This was the only allergy picture that didn't show a woman about to fake sneeze into an oversized tissue against a white background. Photo from Deposit Photos.
If you want to get into a heated playground debate, tell someone you’re
feeding your baby peanut butter. Parental advice is practically a blood
sport—especially when it comes to potential anaphylaxis—and it’s not
without reason. But the truth is that most parental units are probably
not up to date on the latest and greatest ways to keep their kids
Immunologists and allergists have faced an uproar in the last couple of
years, because new evidence suggested that their advice on administering
peanuts to children was entirely backwards. The prevailing wisdom used
to say that you should wait until age two to introduce your kids to
common allergens. Now suddenly you're supposed to give them peanuts
before they're a year old. This seemed, to many people, to be some kind
of admission of ignorance, and solid grounds to dismiss the entire
field. In reality, it's just how science works—physicians give the best
advice they can, and when new evidence comes along that suggests they're
wrong, they have to switch sides. It may be true that some things about
are still up for debate, but there's still plenty of conclusive
evidence that parents could use to keep their children healthy. We just
have to be clear about what's proven, and what's still in need of
What are allergies, anyway?
Allergies are a broad, diverse group of ailments unified by the principle of hypersensitivity. When a person's immune system
starts overreacting to an otherwise harmless substances—like peanuts or
pollen—it becomes an allergy. Your body produces far too much of an
immune response when it detects an allergen, so much so that some people
go into anaphylactic shock. Others just get itchy, or bits of them
swell up, but they're all related responses. Your body is trying to
fight what it thinks is an invader.
still not entirely sure why they develop in some people and not others.
It seems like a combination of genetics and environmental exposure.
What you eat, where you live, who your parents are, how many allergens
you’re exposed to—they all seem to influence your risk. Which is why so
many parents hope to find the right set of conditions to keep their kids
Allergy Rates Are Rising, Even in Adults
But while many parents have these intentions, it seems like every time we survey the American public there are even more food
allergies. Shellfish reactions are up 7 percent, tree nuts are up 18,
and peanuts up by 21. These numbers are courtesy of asurvey presented
this week at the American College of Allergy, Asthma, and Immunology conference, which sampled over 53,000 U.S. households. This rise is almost certainly the result of a combination of factors, but one of the stand out explanations is known as the hygiene hypothesis.
heard it before: kids just aren’t playing in the dirt enough. Young
bodies have to learn how to differentiate dangerous substances from
harmless ones, and if you don’t expose your child to enough would-be
worldly allergens, their immune systems are more liable to get confused.
there’s the influence of antibiotics. A healthy bacterial flora seems
to ward off allergic diseases, so perhaps our propensity to dole out
antibiotics for even minor ailments has hurt our immune systems overall.
Vitamin D deficiency and obesity have also been linked to asthma and
allergies, though the exact mechanism behind this potential connection
is still unclear. And there’s the fact that for many years we told
parents not to give kids allergy-inducing foods until age two, which we
now realize was exactly the opposite of what we should have been doing.
it’s not just kids who are developing more inflammatory reactions. That
same survey found that 45 percent of people with food allergies didn’t
develop them until adulthood. Shellfish seems to be the most common
culprit. Children have the highest proportion of peanut allergies, but
by the time they’re grown up, shrimp has overtaken Skippy’s as public
enemy number one.
still not entirely sure what causes allergies—it’s probably a
constellation of combined attributes—or why certain groups of people
tend to be at higher risk. In the United States, black people generally
develop more allergies. Australia has one of the highest rates in the
world, and immigrants who arrive there from lower-risk countries tend to
have children with increased risk, which suggests there are
environmental factors at work.
There's Still Some Resistance to Giving Peanuts to Babies, Despite All the Evidence
peanut allergy rise could come to an end soon, though it depends on
parents and doctors following the newly-prescribed advice on introducing
allergens to children early on.
January 2017, the National Institutes of Health officially revised its
recommendation on peanut exposure, saying that kids who aren't at any
especially high risk for allergic diseases should be fed peanuts around
age 4-6 months. This was based on a massive study published in the New England Journal of Medicine
back in 2015, showing that kids who ate peanuts at that age were 80
percent less likely to develop an allergy to them. A follow-up study
found that the exposure even protected those who didn't continually
consume the legumes after that first tentative taste. Even high-risk
children should be evaluated to see whether they truly have a reaction,
or whether early introduction could help prevent further development of a
a small survey of pediatricians, also presented at the ACAAI
conference, suggests they aren’t necessarily pushing that advice onto
patients. More than three quarters told their patients to introduce
peanuts later than 4-6 months, and nearly half weren’t testing their
high-risk patients before exposure. The vast majority weren’t fully
following the NIH guidelines.
clinical guidelines, it takes 10 years before they’re fully implemented
in practice,” says Dave Stukus, an associate professor of pediatrics at
Nationwide Children’s Hospital and a spokesperson at the American
College of Allergy, Asthma and Immunology. Stukus was part of the group
that drafted the peanut guidelines at the NIH earlier this year, and he
knows it’s not going to happen overnight. Physicians have to be brought
up to date and educated about how to communicate with their patients.
The hardest people to reach, in Stukus' experience, are the parents with older children who already have
peanut allergies. They can be upset about the sudden switch in
recommendation, and wary of the logistical nightmare of introducing a
baby to peanuts in a household where another child is allergic. "You
have to take the time to explain why the changes are taking place and
what the potential benefits are," he says. "Once you do that, people are
very excited about it."
Having Eczema as a Baby Can Be an Early Sign of Later Asthma and Allergies
might seem unrelated to allergies and asthma, but research has been
building up a theory that eczema early in life can progress into serious
immune problems. The idea is called "atopic march"—atopy is the tendency to develop allergies. The link between eczema and later immune issues
may in part be a predisposition to developing multiple immunological
diseases, but more studies are suggesting that there's also a causal
“eczema” is actually a blanket term for a variety of related skin
problems, many people think of it as a fairly random condition. But the
most common type—atopic dermatitis—is essentially the result of a
defective patch of skin that overreacts to irritants.
eczema, you have an altered skin barrier where the surface is sort of
broken, and it allows moisture to escape. That’s why you get the dry
skin,” explains Stukus. “But the barrier works both ways, so it’s also
letting allergens in when maybe it wouldn’t be if it weren’t impaired.”
That extra exposure and inflamed immune response could sensitize kids to reacting more easily to allergens,
which could prompt the development of asthma and other allergic
responses. "I see this every day in the clinic," says Stukus, "and I
tell my colleagues 'listen, when you have a baby with terrible eczema,
they're declaring themselves to you that they're maybe predetermined to
have allergies and asthma." Eczema gets better after a year or so, and
you probably won't see environmental allergies until age two or three,
and then asthma takes even more time to develop—but they're probably all
What should parents do with this information?
of babies with eczema should consider going to an allergist, who will
have experience treating and managing hypersensitive kids. Your baby
could be tested for peanut allergies before you expose them, just in
case they’re likely to have a severe reaction; the exposure could even
take place in a doctor’s office for safety. It's become pretty common
for parents to pick a spot close to an emergency room for their kid's
first taste of peanut butter.
general, it seems clear that parents should try to introduce allergens
early on. All the evidence suggests that this will actively help
children avoid allergies later. If you’re worried, head to an allergist.
They’ll be able to walk you through the process and address your
concerns, and even provide a plan for how to proceed. It’s scary, but
necessary—and allergies are no joke.