> 00:21:36,080 Speaker 5: that multi allergen introduction will prevent multiple food allergies. And 360 00:21:36,400 --> 00:21:43,879 Speaker 5: we've created puffs, dissolvable puffs that babies can as early 361 00:21:43,920 --> 00:21:47,719 Speaker 5: as four months start having either. I mean, that is 362 00:21:47,840 --> 00:21:51,040 Speaker 5: one way of doing it. It's proven to be highly 363 00:21:51,119 --> 00:21:55,639 Speaker 5: successful in Israel, and that's why we chose that. And 364 00:21:55,680 --> 00:21:58,560 Speaker 5: by the way, it should be said, Israeli babies are 365 00:21:58,600 --> 00:22:01,960 Speaker 5: not protected against food food allergies in general. They have 366 00:22:02,040 --> 00:22:04,560 Speaker 5: the same rates of milk and egg and other food 367 00:22:04,600 --> 00:22:08,359 Speaker 5: allergies as in the UK. So this really seems to 368 00:22:08,440 --> 00:22:12,280 Speaker 5: work well at a population level in Israel. And we 369 00:22:12,320 --> 00:22:14,600 Speaker 5: went down the puff roots, but the other ways that 370 00:22:14,720 --> 00:22:18,240 Speaker 5: can be done as well, pouches. As I said, I'm 371 00:22:18,280 --> 00:22:21,800 Speaker 5: not keen on tablets or powders or. 372 00:22:21,840 --> 00:22:22,800 Speaker 1: You know, like a mix in. 373 00:22:23,040 --> 00:22:26,240 Speaker 5: Well, well, the problem with the mix ins is there's 374 00:22:26,280 --> 00:22:30,960 Speaker 5: a few problems with that, Emily, one real, very real, 375 00:22:31,040 --> 00:22:35,119 Speaker 5: and the other theoretical. So the real problem with a 376 00:22:35,200 --> 00:22:38,320 Speaker 5: mix in and a powder is getting enough of the 377 00:22:38,320 --> 00:22:42,400 Speaker 5: food proteins in. And there have been products out there 378 00:22:42,760 --> 00:22:48,560 Speaker 5: that contain milligram quantities of peanut is we know that 379 00:22:48,600 --> 00:22:51,679 Speaker 5: you need gram quantities, and we've done modeling showing the 380 00:22:51,680 --> 00:22:55,440 Speaker 5: minimum you really require is two grams of peanut protein 381 00:22:55,880 --> 00:22:59,800 Speaker 5: two grams of egg white protein. So the powders usually 382 00:22:59,880 --> 00:23:04,760 Speaker 5: not all but usually contain lower amounts. My other concern 383 00:23:04,880 --> 00:23:08,280 Speaker 5: about the powder is that it comes in mixed with formula. 384 00:23:08,920 --> 00:23:11,000 Speaker 5: And I'm afraid you didn't want to get to the 385 00:23:11,359 --> 00:23:13,240 Speaker 5: dualalagen exposure hypothesis. 386 00:23:13,359 --> 00:23:14,200 Speaker 1: I do. I do. 387 00:23:14,359 --> 00:23:17,560 Speaker 5: Yeah, that sort of ties in because we believe in 388 00:23:17,600 --> 00:23:22,239 Speaker 5: there's strong evidence for that that babies develop peanut and 389 00:23:22,280 --> 00:23:26,760 Speaker 5: other food allergies through their skin. Why through their skins well, 390 00:23:26,800 --> 00:23:30,359 Speaker 5: in general, babies have a thinner skin, a less effective 391 00:23:30,440 --> 00:23:34,600 Speaker 5: skin barrier, and that is particularly the case in babies 392 00:23:34,640 --> 00:23:37,200 Speaker 5: who have exama or dry skin. 393 00:23:37,880 --> 00:23:39,960 Speaker 2: So I want to turn a little bit to something 394 00:23:39,960 --> 00:23:41,879 Speaker 2: else that we've talked about a bit, which for me 395 00:23:43,040 --> 00:23:45,879 Speaker 2: was some of the most surprising things I heard from you. 396 00:23:45,880 --> 00:23:47,760 Speaker 2: And we toashed on a little bit early on. We're 397 00:23:47,800 --> 00:23:50,959 Speaker 2: talking about your work in mice. But one of the 398 00:23:50,960 --> 00:23:53,040 Speaker 2: things that parents hear quite a lot and has come 399 00:23:53,160 --> 00:23:56,480 Speaker 2: up in this conversation is that allergies and ezema are linked. 400 00:23:56,720 --> 00:23:58,600 Speaker 2: If your child has eggzma, they're at a higher risk 401 00:23:58,640 --> 00:24:01,000 Speaker 2: of allergies. And that's just that's act is just true 402 00:24:01,400 --> 00:24:04,199 Speaker 2: in the data. There's a strong correlation there. And I 403 00:24:04,240 --> 00:24:08,000 Speaker 2: had always interpreted this as reflecting some underlying shared cause 404 00:24:08,280 --> 00:24:12,280 Speaker 2: that Basically, some people's immune system reacts differently to things, 405 00:24:12,320 --> 00:24:15,000 Speaker 2: and so it is it is that underlying cause that 406 00:24:15,440 --> 00:24:18,800 Speaker 2: is both the exzema and the allergies. But my sense 407 00:24:18,800 --> 00:24:21,120 Speaker 2: from you is that there's another school of thought that. 408 00:24:21,040 --> 00:24:22,200 Speaker 1: You think is correct. 409 00:24:22,640 --> 00:24:26,080 Speaker 2: Is effectively that the exzema is causing the allergies or 410 00:24:26,080 --> 00:24:27,480 Speaker 2: it's contributing to the allergies. 