Friday, January 06, 2017

New Guidelines for Peanut Allergy Prevention: Feed Peanuts Early!

Yesterday the National Institutes of Health announced new guidelines for preventing peanut allergies. The NIH’s National Institute of Allergy and Infectious Diseases (NIAID) amended their clinical guidelines in light of “emerging data suggesting that peanut allergies can be prevented by the early introduction of peanut-containing foods.”

This is it. Happy New Year. Happy Holidays. Happy Birthday. Happy Anniversary. Happy Everything, because this is a big gift of sorts, overdue in my humble opinion. What I and many others have been waiting to hear for almost almost two years now.

Many of you might recall the LEAP study, the 2015 landmark trial that turned the peanut allergy advice upside down, sideways and then tossed it in the trash. The study outright refuted the existing guidelines implemented in 2000 – the ones espousing early avoidance. Remember the advice? No nuts until 4 to 6 months for most kids. None until age 3 for high-risk kids, even older in some cases. No nuts in pregnancy either for high-risk families (hand raised, you too?).

Not only did LEAP refute early avoidance, the randomized experimental trial showed the practice CAUSED peanut allergies. Yep, the official recommendations created more allergies. Kids who didn’t get the nuts early on ended up with more peanuts allergies. Kids at high risk who got fed peanuts as babies were significantly less likely to have peanut allergies.

Incredible news. Remember, LEAP was the first randomized trial pitting early avoidance (no nuts early, even in pregnancy) versus early exposure. Just huge. HUGE. The media downplayed the headlines a bit, if you remember from my post from back then. Landmark Peanut Allergy Study: The Media Is Not Impressed.  [Recap: Basically, in a reversal of common practice, the media showed unusual restraint in talking about the findings. Curious since it was causal evidence, an experiment, so stronger than correlational research, the latter the kind that so often get misinterpreted, exaggerated really, as causal in the reporting and headlines.]  

Sure, public health minds across the globe got together in the wake of LEAP to noodle on what to tell everybody. Although they agreed early exposure looked pretty darn promising, they made nothing official. Until, finally, yesterday, NIAID released the new guidelines:

Kids at high-risk: Peanuts first between 4 and 6 months
Kids at moderate-risk: Peanuts first before 6 months
Kids at low-risk: Peanuts any time

(High-risk kids have severe eczema or egg allergies. Moderate risk means moderate or mild eczema.)

How Did the Media React?

I probably need not remind anyone here of the increasing incidence of peanut allergies nor the significant toll it can have on children and families. Nor the likely possibility that early exposure contributed to a tripling of the incidence of peanut allergies in the US over the past 10 to 15 years. Preventing peanut allergies is a significant national, no, global public health issue with great human costs. There is no question this tremendously critical public health announcement merits serious news coverage. If there were an occasion that children’s health deserves the front-page or homepage, this is it.

Did it happen?

Yes, The New York Times published it on Page A1 yesterday in the print version with the title Feed Children Peanuts Early, Doctors Advise. Today, one day later, it’s not on the homepage any longer but in Health as the lead story. Feed Your Kids Peanuts, Early and Often, New Guidelines Urge.

The Washington Post had it on the homepage most of the day too. Yippee. USA Today too.

The Los Angeles Times still has it on the homepage. It’s down at the way bottom, keep scrolling, keep going until you get to the science section, there, the second story. Give peanut-based foods early to prevent…

It was nowhere to be found today on The CNN homepage*. In fact there were no child health stories there unless you count “Is Cereal Healthy?” - but they did put it in the health section. 

Not on the Fox News homepage today either even though they have separate sections at the bottom for Family and another for Health. Even though you can read crucial news like the opening of a new roller coaster at Sea World San Diego.

Not on the homepage at HuffPo either.

Frankly it frustrates me that news of value to parents does not tend to land or stay on the homepage. Kids and families are relegated to the less serious news sections. As if the health and well-being of your child or any child for that matter, is not as important as well, politics, business, sports, international affairs, celebrities, you name it. You know it’s bad when a person has to scroll through such dreck as Doctors Find Brain and Skull in Teen’s Ovaries to find out about the latest peanut recommendations. Please, if a parenting or children's health story lands on the front page or homepage, email me or tweet me, because I do not want to miss it. After a few hours, it might get shoved into the health section and I might not know it until my mom or dad sends it to me. 

