A decade after a landmark study proved that feeding peanut products to young babies could prevent development of life-threatening allergies, new research finds the change has made a big difference in the real world.

Peanut allergies began to decline in the U.S. after guidance first issued in 2015 upended medical practice by recommending introducing the allergen to infants starting as early as 4 months. The rate of peanut allergies in children ages 0 to 3 fell by more than 27% after guidance for high-risk kids was first issued in 2015, and by more than 40% after the recommendations were expanded in 2017.

  • lmmarsano@lemmynsfw.com
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    9 hours ago

    tread lightly and do rigorous research on the topic

    Did you?

    Duh, I knew that before you, stupid Mr./Ms. Scientist.

    The problem is the scientists already knew the answer, too. It’s pretty well known by the evidence-based medicine community as a massive fuckup by the medical establishment that sets guidelines. A director of the Evidence-Based Medicine and Public Health Research Group at Johns Hopkins dedicated a chapter on it in his book.

    That chapter explains that pediatric immunologists already knew guidelines for young children to avoid peanuts weren’t supported by science (they violated immune tolerance, a basic principle of immunology) and advised physicians they trained to ignore it.

    full explanation

    The book establishes that medical science can be susceptible to dogmatism & groupthink indolent to examine & update knowledge once it settles into established practice even when it lacks rigorous, scientific evidence. When they discover they are wrong, the establishment tends to be slow in recognizing it & correcting itself: rather than boldly & openly admit they were flatout wrong, they often prefer a face- (& liability-?) saving approach that quietly updates guidelines, slowly backpedals, and lets new practices overtake old with time. The mixed track record of major health recommendations in modern medicine follows a pattern established in the book:

    When we use sound scientific studies to make recommendations, we shine—and help a lot of people. But when we wing it and issue recommendations based on opinion, we have a lousy track record. Sometimes you’ll see that consensus is not driven by science, but by peer pressure.

    The American Academy of Pediatrics (AAP) 2000 recommendation

    for children zero to three years old and pregnant and lactating mothers to avoid all peanuts if any child was considered to be at high risk for developing an allergy

    is a case where they did not follow evidence-based medicine. It’s a case of copycat guidelines: they copied a 1998 UK health department recommendation. That recommendation was based on

    one sentence stating that moms who eat peanuts are more likely to have children with peanut allergies

    and referred to a single study lacking support for that statement.

    The report cited a 1996 British Medical Journal (BMJ) study. So I pulled that up and took a close look.

    I couldn’t believe it.

    The actual data did not find an association between pregnant moms eating peanuts and a child’s peanut allergy. But that didn’t matter: The train had left the station.

    Bewildered by how the study seemed so badly misconstrued, I called its lead author, Dr. Jonathan Hourihane, a professor of pediatrics in Dublin. He shared the same frustration and told me he had opposed the peanut avoidance guideline when it came out. “It’s ridiculous,” he told me. “It’s not what I wanted people to believe.”

    He had not been consulted on the national guideline.

    Predictably

    Peanut allergies soared. More concerning, extreme peanut allergies, which can be life-threatening, became commonplace in America.

    Suddenly, emergency department visits for peanut anaphylaxis — a life-threatening allergic swelling of the airways — skyrocketed, and schools began enacting peanut bans.

    As things got worse, many public health leaders doubled down. If only every parent would comply with the pediatrics association guideline, they thought, we as a country could finally beat down peanut allergies and win the war.

    Immunologists had objected.

    Gideon Lack, a pediatric allergist and immunologist in London, challenged the UK guideline. It “was not evidence-based,” he wrote in The Lancet in 1998. “Public-health measures may have unintended effects … they could increase the prevalence of peanut allergy.”

    Two years later, the same year the AAP issued their peanut avoidance recommendation

    Then they tried to dissuade with a study.

    They found that Jewish children in Israel had one-tenth the rate of peanut allergies compared to Jewish children in the UK, suggesting it was not a genetic predisposition, as the medical establishment had assumed. Lack and his Israeli colleagues titled their publication “Early Consumption of Peanuts in Infancy Is Associated with a Low Prevalence of Peanut Allergy.”

    However, their publication in 2008 was not enough to uproot the groupthink.

    The medical community maintained the guidelines & wouldn’t fund studies to corroborate.

    Avoiding peanuts had been the correct answer on medical school tests and board exams, which were written and administered by the American Board of Pediatrics. Many in the medical community dismissed Lack’s findings and continued to insist that young children avoid peanuts. For nearly a decade after AAP’s peanut avoidance recommendation, neither the National Institutes of Health’s (NIH’s) National Institute of Allergy and Infectious Diseases (NIAID) nor other institutions would fund a robust study to evaluate the recommendation, to see if it was helping or hurting children.

    Several years later

    As things got worse, a dissenting Lack decided to conduct a clinical trial randomizing infants to peanut exposure (at 4-11 months of age) versus no peanut exposure. He found that early peanut exposure resulted in an 86 percent reduction in peanut allergies by the time the child reached age 5 compared to children who followed the AAP recommendation. He blasted his findings to the world in a New England Journal of Medicine publication in 2015, finally proving what immunologists like Buckley had known for decades: Peanut abstinence causes peanut allergies. It was now undeniable; the AAP had it backward.

    Lack is now recognized as a hero in the field of allergy. But when he did his big study, he was heavily criticized.

    It would take the AAP two years after Lack’s randomized trial was published to reverse its 2000 guidance for pediatricians and parents. It would also take two years for the NIH’s NIAID division to issue a report supporting the reversal.

    It was “an embarrassingly simple study” the AAP failed to demand.

    The whole ordeal is the predictable outcome of medical guideline associations correcting a well-documented disaster they recklessly created & hope to quietly sweep under the rug. How those associations haven’t been sued into oblivion for incompetent negligence is a real mystery.

    The comment above yours is right: it entirely is as stupid as it seems.