Nuts
February 24, 2015 at 7:22 PM by Dr. Drang
When I ran across this New York Times article last night, I had a bad feeling. In classic inverted pyramid style, the gist of the article is in the first paragraph:
Turning what was once conventional wisdom on its head, a new study suggests that many, if not most peanut allergies can be prevented by feeding young children food containing peanuts beginning in infancy, rather than avoiding such foods.
Today I saw it at the top of the “most emailed” list the Times runs in its sidebar. This could be because lots of people are interested in peanut allergies, or science and medicine in general, but I suspect it’s really because the article confirms many people’s preconceived notions about overprotective parents, malpractice-averse doctors, and an alarmist press corps.
In fact, I don’t believe the reported study turns conventional wisdom on its head at all. Most of the people I’ve met who don’t have a child with peanut allergies were already certain that the problem was, if not entirely in the heads of a group of Munchausen-by-proxy parents, then certainly due to kids being raised in environments that are too clean, too safe, and too antiseptic. For these people, it’s obvious that exposure to peanuts will toughen up a kid’s immune system, and it’s about time doctors recognize that.
I am, as you’ve surely guessed by now, not a disinterested party in this matter. I’m not exactly sure when my wife and I realized our third child, Matt, had peanut and tree nut allergies, but he was pretty young. A little peanut butter at the corner of his mouth caused that side of his face to puff up and squeeze his eye shut. We thought back to a couple of times when he was even younger and had become suddenly sick for seemingly no reason. In one case he’d just eaten a piece of cookie that—we guessed in hindsight—had traces of nut in it.
Had we been especially cautious in what we fed Matt? Not really. He was, as I said, our third child, so we had the cavalier attitude common to experienced parents. Matt certainly didn’t get the intense scrutiny our oldest did. We fed him what seemed right based on what his older sister and brother had eaten when they were his age, adjusted for his apparent tastes and tolerances.
His tolerance for peanuts and nuts was essentially zero. When he went in for allergy tests, his reactions to the pinpricks on his back were so severe the allergist would stop the test before it was finished. When Matt was in elementary school, my wife once had trouble getting his EpiPen prescription filled at Walgreen’s. The pharmacist had no experience with a boy his age getting the full-sized EpiPen. He was sure the prescription should have been for an EpiPen Jr., but he was wrong.
Don’t get me wrong. I’m not saying the study is invalid or unimportant or that the Times did a poor job of reporting it. It would be wonderful if it leads to effective methods to reduce peanut allergies. I do, however, think this passage could have come earlier than the 16th and 17th paragraphs:
The study, sponsored by the National Institutes of Health and other organizations in the United States and Britain, involved infants 4 to 11 months old deemed to have a high risk of peanut allergy because they already had severe eczema or were allergic to eggs.
The infants were given skin-prick tests for peanut allergy. Those already allergic to peanuts were excluded from the study.
So this study has nothing to say about kids who have a peanut allergy before their first birthday.1 But that won’t stop your crazy uncle from emailing you the article and saying he knew it all along.
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Actually, if you go to the New England Journal of Medicine article on which the Times story is based, you’ll learn that it’s more complicated than that. In the pre-trial screening, 542 children had no reaction and 98 had a relatively minor reaction to the skin-prick test. These were the children that were accepted into the trial. Excluded from the trial, and for good reason, were the 76 children who had a significant reaction to the pre-trial skin-prick test. ↩