411 00:24:27,840 --> 00:24:29,639 Speaker 1: Is that the right way to say that? Or am 412 00:24:29,640 --> 00:24:30,320 Speaker 1: I getting that wrong? 413 00:24:30,400 --> 00:24:33,160 Speaker 5: Well, you're saying it absolutely the way I mean logically. 414 00:24:33,200 --> 00:24:38,440 Speaker 5: The three possibilities if two things are strongly associated. One 415 00:24:38,520 --> 00:24:41,840 Speaker 5: is there's an underlying shared cause, and I think to 416 00:24:41,880 --> 00:24:46,200 Speaker 5: some extent that is true for peanut energy and exzema, 417 00:24:46,280 --> 00:24:49,960 Speaker 5: or food energies and exzema. The other is that food 418 00:24:50,000 --> 00:24:53,600 Speaker 5: allergies cause exzema. And the third is that exzema causes 419 00:24:53,640 --> 00:24:58,560 Speaker 5: food allergies. And this is a perfect example where correlation 420 00:24:58,760 --> 00:25:02,119 Speaker 5: does not prove cause. Out we saw this very high 421 00:25:02,160 --> 00:25:07,040 Speaker 5: correlation in pediatrics amongst babies with eggzema and saw they 422 00:25:07,080 --> 00:25:10,080 Speaker 5: had food allergies, and we said, well, it must be 423 00:25:10,119 --> 00:25:13,440 Speaker 5: the food allergies. Thats causing their eggzema. Remove the milk, 424 00:25:13,600 --> 00:25:17,600 Speaker 5: remove the eggs, remove the peanuts, and that's the worst 425 00:25:17,640 --> 00:25:21,000 Speaker 5: thing you can do. Why Because it's the eggzema that 426 00:25:21,160 --> 00:25:24,680 Speaker 5: leads to the food allergies. And that's the second part 427 00:25:24,720 --> 00:25:28,080 Speaker 5: of the dual allergen exposure hypothesis. You can be exposed 428 00:25:28,119 --> 00:25:31,520 Speaker 5: to foods in two ways, one by eating it or 429 00:25:32,359 --> 00:25:36,200 Speaker 5: through the skin. If you've got ezema all over your cheeks, 430 00:25:36,240 --> 00:25:38,920 Speaker 5: you've got dry skin over your cheeks as an infant, 431 00:25:39,520 --> 00:25:43,160 Speaker 5: and foods get on that skin. Your parent has eaten 432 00:25:43,160 --> 00:25:46,240 Speaker 5: a peanut butter sandwich or had an on egg omelet 433 00:25:46,600 --> 00:25:50,720 Speaker 5: and touches your face, kisses your face. The baby is 434 00:25:50,800 --> 00:25:54,719 Speaker 5: exposed to foods through their skin from the parents' hands, 435 00:25:54,960 --> 00:25:58,399 Speaker 5: and those food molecules can penetrate the skin and be 436 00:25:58,480 --> 00:26:02,800 Speaker 5: taken up by are called antigen presenting cells under the skin. 437 00:26:03,480 --> 00:26:06,120 Speaker 5: And we know that we know already from house models 438 00:26:06,119 --> 00:26:09,920 Speaker 5: previously that if you're exposed to proteins through the skin, 439 00:26:10,040 --> 00:26:14,440 Speaker 5: especially an inflamed skin, that leads to an allergic type response. 440 00:26:15,240 --> 00:26:18,200 Speaker 5: And we believe that we don't have strong but we 441 00:26:18,280 --> 00:26:21,640 Speaker 5: have good reason to believe that from an evolutionary perspective. 442 00:26:22,080 --> 00:26:26,159 Speaker 5: That's because helminthic parasites would burrow their way through the 443 00:26:26,200 --> 00:26:32,159 Speaker 5: skin worms and that's a worm, absolutely, and the body 444 00:26:32,200 --> 00:26:37,800 Speaker 5: to reject it would mount ig allergic antibodies. So really 445 00:26:37,800 --> 00:26:42,359 Speaker 5: what this is is a rejection response. So we believe 446 00:26:42,480 --> 00:26:48,880 Speaker 5: that we misinterpreted this association to mean food allergies called exzema, 447 00:26:49,280 --> 00:26:52,360 Speaker 5: whereas I believe it's small and a lot of colleagues 448 00:26:52,400 --> 00:26:56,440 Speaker 5: believe now that exzema leads to food allergies. But as 449 00:26:56,440 --> 00:26:59,760 Speaker 5: you say, there may well be an underlying shared genetic 450 00:26:59,880 --> 00:27:01,440 Speaker 5: or other factors involved. 451 00:27:01,640 --> 00:27:03,879 Speaker 2: But I mean, it's an extremely interesting idea, and it 452 00:27:03,960 --> 00:27:08,200 Speaker 2: just to sort of recap in slightly more lay terms. Effectively, 453 00:27:08,280 --> 00:27:10,560 Speaker 2: the idea is that the allergens are going through the 454 00:27:10,760 --> 00:27:13,240 Speaker 2: through the window, and they should have gone through the door, 455 00:27:13,240 --> 00:27:15,760 Speaker 2: and when they come in through the window, there's a 456 00:27:16,040 --> 00:27:19,600 Speaker 2: response mounted and your body says, hey, this is something 457 00:27:19,600 --> 00:27:20,119 Speaker 2: we don't like. 458 00:27:20,200 --> 00:27:23,440 Speaker 1: This is a problematic entrant of some type. 459 00:27:23,440 --> 00:27:25,480 Speaker 2: And then when you see it again, even coming in 460 00:27:25,480 --> 00:27:28,000 Speaker 2: the right way, your body is already sensitized to. 461 00:27:28,040 --> 00:27:32,480 Speaker 5: This absolutely, And I like your window door analogy, only 462 00:27:32,520 --> 00:27:35,280 Speaker 5: I would flip the other way round. Okay, just if 463 00:27:35,320 --> 00:27:38,639 Speaker 5: you take a day to day scenario, someone knocks at 464 00:27:38,880 --> 00:27:42,360 Speaker 5: your front door and politely asks you directions or something. 