At this moment in history, many of us are appreciating just how fast scientific research can advance when experts join together to save lives. I didn’t need the COVID-19 crisis, however, to notice this power. For the last few years, I’ve had the privilege of being involved with the effort to prevent food allergies in children, and the advances we’ve made in the past decade only seem to be accelerating. Science is unfolding that helps shine the light on a whole new field of prevention medicine. As a result of what I’ve witnessed, I foresee a time when my grandchildren can enjoy a simple pleasure that I recall from my own childhood: treating their classmates to homemade cupcakes. What makes me so optimistic? Let’s look at where we’ve been and where we’re going.

 Food allergies remain a huge problem for today’s children. The potentially deadly reactions to common foods affect 8% of US kids, more than doubling between 1999 and 2018.1,2 In the average elementary school classroom two children will have food allergies, making a cupcake that might contain traces of peanut, egg white, or milk into a frosted time bomb.1 Most parents are alert to the threat of peanut allergy, but peanuts as a single allergy only account for 7% of the food allergy population.1,3 This means over 90% of people in the United States with food allergies have an allergy in addition to, or different from, peanut alone. Almost 40% of affected children react to more than one food.1 This isn’t just a peanut problem.

 Until five years ago, we all thought we knew what to do to avoid food allergies: restrict children’s intake of allergenic foods as long as possible.4,5 The drawers of my old office still hold moldering handouts instructing parents not to allow their children to eat peanuts until age 2 or 3 years and to avoid eggs for at least the first year of life.5 It turns out that this advice was worse than wrong, it was backwards! Food allergies continued to rise as pediatricians like me cautioned against eating potential allergens during infancy.6 Enter the LEAP trial, the study that turned the food allergy world upside down.7

 The LEAP researchers were intrigued by what seemed to be a paradox: in Israel, children teethed on Bamba, a peanut-based cookie, and these children had lower rates of peanut allergy than those in countries that followed the food avoidance advice popular at the time. Using carefully calibrated exposure to peanut proteins, the researchers showed that high-risk children who started eating peanut products during infancy (as young as 4 months of age) and continued until they were 5 years old, were 81% less likely to develop peanut allergy.7 Amazing news! The floodgates opened, and what poured out was peanut butter.

 Behind it came an outpouring of creatively named studies: EAT, PASTURE, IM EATING —never have so many doctors worked so hard at crafting acronyms.8–10 But even as the art of naming studies advanced, the science of preventing food allergies advanced farther. We learned that early introduction of allergenic foods — peanut, egg, milk, fish, sesame, wheat, soy — was safe and well-tolerated in breastfed infants as young as 3 months of age which further endorsed the value of diverse foods in the diet.8 The term “diet diversity” is meaningful and packs a powerful punch. Research published this year found that when infants are exposed to a diverse diet early in life, sustained over time, it may reduce the likelihood of children developing food allergies by up to 96% in the first 10 years of life.11

 Where science leads, technology follows, and now the food industry is working to develop products that make parents’ lives easier. It’s a challenge for families to get food diversity into their babies every day when their immune systems are most open to learning, the so-called “critical period of immune development.” Can you figure out a good recipe that incorporates proteins from peanuts, eggs, milk, wheat, fish, and soy that your 4 to 6-month-old infant can safely enjoy every day? If you can, please share! But if you can’t, don’t worry, companies like SpoonfulOne are making it easy for you by using research to determine how the immune system learns from exposure to diverse foods early and making it easy for you to get your baby’s tummy exposed every day as they are growing up. I’m looking forward to the widespread adoption of such foods so that one day I can share my mother’s cupcakes with my grandchildren’s classmates. Science, innovation, smart recommendation, and convenience….yum.

  #SpoonfulOnePartner *Dr. Hill is a scientific board member and advisor for SpoonfulOne and Before Brands.

Bibliography

  1. Gupta RS, Warren CM, Smith BM, et al. The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States. Pediatrics. 2018;142(6). doi:10.1542/peds.2018-1235
  2. Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128(1):e9-17. doi:10.1542/peds.2011-0204
  3. Gupta RS, Warren CM, Smith BM, et al. Prevalence and severity of food allergies among US adults. JAMA Netw Open. 2019;2(1):e185630. doi:10.1001/jamanetworkopen.2018.5630
  4. Høst A, Koletzko B, Dreborg S, et al. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child. 1999;81(1):80-84. doi:10.1136/adc.81.1.80
  5. American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000;106(2 Pt 1):346-349.
  6. Anvari S, Chokshi NY, Kamili QUA, Davis CM. Evolution of guidelines on peanut allergy and peanut introduction in infants: A review. JAMA Pediatr. 2017;171(1):77-82. doi:10.1001/jamapediatrics.2016.2552
  7. Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372(9):803-813. doi:10.1056/NEJMoa1414850
  8. Perkin MR, Logan K, Tseng A, et al. Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants. N Engl J Med. 2016;374(18):1733-1743. doi:10.1056/NEJMoa1514210
  9. Roduit C, Frei R, Depner M, et al. Increased food diversity in the first year of life is inversely associated with allergic diseases. J Allergy Clin Immunol. 2014;133(4):1056-1064. doi:10.1016/j.jaci.2013.12.1044
  10. Holl JL, Bilaver LA, Finn DJ, Savio K. A Randomized Trial of the Acceptability of a Daily Multi-Allergen Food Supplement for Infants. Pediatr Allergy Immunol. February 2020. doi:10.1111/pai.13223

11. Venter C, Maslin K, Holloway JW, et al. Different measures of dietary diversity during infancy and the association with childhood food allergy in a UK birth cohort study. J Allergy Clin Immunol Pract. January 2020. doi:10.1016/j.jaip.2020.01.029*

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