When my son was eight months old, I gave him egg whites for breakfast. Fifteen minutes later, as the hives on his face expanded before my eyes, I was being grilled in an exam room by the on-call pediatrician. “Can you explain to me why you decided to introduce egg whites before the AAP recommends?”
Feeling more than a little ashamed and defensive I explained I hadn’t introduced egg whites before the American Academy of Pediatrics’s (AAP) recommended guidelines. The AAP hadn’t recommended restricting highly allergenic foods for low-risk children since at least 2008 and this was supported by guidelines from NIAID, the National Institute of Allergy and Infectious Diseases.
The pediatrician looked over my son, said the reaction was mild and he would likely outgrow it (he has), and said the last he checked egg whites weren’t to be introduced before 12 months, motioned towards my son and said “and this is why.” He left the room with what could be interpreted as a door slam.
This incident made me realize two things: 1. My regular pediatrician was awesome and I never wanted to deal with this guy again and 2. There are real-world implications when practice lags behind science.
The New England Journal of Medicine released a study and editorial last Monday concerning a new strategy for combating peanut allergies. The materials imply that I did make a mistake when I gave my son egg whites for the first time, but not the mistake my grumpy substitute pediatrician thought.
But first, let’s breakdown what the study actually says:
- The trial’s participants were infants (between ages four and eleven months) with a known egg allergy or eczema, both considered high risk for developing a peanut allergy;
- Because the trial involved infants at high risk to develop a deadly allergy to peanuts, the trial was not “double blind,” meaning that both the researchers and the parents knew if the children were being given peanut protein or were avoiding it;
- Participants were given small but increasing amounts of peanut protein;
- At five years old, only 1.9% of participants that had been given small amounts of peanut protein had developed a peanut allergy, compared to 13.7% in the avoidance group.
- In total the trial included 628 participants, 530 of which tested negative for peanut allergies at the start, and 98 infants that tested weak positive.
In the blogosphere (If you’re under 30 Google it) a number of well-meaning parents and individuals have tried to make sense of the results and have misinterpreted them, leading to further confusion among doctors and patients. Let’s breakdown what the study does not say:
- The study does not propose a cure or treatment for children that have already had an allergic reaction to peanuts;
- Participants were given peanut protein as a part of the trial, not peanuts or peanut products;
- The study does not represent a change in policy or treatment guidelines from the AAP or NIAID.
What this means is that if your child has already had a reaction to peanuts, this study doesn’t have any new information about treatment. Treatment for peanut allergies remains the same: avoid peanuts. The infants in the study were also closely monitored in a medical setting for signs of a worsening allergy or the development of a deadly reaction. In essence, this study comes with a big DO NOT TRY THIS AT HOME warning for parents of children at high risk to develop a peanut allergy.
At his nine-month well-baby check-up, I talked with our regular pediatrician about my son’s reaction to egg whites. We realized that we hadn’t discussed the introduction of highly allergenic foods in-depth at his six-month visit and she suggested my mistake was not ignoring the AAP and NIAID guidelines, but was likely that I gave him too much of an allergenic food, all at once, for the first time. We were also able to agree that I was likely allergic to the substitute pediatrician, and small doses of him over time weren’t likely to fix it.
American Academy of Pediatrics. What you need to know about the new guidelines for the diagnosis and management of food allergy in the U.S. Retrieved March 4, 2015.
National Institutes of Health. Guidelines for the Diagnosis and Management of Food Allergy in the United States. National Institute for Allergy and Infectious Diseases. Retrieved March 4, 2015.
American Academy of Allergy, Asthma and Immunology. Food allergy: A practice parameter update—2014. Practice Primer. Retrieved March 4, 2015.
Rebecca S. Gruchalla, M.D., Ph.D., and Hugh A. Sampson, M.D. EDITORIAL: Preventing Peanut Allergy through Early Consumption — Ready for Prime Time? New England Journal of Medicine 2015; 372:875-877
Du Toit, Roberts and Sayre et al. Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. New England Journal of Medicine 2015; 372:803-813 February 26, 2015