465 00:27:42,680 --> 00:27:45,760 Speaker 5: You'll be civil to that person. But if that person 466 00:27:46,320 --> 00:27:49,239 Speaker 5: sort of knocks through your bedroom window and tries to 467 00:27:49,280 --> 00:27:52,399 Speaker 5: break into your house, that way, you'll you know, you 468 00:27:52,400 --> 00:27:55,040 Speaker 5: won't be quite as friendly in your greetings. And the 469 00:27:55,080 --> 00:27:58,520 Speaker 5: body is like that. It depends on the root of entry. 470 00:27:59,640 --> 00:28:02,600 Speaker 5: If it comes in through the mouth very early on, 471 00:28:02,920 --> 00:28:04,840 Speaker 5: well that must be a food. It must be a 472 00:28:04,880 --> 00:28:10,040 Speaker 5: good protein antigen, and we mount what's called a tolerogenic 473 00:28:10,240 --> 00:28:14,159 Speaker 5: response with the immune system goes in a direction that 474 00:28:14,200 --> 00:28:17,920 Speaker 5: will prevent the development of food anergies. If you're exposed 475 00:28:18,000 --> 00:28:22,280 Speaker 5: very early on through a broken down skin, the immune 476 00:28:22,320 --> 00:28:25,160 Speaker 5: system and the cell sitting in that skin issue out 477 00:28:25,200 --> 00:28:29,440 Speaker 5: an alarm. Hey there's an invader coming in. Let's mount 478 00:28:29,440 --> 00:28:31,159 Speaker 5: an allergic response to repel it. 479 00:28:31,920 --> 00:28:34,920 Speaker 2: So would you, I mean sort of taking the logical 480 00:28:34,960 --> 00:28:37,800 Speaker 2: step I think for parents, And I understand this is 481 00:28:38,080 --> 00:28:41,160 Speaker 2: still not something where we have large Randomez trial evidence, 482 00:28:41,160 --> 00:28:42,560 Speaker 2: and I want to talk about how we get that. 483 00:28:42,680 --> 00:28:45,720 Speaker 2: But say, if this is true, then one thing I 484 00:28:45,800 --> 00:28:48,840 Speaker 2: might conclude as a parent is that if I have 485 00:28:49,000 --> 00:28:53,000 Speaker 2: a baby with egzima and I did have two of those, 486 00:28:53,440 --> 00:28:57,760 Speaker 2: that the best way to prevent allergies is initially when 487 00:28:57,760 --> 00:29:00,680 Speaker 2: they are infants before they are having solid food, for 488 00:29:00,760 --> 00:29:05,720 Speaker 2: me to avoid allergens in my household and then to 489 00:29:06,400 --> 00:29:09,680 Speaker 2: introduce allergens to them more or less as soon as 490 00:29:09,760 --> 00:29:12,920 Speaker 2: is they are having solid food. So I avoid this 491 00:29:14,040 --> 00:29:17,120 Speaker 2: other alternative exposure approach. 492 00:29:17,640 --> 00:29:23,520 Speaker 5: Yes, I mean, and logically that makes sense. In countries 493 00:29:23,560 --> 00:29:27,600 Speaker 5: where peanuts are not consumed, you don't see peanut allergy. 494 00:29:27,680 --> 00:29:30,680 Speaker 5: So you could argue in households where peanuts and other 495 00:29:30,840 --> 00:29:33,880 Speaker 5: allergens are not consumed, you won't see those food allergies. 496 00:29:34,240 --> 00:29:39,640 Speaker 5: But bear in mind there's not just peanuts. There's eggs, milk, tree, nuts, sesame, weed, fish, 497 00:29:39,960 --> 00:29:42,720 Speaker 5: et cetera. And that would mean you'd need to avoid 498 00:29:42,840 --> 00:29:45,960 Speaker 5: all these foods in your household. And even so, it 499 00:29:45,960 --> 00:29:49,760 Speaker 5: wouldn't be a guarantee, first of all, because peanut is 500 00:29:49,800 --> 00:29:53,600 Speaker 5: a very tenacious, persistent protein that hangs around for long 501 00:29:53,640 --> 00:29:58,280 Speaker 5: periods of time. Secondly, there's going to be so called 502 00:29:58,520 --> 00:30:04,640 Speaker 5: contamination people who are eating peanut entering your home environment, friends, relatives. 503 00:30:05,160 --> 00:30:07,960 Speaker 5: So although it may be a strategy that. 504 00:30:08,080 --> 00:30:09,920 Speaker 1: Is it's a lot of work, very. 505 00:30:09,760 --> 00:30:11,680 Speaker 5: Difficult to put to the test. As you say, it's 506 00:30:11,680 --> 00:30:13,520 Speaker 5: a lot of work, it's a lot of work and 507 00:30:13,600 --> 00:30:18,000 Speaker 5: may not work in our view now myself and mine 508 00:30:18,000 --> 00:30:21,640 Speaker 5: and that of many got my colleagues, is introduce babies 509 00:30:21,680 --> 00:30:26,160 Speaker 5: to those foods much earlier on orally. And we do 510 00:30:26,280 --> 00:30:31,160 Speaker 5: believe that the oral root trumps the skin root. So 511 00:30:31,240 --> 00:30:35,000 