New NIAID Guidelines for Preventing Peanut Allergy

The National Institute of Allergy and Infectious Diseases (NIAID) has issued new guidelines for the introduction of peanut containing foods to infants who are at high risk for the development of peanut allergy.  It has made the national news in Canada and has been seen as quite controversial, particularly in the food allergy community.  Read the details from NIAID:  https://www.niaid.nih.gov/diseases-conditions/food-allergy

Therefore, I had an email today asking my opinion on that controversy.  So here is what I emailed back – it’s my personal opinion only and should be taken as such:

This is a controversial recommendation only in some circles, particularly the allergy community.  The vast majority of the general public probably weren’t aware of previous recommendations.

The first controversy is for identifying high risk families.  Those are people who already have food allergies in the family and/or severe eczema and know that they are at risk.  Most first time parents have no idea about this and frankly, most general practitioner doctors know little about advising on the risk of food allergies (similar to little depth of knowledge about nutrition; they’re simply not taught about it).  So it’s not as likely that first-time pregnant mother and father would be apprised upon pregnancy and/or delivery that they were of high risk to start with.  However, those who take their children to pediatric specialists will be educated since since the pediatric doctors associations for both Canada and the USA have begun implementing these guidelines with their patients.  Like all education, it will take time to spread, especially through communities without the means to have specialized medical attention.

The second part of the controversy comes where the previous recommendations that we were to not introduce high allergenic foods (Canada has a top 11 list, US 8 and Europe 14) to babies before the age of 6 months, and if you were a high risk family, not to introduce them until at least age 3.  However, the science now shows that there was no reduction in the prevalence of food allergies during this time, in fact quite the opposite.  Food allergies continued to increase.  Additionally, we also know that food allergens are given to the infant through breastfeeding so it’s not just about first-hand introduction but also what the nursing mother is eating.

So now research tells us we’re better off introducing earlier rather than later and the Canadian Learning Early About Peanut (LEAP) study has provided us with some excellent information to build continued food allergy research on.  For the LEAP study results, read this link from the Canadian Medical Association Journal from October 2015:   http://www.cmaj.ca/site/misc/pr/19oct15_pr.xhtml

Parents who already have a food allergic child or who are very aware that they are high risk due to genetics or eczema (again, assuming they’ve been educated on this), are now terrified to give an allergenic food to their children (which is why they’ve also recommended doing it in a medical setting for high risk families) because they’re worried about first time anaphylaxis which is very scary.  At the same time, parents of food allergic children have a great deal of guilt/anxiety wondering if their actions caused the food allergy.  Was it because they DID give the allergen early or because they DIDN’T know that they were supposed to wait or did they CAUSE it unknowingly through nursing?   There are no easy answers.

Of course, there are still children who will react no matter what precautions are taken both in high risk families and those who have never had anyone in their family with either food allergies or eczema.  We still know so little about the mechanisms that “turn on” food allergies.

My husband and I both personally believe that in our family’s situation, it had to do with both of our children needing heavy doses of antibiotics before by 3 months for our eldest and 9 months for our youngest, along with being a high risk family (I have asthma, eczema, environmental and sulfa allergies and Rob is allergic to shrimp and clam).  Additionally, our youngest had severe eczema.  We wouldn’t change that our children were given antibiotics (both were organ saving/life saving interventions) but what we now know about the gut biome might have helped us with nutritional recovery to build gut health back up in both of our children.  My eldest outgrew her food allergies (dairy and soy) at the age of 1 but now has an autoimmune disorder while my youngest continues to have 4 life-threatening food allergies after also outgrowing dairy by the age of 1.

So that’s my two cents – whatever that’s worth!  What are your thoughts?