Anyhow.....I wonder when and how the American Academy of Pediatrics will update their guidelines. Especially the exclusive breastfeeding rec. One thing is certain, you will never see the AAP make this announcement:

CAUTION: Breastfeed exclusively for 6 months at your child’s peril.

I’m telling you, this is going to get interesting. I’m curious whether even earlier exposure would help more children? I have to go read the new paper more thoroughly. 

My hubby wanted to know why all kids weren't instructed to nibble on nuts earlier. It's a complicated issue. The entirely too short answer involves the fact that the LEAP study only involved high risk kids. It is not known what happens when kids at low and moderate risk get nuts early. So it's a balancing act. The officials have to make decisions based on lots of grey areas - namely the potential risks and benefits of feeding a known allergen to one group that is already at medium risk of developing the allergy and another, at only low risk. The latter group, they seem to be doing just fine under the old guidelines. When they get nuts doesn't seem to be an issue for them. So why upset their apple cart? 

The medium risk kids, they are challenge. For them, the risk of peanut allergy has to be considered with the unknowns, the uncertainties of feeding kids early nuts and hence the 6 months instead of 4 to 6 month window. 

Already 2017 has delivered one gift, more hope for peanut allergy prevention.

Cheers.


UPDATE: CNN did feature the article on their homepage January 5th, but not as one of the featured stories. 

Also, I wanted to thank the brave families who agreed to participate in all the above research. Besides the considerable health risks involved, participating required a large time commitment. So thank you.

For more info on what the new guideline mean and don't mean - especially for children already diagnosed with peanut allergies - check out this post on HuffPo by my friend, Lianne Mandelbaum, The Nut No Traveler. Let Them Eat Peanuts - Do You Really Understand What the New Guidelines Mean?

Wednesday, November 16, 2016

Backlash against Experts and Media

Whatever we might think about current events in the United States, most of us could probably agree a backlash against traditional authority and expertise has ripped through the place. A fair share probably agree this discontent and distrust extends to experts in general, for instance, in the media, the economy, the educational system, and the sciences.

So I feel the need to get something off my chest.

It’s no secret, I have a complicated relationship with experts and the media. To put it mildly. I’ve spent years of my life, my entire career really, immersed in expertise and research one way or another. Although I'm not a journalist, I've been a parenting columnist, a writer, and a blogger so I guess I'm part of the media. Yet I have spent the past decade or so debunking experts and news about kids, questioning the claims, the reporting, studies, evidence and even the expertise of some supposed experts. I’ve urged parents to do the same. I’ve urged you to do the same. To think critically, carefully, about news and advice, including the sources reporting it and the evidence behind it.

Now on first glance, this approach might sound like I’m suggesting all experts and media are worthless and should be fired. Ignored. Tossed in a new circle of hell roiling with pundits, publishers, and mommy bloggers posting the same useless or flawed advice over and over again. And researchers so in love with their own beliefs they keep finding the same thing over and over. On some days, out of sheer frustration I might have been tempted to suggest this course of action. Also, I admit, there have been times I might have used too much snark and had too much fun.

But I want to make something absolutely clear - I still believe in experts and the media even if they are imperfect.  


I NEED them. I need the news media to evolve in this new digital economy, and do a better job at cutting through the swath of information and misinformation in this post-fact era when even the facts seem up for grabs. Yes we all need the writers and news organizations trained and devoted to discovering and communicating reliable, credible, nuanced, accurate and unbiased knowledge, including scientific knowledge. Of course we also need the researchers, pediatricians and other professionals working with children steeped in experience and expertise. We will need to rely on them in this highly fractured, everybody and anybody can play an expert or can-dig-up-or-do-a-study world - with more news, more experts, more outlets, more platforms, more claims, more spin, more opinion, more evidence, more studies, more sophisticated science than ever...as traditional newsrooms (how quaint that even sounds), the Washington Posts, New York Times, etc. continue to shrink and more people turn to social media for their news and hopefully someday Facebook and Google stop promoting unreliable news and outright fake news. It is only a matter of time before FB starts hiring all the unemployed editors and reporters to start producing their own news. (Then will they care about the accuracy of news and information?) 

We need to talk about the experts more. And the media. And not just when it comes to politicians and elections. This is my hope for the coming year.