60k Kids Have Avoided Peanut Allergies Due to 2015 Advice, Study Finds

They know that skin and mucosa sensitization can occur in response to allergens.

A reasonable hypothesis is that there’s some boot-up process with the immune system that needs to occur before anything happens. The kids are dying today. “Avoid the thing that can cause sensitization” is a conservative position.

It is unusual that it should have been opposite and that oral exposure induces tolerance. It’s the fog of war.

The standard conservative intervention has helped in the past: I’m pretty sure seatbelts didn’t have strong mortality data before they were implemented. If it had turned out that more people were killed by seatbelts that trapped them in vehicles it would make for a similar story. I think they also got rid of all blood from donors who were men who have sex with men during the initial stages of the HIV pandemic (no evidence at the time).

Edit for response to comment below since rate-limited:

Wait, I thought it was on the order of ~150/year people dying from food anaphylaxis though I didn’t research that strongly. It was off my head. If you’re right, the conservative advice seems definitely far too much of an intervention and I agree entirely.

For instance the "cry it out method" did massive amounts of psychological damage to more than one generation, but it seemed to work in the short term as the babies eventually learned to "self-soothe".

Even now I still see parents and grandparents suggesting it in parenting groups; and taking extreme umbrage at the idea that it might have damaged them/their children.

Anaphylactic shock is scary and peanut fear was a big deal in the late 1990s but actual risk of harm was very low. The guidance was more about the psychosocial burden placed on parents when there was no guidance. Anxious parents have been studied, that mechanism is reasonably well understood and that harm can be quantified.

For example: https://www.nejm.org/doi/full/10.1056/NEJMoa013536 https://d1wqtxts1xzle7.cloudfront.net/74207249/j.1399-3038.1...

It is also the case that after sensitization, avoiding the food can lead to eventual desensitization (although it is riskier in the meantime), which was interpolated to support avoidance: https://onlinelibrary.wiley.com/doi/abs/10.1002/j.1536-4801....

I hadn't heard of this. Very intriguing that only camp infants would be affected.

Not just parents sheltering kids. Take a look at this (in)famous tweet https://x.com/d_spiegel/status/1271696043739172864 from *June 2020* ...

"[eg] women aged 30–34, around 1 in 70,000 died from Covid over peak 9 weeks of epidemic. Over 80% pre-existing medical conditions, so if healthy less than 1 in 350,000, 1/4 of normal accidental risk"

It will be interesting to see what happens with allergies for those who were born in the 2020-2023 timeframe.

The thing I'm a bit curious about is how the research on peanut allergies leading to the sort of uhhh... cynic's common sense take ("expose em early and they'll be fine") is something that we only got to in 2015. Various allergies are a decently big thing in many parts of the world, and it feels almost anticlimactic that the dumb guy take here just applied, and we didn't get to that.

Maybe someone has some more details about any basis for the original guidelines

In 2000, the American Academy of Pediatrics recommended not allowing your kids peanuts until they were 3 years old. It was just parents following doctor's (bad) advice.

Are there missteps? Certainly. Figuring out what is effective, what has bad secondary effects (fragility, allergies etc) and what is simply wrong is an ongoing effort and that's great, but less dying is a pretty nice baseline and progress on that front is inarguable.

For baby number 2, soap and water is enough. There's no time for Sterile Field nonsense. This kid isn't allergic to anything.

There was a local mom who had 4 thriving kids. When their baby dropped the pacifier in the dirt, it just got brushed off and handed back to the baby. I don't think those kids had any allergies.

The hygiene hypothesis is not impossible, but evidence for and against it is questionable. But anyway, for peanuts it's not the hygiene.

It's a much more complex mechanism that retrains your immune system from using the non-specific rapid-response allergic reaction to the T-cell-mediated response.

The same method can be used to desensitize yourself to poison oak or ivy. You need to add small amounts of them into your food, and eventually you stop having any reaction to urushiol contact with the skin.

The real problem is some of those claims and reports were true, but we were so inundated with the rhetoric that everything was going to kill us that many of us sort of lapsed into apathy about it. Stepping back, the food industry in the US clearly does not have consumer health at heart and we struggle to find healthy options that avoid heavy processing or synthetic fillers. Those parents who sheltered their babies back then may have been on to something when it came to stuff we consume and we should have been on the path to demand better from our food sources had more of us been more diligent with our grocery choices (myself included, at the time), but instead we ended up with bread that lasts unnaturally long and has an allowable amount of sawdust as an ingredient.

I don't agree that this is "all" that it has done.

There are many cases where reducing exposure as much as possible is the correct thing to do. Lead is the best-known example.

As the other reply pointed out, the second-order effect, the nuance that comes later is that sometimes this isn't the right thing to do.

But it would be basically incorrect to reduce it to blanket, binary, "all good" vs "all bad" black-or-white conclusions, just because the there is a smaller course correction when it's found out to be not entirely good. Concluding that "all it's done is cause problems" is a knee-jerk reaction.