Speaker 5: if a baby's exposed both through the skin where and 512 00:30:35,040 --> 00:30:38,160 Speaker 5: it takes tiny doses. This is the interesting thing. It 513 00:30:38,200 --> 00:30:43,160 Speaker 5: only takes tiny doses less than microgram doses to cause 514 00:30:43,840 --> 00:30:46,280 Speaker 5: the development of food allergy through the skin where is 515 00:30:46,360 --> 00:30:50,280 Speaker 5: to protect orally, you need gram doses. So get the 516 00:30:50,280 --> 00:30:53,280 Speaker 5: baby onto good amounts of these foods the same way 517 00:30:53,320 --> 00:30:55,600 Speaker 5: the rest of the family is eating them, and that 518 00:30:55,680 --> 00:30:59,240 Speaker 5: ought to protect against peanut and we believe other food 519 00:30:59,280 --> 00:31:00,240 Speaker 5: allergies as well well. 520 00:31:00,520 --> 00:31:02,920 Speaker 2: Are their efforts to test these sort of dual allergen 521 00:31:03,280 --> 00:31:06,480 Speaker 2: eggma hypotheses in randomized trials, so. 522 00:31:06,800 --> 00:31:11,800 Speaker 5: There's observational data. For example, we did a case controlled 523 00:31:11,840 --> 00:31:15,320 Speaker 5: study where we Adam Fox, colleague of mine when he 524 00:31:15,400 --> 00:31:19,840 Speaker 5: did his PhD thesis equivalent in the UK, looked at 525 00:31:20,040 --> 00:31:24,880 Speaker 5: environmental peanut consumption in the home and found there was 526 00:31:24,920 --> 00:31:28,040 Speaker 5: a strong association between that and the risk of developing 527 00:31:28,080 --> 00:31:31,200 Speaker 5: peanut allergy. It was almost like a dose response curve. 528 00:31:31,480 --> 00:31:33,800 Speaker 5: The more peanut there was around in these babies with 529 00:31:34,240 --> 00:31:37,800 Speaker 5: the higher chance of developing peanut allergy. But when, and 530 00:31:37,840 --> 00:31:40,720 Speaker 5: although this wasn't a randomized controlled study, when you looked 531 00:31:40,720 --> 00:31:45,560 Speaker 5: at the babies who'd eaten significant quantities of peanut early 532 00:31:45,600 --> 00:31:48,680 Speaker 5: on in the first year of life, that relationship was destroyed. 533 00:31:48,680 --> 00:31:53,200 Speaker 5: The line was flat, so you saw both oral versus 534 00:31:53,240 --> 00:31:58,160 Speaker 5: skin interacting. The same has been shown very interestingly for 535 00:31:58,800 --> 00:32:02,120 Speaker 5: people who like to win jewelry and can't afford the 536 00:32:02,240 --> 00:32:05,640 Speaker 5: very expensive jewelry. Nickel is a very common ingredient and 537 00:32:05,720 --> 00:32:09,680 Speaker 5: in many people that causes a form of exemer called 538 00:32:09,800 --> 00:32:15,240 Speaker 5: contact dermatitis, and we know especially there've been studies showing 539 00:32:15,360 --> 00:32:19,840 Speaker 5: that young girls and teenage girls who'd had their ears 540 00:32:19,960 --> 00:32:23,640 Speaker 5: pierced had a higher chance of developing allergies to nickel. 541 00:32:24,280 --> 00:32:29,320 Speaker 5: But if they had orthodontic braces in the mouth applied 542 00:32:29,400 --> 00:32:33,040 Speaker 5: several years before that contained nickel, they seem to be 543 00:32:33,120 --> 00:32:37,480 Speaker 5: almost completely protected against developing nickel allergy, which means a 544 00:32:37,480 --> 00:32:44,000 Speaker 5: beautiful non allergic example of the dual allergen exposure hypothesis. 545 00:32:44,480 --> 00:32:46,880 Speaker 5: But they've been studies that have been a bit disappointing 546 00:32:47,320 --> 00:32:54,400 Speaker 5: using emollients, so those are moisturizers essentially to try and 547 00:32:54,800 --> 00:32:59,760 Speaker 5: protect the skin barrier in babies with dry skin and exoma. Regrettably, 548 00:33:00,240 --> 00:33:03,000 Speaker 5: so far we have not seen a reduction in peanut allergy. 549 00:33:03,440 --> 00:33:07,040 Speaker 5: It may take more than that. But also the use 550 00:33:07,080 --> 00:33:11,840 Speaker 5: of topical steroids chatty reduce the inflammation that is already present, 551 00:33:12,400 --> 00:33:16,440 Speaker 5: so there is definitely an In fact, I'm involved in 552 00:33:16,480 --> 00:33:19,280 Speaker 5: a multi center study with my colleagues in the UK 553 00:33:20,240 --> 00:33:23,360 Speaker 5: and in the US called the Seals Study, where we 554 00:33:23,440 --> 00:33:26,800 Speaker 5: are taking very young babies in the first week's couple 555 00:33:26,840 --> 00:33:31,120 Speaker 5: of months of life at high risk who have already 556 00:33:31,320 --> 00:33:34,880 Speaker 5: very early onset exama or dry skin, and we are 557 00:33:35,240 --> 00:33:39,040 Speaker 5: regularly moisturizing them and as soon as they develop any 558 00:33:39,160 --> 00:33:42,920 Speaker 5: hint of redness of the skin the beginnings of inflammatory ezema, 559 00:33:43,160 --> 00:33:46,800 Speaker 5: we treat proactively with topical steroids. So