Friday, February 27, 2015

Landmark Peanut Allergy Study: The media is not impressed

Ground-breaking studies are rare. This is one of them. The first randomized trial of peanut consumption in infants at risk for peanut allergies (eczema, egg allergies). A study out of London provides the first strong evidence, experimental evidence, that eating peanuts early in life prevents peanut allergies. Half the kids received nuts between 4 and 11 months and continued eating them regularly (early exposure), the other half, no nuts at all (early avoidance). Later at age 5, children who ate nuts were significantly less likely to have a peanut allergy - only 2% became allergic, compared to 14% who avoided nuts.

Several years ago the current research team, led by Gideon Lack, found Jewish children raised in the UK had 10 times the rate of peanut allergies as Israeli children. The first group generally avoided nuts, the second, ate them as infants. The results got people wondering whether early avoidance was the wrong approach.

Huge implications here. HUGE.

The WHO recommends early avoidance of nuts. In 2000 the American Academy of Pediatrics started recommending children should delay eating nuts until age 3, those at most risk, not until age 8. Naturally, pregnant and breastfeeding women were also told not to eat nuts. Then in 2008 the AAP retracted its early avoidance recommendation citing a lack of evidence for its support. So the pediatric group now doesn't push early avoidance but it does not recommend early exposure as a prevention of allergies. Maybe it will soon. Some high-profile doctors are calling for immediate changes, namely testing at-risk infants for peanut allergies and for those not yet allergic, providing them with small doses of peanuts.

What a reversal. This kind of sweeping change does not often visit the parenting public, certainly not results with such life-altering consequences. Savor it. Relish it. Empirical evidence answering some very important questions.

This is a big moment. Big news. No, I am not being snide, I really mean big news this time.  

"This is a major study — really what we would call a landmark study," says Scott Sicherer, who advises the American Academy of Pediatrics on allergies. "There's been a huge question about why there's an increase in peanut allergy and what we can do to try to stem that increase. And this is a study that directly addresses that issue." NPR 
"For a study to show a benefit of this magnitude in the prevention of peanut allergy is without precedent. The results have the potential to transform how we approach food allergy prevention." Anthony S. Fauci, M.D., National Institute of Allergy and Infection Disease, Science  Daily
"This is transformational, it's the first time it's ever been done...Recent advances in research have shown that you can be desensitized once you have it. Up until now, there hasn't been any research on how to prevent it," says Dr. Lee Tak Hong, director of the Allergy Centre of the Hong Kong Sanatorium and Hospital. CNN

The media, of course,  responded to the enormity of the occasion:

Early Consumption May Prevent Peanut Allergies, New Study Suggests CNN 
Feeding Babies Foods With Peanuts Appears To Prevent Allergies NPR 
Feeding Infants Peanut Products Could Prevent Allergies, Study Suggest Well Blog, New York Times 
Eating Peanuts Early Could Prevent Allergy in Infants Yahoo News

 Could. May. Appears. Suggests. 

This was the moment, my dear headline writers, to pull out the causal language, the GROUDBREAKING STUDY - as opposed to the times writing about all those studies of questionable or limited societal or scientific import. You know, the ones that get the causal, dramatic treatment every other day. I mean, seriously, now you get hesitant? This is what happens when we become de-sensitized to dramatic news articles and headlines. If every study reportedly shows A Causes B, when the big study comes along showing A causes B, then people don't recognize it. The little studies start looking big and the big ones, not so great. Yikes. It might also be the case that given the gravitas of the study, the media chose to pull out the caution. I don't know. I wish I did. 



You can read the study for free right now at The New England Journal of Medicine. 

2 comments:

katja said...

Again with avoidance we saw a sweeping recommendation made without sufficient evidence that ended up causing more harm than good. Thanks for this article.

Polly Palumbo, Ph.D. said...

Hi Katja, yes, like say, the no screens for under twos policy? Or two hours or less of screen time for those two and older? Or breastfeeding for one year? Is that the tip of the ice berg? Any others?