Saturday, March 05, 2016

Peanut Allergies Versus Breast-Is-Best: The battle begins

Did you catch the new peanut allergy study in the news this week? A follow-up to last year's landmark trial last year provides further evidence that exposure to peanuts in infancy prevents peanut allergies. The latest LEAP study showed a peanut mush protected kids at high risk at least until 6 years old, the age of the kids at the end of the trial. This protection or tolerance remained even for the kids who didn't get the weekly peanut dose for the last 12 months. This finding suggests kids are able to keep up their tolerance even without regular peanut consumption. This is very welcome news. 

There isn't yet a lot of media coverage thus far. But there is one very interesting repercussion of these studies. Yes, its implication for Boob-Is-Best, specifically the WHO's and every other pediatric body's recommendation for exclusive breastfeeding until age 6 months. The new peanut studies directly challenge the exclusivity part by promoting the introduction of peanuts before 6 months. The research suggests introduction of peanuts should occur at least by 4 months. 

Amazingly, the New York Times article on the new study takes up breastfeeding in the second paragraph and quotes one of the stars of the food allergy world, Gideon Lack (with by far the best name):

“At least as far as peanut is concerned, I would recommend parting from that,” Dr. Gideon Lack, professor of pediatric allergy at King’s College London, said in an interview. Well column, New York Times

So we're headed to a show-down of public health policies. As a mother, there is no way I'd choose exclusive breast milk over the prevention of food allergies. Not a chance. The evidence for exclusivity in breastfeeding is particularly weak, even compared to other breastfeeding research. Pediatricians and some researchers have questioned it in the past. It's more than time public health officials here speak frankly about its paltry evidence and now, risks. 

Let me repeat, there are risks to adhering to the official 6-month exclusive breastfeeding recommendation. 

This doesn't invalidate the breast-is-best, in fact there is some evidence breastfeeding during the introduction of foods might protect children from allergies. Of course there is also evidence it might promote some food allergies. There is no reason at this point breastfeeding and food allergy prevention can't peacefully co-exist. It's the public health experts, including the AAP, the CDCs and the WHO who have turned the infant feeding recommendations into this stringent state and insisted on only feeding breast milk for the first six months - that has now put families in this position. 

Public health authorities need to re-think their position immediately. Their continuing insistence on exclusivity for 6 months (in the face of lackluster evidence) puts kids at risk and they should be held responsible for the promotion of peanut allergies. At the very least they need to acknowledge exclusive breastfeeding for 6 months puts high-risk children at even higher risk of peanut allergies. 

The research involving food allergies and infant feeding is complicated for a number of reasons, both from a methodological and a logistical perspective. It's a challenge for researchers, statisticians, and let's not forget, the children who bravely participate.  

This research doesn't happen without the families who enrolled in this study with great potential risk to their children and not a little stress or anxiety. I don't often mention the volunteers who make this kind of research possible but I will now - thank you to you all, for your time, your persistence and courage. 

What would you choose? The murky benefits of exclusively breastfeeding for 6 months or protection from peanut allergies and possibly other food allergies?



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