that may be 560 00:33:47,440 --> 00:33:53,800 Speaker 5: an approach that is promising. There are some new, very 561 00:33:53,960 --> 00:33:59,320 Speaker 5: interesting new products today that are used the monoclone lantibodies 562 00:33:59,760 --> 00:34:04,480 Speaker 5: that are used to treat exzema now an asthma that 563 00:34:04,640 --> 00:34:09,360 Speaker 5: target the inflammatory pathway in the skin, in the immune 564 00:34:09,360 --> 00:34:14,040 Speaker 5: system that lead to exemer asthma and food allergies and 565 00:34:14,160 --> 00:34:20,359 Speaker 5: really very successfully we'll switch off exzema, and you are 566 00:34:20,400 --> 00:34:23,920 Speaker 5: one of the questions. These molecules seem to be very 567 00:34:23,960 --> 00:34:26,799 Speaker 5: safe if you gave them to high risk babies very 568 00:34:26,800 --> 00:34:30,600 Speaker 5: early on. Could you prevent peanut allergy by preventing the 569 00:34:30,640 --> 00:34:34,720 Speaker 5: development of ezema? So that's partway that remains, And actually 570 00:34:34,880 --> 00:34:38,000 Speaker 5: it's a part way I like because I spoke to 571 00:34:38,000 --> 00:34:40,279 Speaker 5: you about the food we've developed, and we have been 572 00:34:40,320 --> 00:34:45,000 Speaker 5: able to produce foods that contain five allergens five nuts, 573 00:34:45,040 --> 00:34:48,000 Speaker 5: including peanuts. But you still have a lot of foods 574 00:34:48,040 --> 00:34:52,200 Speaker 5: to consider sixteen potential allergens, and to eat all of 575 00:34:52,239 --> 00:34:57,640 Speaker 5: these insufficient amounts early enough in life to prevent all 576 00:34:57,680 --> 00:35:01,200 Speaker 5: these food aalergies maybe a challenge. And one way forward, 577 00:35:01,239 --> 00:35:04,720 Speaker 5: which would be really wonderful, would be just to prevent 578 00:35:04,760 --> 00:35:07,040 Speaker 5: the development of exzema, which is. 579 00:35:06,760 --> 00:35:08,960 Speaker 1: Also very unpleasant to begin with. 580 00:35:09,200 --> 00:35:13,520 Speaker 5: Yes, not a pleasant, so yeah, sleepless nights and everything. 581 00:35:14,560 --> 00:35:17,880 Speaker 5: So that based on the dual allergen exposure hypothis, you 582 00:35:17,920 --> 00:35:20,760 Speaker 5: can make a number of predictions. One is that oral 583 00:35:20,800 --> 00:35:23,400 Speaker 5: consumption will prevent food allergies. 584 00:35:23,600 --> 00:35:25,520 Speaker 2: That's the actionable I mean, I think if we had 585 00:35:25,560 --> 00:35:28,200 Speaker 2: to say, like, what's the actionable takeaway. I think that's 586 00:35:28,880 --> 00:35:32,160 Speaker 2: that is for parents. The actionable takeaway is really that 587 00:35:33,000 --> 00:35:39,120 Speaker 2: oral exposure in a consistent manner to these allergens, starting 588 00:35:39,640 --> 00:35:42,960 Speaker 2: as soon as you introduce foods, is the best way 589 00:35:43,000 --> 00:35:44,880 Speaker 2: we know to prevent allergens at the moment. 590 00:35:45,160 --> 00:35:49,680 Speaker 5: Yeah, and early on you'd ask me about putting my 591 00:35:49,840 --> 00:35:54,400 Speaker 5: concerns about putting powder in formula. I mentioned two concerns. 592 00:35:54,680 --> 00:35:58,000 Speaker 5: One is that there's not enough of the allergen getting 593 00:35:58,040 --> 00:36:02,120 Speaker 5: into the baby because it's difficult to put this in 594 00:36:02,120 --> 00:36:06,040 Speaker 5: a bout the film already mixed with milk, which but 595 00:36:06,640 --> 00:36:10,920 Speaker 5: the other is that exema occurs and dry skin occurs 596 00:36:11,000 --> 00:36:14,839 Speaker 5: mainly primarily initially on the cheeks of babies, and if 597 00:36:14,880 --> 00:36:19,440 Speaker 5: they are being exposed to low dose microgram or milligram 598 00:36:19,520 --> 00:36:23,480 Speaker 5: exposure through the skin, they're inflamed skin and they're not 599 00:36:23,560 --> 00:36:28,040 Speaker 5: having sufficient quantities going down the gastric intestinal room because 600 00:36:28,040 --> 00:36:30,480 Speaker 5: one of that face it milk does tend to spill, 601 00:36:30,719 --> 00:36:34,440 Speaker 5: as do all foods, but particularly milk and liquid on 602 00:36:34,480 --> 00:36:38,240 Speaker 5: the baby's cheek. There's a theoretical concern by giving low 603 00:36:38,320 --> 00:36:43,719 Speaker 5: dose allergen or foreign proteins that cause allergies through the 604 00:36:43,800 --> 00:36:46,799 Speaker 5: skin and not sufficient through the gut, as this is 605 00:36:46,800 --> 00:36:51,840 Speaker 5: a potential set up for paradoxically increasing food allergies. Of 606 00:36:51,920 --> 00:36:56,239 Speaker 5: course that remains to be broken and very difficult to 607 00:36:56,320 --> 00:36:58,920 Speaker 5: prove that is theory. But what we do know is 608 00:36:58,960 --> 00:37:03,720 Speaker 5: that low dose exposure through the skin does lead to food, 609 00:37:03,800 --> 00:37:06,000 Speaker 5: especially peanuts, allergies. 610 00:37:06,600 --> 00:37:09,080 Speaker 2: Okay, So here are a couple lightning round questions about 611 00:37:09,120 --> 00:37:12,840 Speaker 2: allergies that I've gotten from readers over the years. Allergens 612 00:37:13,000 --> 00:37:16,239 Speaker 2: and the exposure allergens through breast milk so and through pregnancy. 613 00:37:16,560 --> 00:37:17,920 Speaker 2: So I think a lot of a question we get 614 00:37:17,920 --> 00:37:20,919 Speaker 2: a lot from people is if I consume a lot 615 00:37:20,960 --> 00:37:25,360 Speaker 2: of some allergen peanuts, eggs, et cetera while I'm pregnant 616 00:37:25,800 --> 00:37:28,000 Speaker 2: or while I'm breastfeeding, is that going to make my 617 00:37:28,080 --> 00:37:30,680 Speaker 2: kid less likely to be allergic or likely to be allergic? 618 00:37:30,800 --> 00:37:31,680 Speaker 1: Does it not matter? 619 00:37:32,280 --> 00:37:34,640 Speaker 5: So people have looked at this, obviously not in a 620 00:37:34,719 --> 00:37:39,480 Speaker 5: randomized controlled trial, but observational studies go both ways. So 621 00:37:39,560 --> 00:37:43,880 Speaker 5: though some studies showing that mothers who eat more peanuts 622 00:37:43,920 --> 00:37:47,440 Speaker 5: while breastfeeding the babies are protected, others that show the 623 00:37:47,520 --> 00:37:50,919 Speaker 5: exact opposite. This study that I mentioned to you, where 624 00:37:50,920 --> 00:37:55,359 Speaker 5: we showed the dose response curve between environmental exposure, which 625 00:37:55,400 --> 00:38:00,600 Speaker 5: basically was based on total family consumption. Each family unit member, 626 00:38:01,760 --> 00:38:04,279 Speaker 5: we calculate the amount of peanut they were eating and 627 00:38:04,360 --> 00:38:08,480 Speaker 5: came up with a total family consumption and that was 628 00:38:09,000 --> 00:38:12,080 Speaker 5: the environmental exposure that the young babies had. And we 629 00:38:12,200 --> 00:38:18,319 Speaker 5: did find that maternal consumption of peanut during both pregnancy 630 00:38:18,440 --> 00:38:23,880 Speaker 5: and the breastfeeding period was slightly correlated with developing peanut allergy. 631 00:38:24,520 --> 00:38:29,719 Speaker 5: But when you put into a regression analysis where you 632 00:38:29,760 --> 00:38:34,360 Speaker 5: look at all the variables and you looked at family consumption, 633 00:38:34,960 --> 00:38:39,560 Speaker 5: family consumption trumped all and the association between maternal consumption 634 00:38:41,000 --> 00:38:46,279 Speaker 5: and the development of peanut allergy, that association disappeared. And 635 00:38:46,320 --> 00:38:49,000 Speaker 5: we believe that simply a mother eating a lot of 636 00:38:49,440 --> 00:38:53,799 Speaker 5: peanut while breastfeeding simply is a marker of the rest 637 00:38:53,840 --> 00:38:56,360 Speaker 5: of the family eating a lot of peanut. There happens 638 00:38:56,360 --> 00:38:58,600 Speaker 5: to be a lot of peanut butter in that household, 639 00:38:58,880 --> 00:39:04,200 Speaker 5: the family's eating it, and the baby has a higher risk. Again, 640 00:39:04,360 --> 00:39:07,640 Speaker 5: this is where it's so difficult, you know, when you've 641 00:39:07,640 --> 00:39:14,240 Speaker 5: got multiple possible causes making spurious or wrong wrong correlations. 642 00:39:14,480 --> 00:39:18,480 Speaker 2: Okay, second question, Let's imagine that my kid does develop 643 00:39:18,560 --> 00:39:23,239 Speaker 2: an allergy. Is that necessarily an allergy forever or do 644 00:39:23,480 --> 00:39:27,239 Speaker 2: allergies pass and does that differ across different allergens. 645 00:39:27,520 --> 00:39:31,520 Speaker 5: So egg and milk allergy go away in the majority 646 00:39:31,960 --> 00:39:37,520 Speaker 5: of babies, usually between one and three years of life, 647 00:39:37,960 --> 00:39:44,440 Speaker 5: but a not insignificant minority, about ten to twenty percent, 648 00:39:44,600 --> 00:39:51,040 Speaker 5: will have persistent egg and milk allergy. With peanuts, knots seeds, 649 00:39:51,560 --> 00:39:55,640 Speaker 5: we see the reverse. These food allergies develop very early 650 00:39:55,719 --> 00:40:00,799 Speaker 5: on but tend to persist later into adelaie essence and 651 00:40:01,040 --> 00:40:04,360 Speaker 5: young adulthood. No one has actually followed up people with 652 00:40:04,400 --> 00:40:08,279 Speaker 5: peanut allergy for fifty years, but we know that bar 653 00:40:08,520 --> 00:40:12,160 Speaker 5: the twenty to twenty five percent of children with peanut 654 00:40:12,239 --> 00:40:15,759 Speaker 5: allergy who outgrow it, because about a quarter a fifth 655 00:40:15,800 --> 00:40:18,839 Speaker 5: to a quarter will outgrow it, the vast majority will 656 00:40:18,840 --> 00:40:22,400 Speaker 5: have life long pe nut allergy. Same seems to apply 657 00:40:22,480 --> 00:40:25,880 Speaker 5: to tree, nuts and seeds. But that's one of the 658 00:40:25,920 --> 00:40:29,040 Speaker 5: reasons too, by the way, that pe nut and nuts 659 00:40:29,080 --> 00:40:32,200 Speaker 5: are such an important one group, because you want to 660 00:40:32,239 --> 00:40:35,840 Speaker 5: prevent You don't want something. Okay, if it's a problem 661 00:40:35,880 --> 00:40:38,200 Speaker 5: that's there for a year or two, you can live 662 00:40:38,239 --> 00:40:40,040 Speaker 5: with it, adapt to it. But if it's going to 663 00:40:40,080 --> 00:40:43,719 Speaker 5: be there for the duration of that person's life. It 664 00:40:43,800 --> 00:40:46,960 Speaker 5: becomes a huge burden and affects all sorts of things, 665 00:40:47,040 --> 00:40:48,680 Speaker 5: quality of life, et cetera. 666 00:40:54,120 --> 00:40:56,719 Speaker 2: This has been amazing. I feel like for me, this 667 00:40:56,800 --> 00:40:59,560 Speaker 2: is such a treat because I really am an enormous 668 00:40:59,600 --> 00:41:03,319 Speaker 2: fan of your work and I think it is such 669 00:41:03,360 --> 00:41:06,640 Speaker 2: a great example of how science evolves. 670 00:41:06,680 --> 00:41:09,600 Speaker 5: Well, it's been a pleasure talking to you, Emily. I'm 671 00:41:09,600 --> 00:41:12,960 Speaker 5: a big fan of your work, and you're good at 672 00:41:12,960 --> 00:41:16,200 Speaker 5: debunking a lot of science myths, so it was good 673 00:41:16,200 --> 00:41:16,719 Speaker 5: to talk to you. 674 00:41:16,920 --> 00:41:18,759 Speaker 1: It was great to talk to you. Thank you so much. 675 00:41:19,120 --> 00:41:26,000 Speaker 5: Bye bye. 676 00:41:26,920 --> 00:41:29,200 Speaker 2: Thank you again to doctor Gideon Lack for joining me 677 00:41:29,360 --> 00:41:32,239 Speaker 2: and for his tremendous work in this field. You can 678 00:41:32,280 --> 00:41:34,520 Speaker 2: read his paper on the Leap study, as well as 679 00:41:34,560 --> 00:41:37,960 Speaker 2: the American Academy and Pediatrics response to its recommendations, on 680 00:41:38,000 --> 00:41:42,439 Speaker 2: our episode website and in the show notes more apparent data, 681 00:41:42,600 --> 00:41:46,080 Speaker 2: including your own stories about introducing allergens after the break. 682 00:42:06,920 --> 00:42:08,960 Speaker 6: Hi, Emily, Hi, my name is Haley Goodwin. 683 00:42:09,080 --> 00:42:10,240 Speaker 7: This is Dana Johnson. 684 00:42:10,280 --> 00:42:11,480 Speaker 8: Hello, my name is Amy. 685 00:42:11,320 --> 00:42:15,040 Speaker 4: Timpy and this is a story about allergen introduction. 686 00:42:18,800 --> 00:42:24,240 Speaker 8: My story regarding allergens pertains to how different. The recommendations 687 00:42:24,239 --> 00:42:27,560 Speaker 8: can be depending on where you bring your child. 688 00:42:28,040 --> 00:42:29,200 Speaker 1: For pediatric visits. 689 00:42:29,200 --> 00:42:31,399 Speaker 7: When our first daughter turned six months old, I made 690 00:42:31,400 --> 00:42:34,400 Speaker 7: her a peanut butter, egg and banana pancake, just like 691 00:42:34,480 --> 00:42:37,840 Speaker 7: everyone else on Instagram, and of course she developed a 692 00:42:37,880 --> 00:42:40,880 Speaker 7: red rash around her face and my husband was like, darn, 693 00:42:40,920 --> 00:42:43,520 Speaker 7: guess she has an egg allergy. Continue on with the 694 00:42:43,560 --> 00:42:44,160 Speaker 7: peanut butter. 695 00:42:44,480 --> 00:42:49,759 Speaker 8: When my firstborn was an infant, we lived in a 696 00:42:49,880 --> 00:42:54,400 Speaker 8: university city. The pediatrician educated us on the risk for 697 00:42:54,480 --> 00:42:57,439 Speaker 8: allergies and at six months told us that my daughter 698 00:42:57,520 --> 00:43:00,520 Speaker 8: was moderate at risk and that she should begin introducing 699 00:43:00,560 --> 00:43:01,480 Speaker 8: peanut products. 700 00:43:01,520 --> 00:43:04,040 Speaker 7: Little did we know she also had peanut, walnut, and 701 00:43:04,080 --> 00:43:08,120 Speaker 7: pecan allergies, and so as we continue to introduce these nuts, 702 00:43:08,160 --> 00:43:11,279 Speaker 7: she continued to get this red rash, and so we 703 00:43:11,440 --> 00:43:14,520 Speaker 7: saw the allergist who was fairly out of date and 704 00:43:14,560 --> 00:43:17,640 Speaker 7: said no nuts of any type until she's five. 705 00:43:18,000 --> 00:43:20,160 Speaker 8: Flashed forward a few years and we moved to a 706 00:43:20,200 --> 00:43:25,840 Speaker 8: different city, and my second born, at her nine month visit, 707 00:43:26,360 --> 00:43:31,680 Speaker 8: was told not to introduce peanuts, eggs, or other allergens, 708 00:43:31,719 --> 00:43:35,239 Speaker 8: and when I told her, well, we've actually already introduced 709 00:43:35,280 --> 00:43:38,880 Speaker 8: them because she's moderate risk. She looked at me like 710 00:43:39,600 --> 00:43:46,560 Speaker 8: I was crazy. I then ended up informing the pediatrician 711 00:43:46,760 --> 00:43:49,880 Speaker 8: and she said that yes, it should have been corrected, 712 00:43:50,040 --> 00:43:54,120 Speaker 8: and that their binders the nurses were educating parents on 713 00:43:54,200 --> 00:43:55,000 Speaker 8: were outdated. 714 00:43:55,440 --> 00:43:59,000 Speaker 7: Thankfully, we chose not to follow that advice and sought 715 00:43:59,040 --> 00:44:01,960 Speaker 7: the advice of ad for an allergist who introduced us 716 00:44:02,120 --> 00:44:07,480 Speaker 7: to oral immunotherapy or OIT. We started OIT for our 717 00:44:07,560 --> 00:44:10,840 Speaker 7: daughter at two and a half and did weekly visits 718 00:44:10,880 --> 00:44:14,319 Speaker 7: to the allergists who lived about three hours away. And 719 00:44:14,360 --> 00:44:18,759 Speaker 7: now she is in first grade with no benadryl, no EpiPen. 720 00:44:19,320 --> 00:44:24,000 Speaker 7: She regularly eats peanuts freely and enjoys them. She still 721 00:44:24,040 --> 00:44:30,280 Speaker 7: doesn't like eggs, but she no longer is allergic to them. 722 00:44:30,360 --> 00:44:35,520 Speaker 4: So with my first super anxious BOUTE introducing allergens, and 723 00:44:35,560 --> 00:44:35,960 Speaker 4: I was. 724 00:44:35,920 --> 00:44:39,799 Speaker 6: Told, with eggs, mix it with breast milk. Boom, you're good. 725 00:44:40,680 --> 00:44:42,800 Speaker 4: So, you know, I hardboiled the egg, took the yolk, 726 00:44:43,120 --> 00:44:45,240 Speaker 4: mashed it up, mixed it with breast milk. 727 00:44:45,719 --> 00:44:48,239 Speaker 6: Baby loved it great. You know. 728 00:44:48,400 --> 00:44:52,239 Speaker 4: Then a month later have scrambled eggs again, and this 729 00:44:52,280 --> 00:44:56,120 Speaker 4: time we're at a park and his ears start swelling up, 730 00:44:56,520 --> 00:44:59,120 Speaker 4: and you know, I stopped feeding the egg right away, 731 00:44:59,560 --> 00:45:03,600 Speaker 4: realized it was an allergic reaction. But you know, book 732 00:45:03,600 --> 00:45:06,560 Speaker 4: an allergist appointment and find out that you know, the 733 00:45:06,600 --> 00:45:07,759 Speaker 4: actual allergen for. 734 00:45:07,760 --> 00:45:11,680 Speaker 6: Egg is usually in the whites, not the yoke. 735 00:45:12,320 --> 00:45:17,200 Speaker 4: So by introducing him to this yolk and breast milk, 736 00:45:17,239 --> 00:45:20,200 Speaker 4: which is what everyone says to do, I actually wasn't 737 00:45:20,239 --> 00:45:25,560 Speaker 4: exposing him to the allergen and didn't catch it. But anyways, 738 00:45:25,600 --> 00:45:27,640 Speaker 4: I always share that anecdote with people because I think 739 00:45:27,680 --> 00:45:30,080 Speaker 4: it's important to know where the allergen lies. 740 00:45:32,480 --> 00:45:35,399 Speaker 7: And that's our story of having an allergic reaction at 741 00:45:35,440 --> 00:45:36,200 Speaker 7: six months old. 742 00:45:36,800 --> 00:45:37,640 Speaker 6: Thanks for listening. 743 00:45:45,920 --> 00:45:47,920 Speaker 2: Thank you so much for sharing your stories with me. 744 00:45:48,600 --> 00:45:50,480 Speaker 2: Please keep an eye out for our calls for more 745 00:45:50,520 --> 00:45:54,239 Speaker 2: stories like these. Parent Data is produced by Tamar Avishai 746 00:45:54,520 --> 00:45:57,080 Speaker 2: with support from the parent Data team and pr Rex. 747 00:45:58,000 --> 00:46:02,040 Speaker 2: Also special thanks to our house violinist, my daughter Penelope. 748 00:46:01,480 --> 00:46:02,840 Speaker 4: No problem mom. 749 00:46:03,239 --> 00:46:05,319 Speaker 2: If you have thoughts on this episode, please join the 750 00:46:05,320 --> 00:46:09,319 Speaker 2: conversation on my Instagram at prof Emily Oster and if 751 00:46:09,360 --> 00:46:12,080 Speaker 2: you want to support the show, become a subscriber to 752 00:46:12,120 --> 00:46:15,759 Speaker 2: the parent Data newsletter at parentdata dot org, where I 753 00:46:15,760 --> 00:46:18,279 Speaker 2: write weekly posts on everything to do with parents. And 754 00:46:18,400 --> 00:46:22,080 Speaker 2: data to help you make better, more informed parenting decisions. 755 00:46:22,640 --> 00:46:24,880 Speaker 2: You can subscribe for free or sign up for a 756 00:46:24,880 --> 00:46:28,239 Speaker 2: paid subscription, which comes with great benefits, including an ad 757 00:46:28,239 --> 00:46:31,760 Speaker 2: free version of this podcast and full access to literally 758 00:46:31,920 --> 00:46:35,560 Speaker 2: hundreds of my posts at parentdata dot org. If you 759 00:46:35,680 --> 00:46:37,360 Speaker 2: like what you hear, please leave the show or a 760 00:46:37,440 --> 00:46:40,480 Speaker 2: positive review on Apple Podcasts. It really helps people find 761 00:46:40,480 --> 00:46:41,120 Speaker 2: out about us. 762 00:46:41,400 --> 00:46:44,000 Speaker 6: Write Penelope, write Mom. 763 00:46:44,360 --> 00:46:45,280 Speaker 1: We'll see you next time.