On Thursday, the National Institute of Allergy and Infectious Diseases released formal, detailed guidelines for pediatricians and allergists.
The document, published in six medical journals, includes three separate sets of recommendations based on the level of risk an infant has for developing a peanut allergy. Those at highest risk are defined as babies with severe eczema — a skin condition where patches of skin become inflamed, itchy, red and cracked — or egg allergy or both. Those in the middle group have mild-to-moderate eczema. And those in the lowest-risk group have no eczema or food allergies.
The Post goes on to explain the reasons for this change in recommendations: research conducted by Israeli and English scientists on Jewish children in their respective countries, the findings of which were released in 2008. What took so long?
That’s not a rhetorical question. I would really like to know why it took eight years for the United States government to catch up to recommendations that became, for pediatricians and allergists up to date on their research, commonplace years ago.
Why Did It Take Eight Years to Change Peanut Guidelines?
The tale of peanut recommendations isn’t a standard indictment against the government’s usual slow-footedness or ineptitude—it’s actually malpractice that likely resulted in the illnesses and even deaths of American children. In the same Post piece on the change in recommendations we learn,
The number of American children with nut allergies has quadrupled in the past 13 years, and peanut allergies are now estimated to affect 2 percent of them. Most schools now ban foods with peanuts, and manufacturers are required to label major allergens. The soaring price of EpiPens, which are used to treat a severe allergic reaction and retail for up to $650 for a two-pack, has become a hot political topic.
In the report that led to these recommendations, researchers arrived at unambiguous findings: of over 4,600 Jewish children (of similar genetic makeup) who were exposed early to peanut products in Israel, only eight developed peanut allergies. Of almost 4,000 Jewish children in the UK who were not exposed early, 73 did. In its conclusions, the study’s authors wrote,
We demonstrate that Jewish children in the UK have a prevalence of PA [peanut allergies] that is 10-fold higher than that of Jewish children in Israel. This difference is not accounted for by differences in atopy, social class, genetic background, or peanut allergenicity. Israeli infants consume peanut in high quantities in the first year of life, whereas UK infants avoid peanuts. These findings raise the question of whether early introduction of peanut during infancy, rather than avoidance, will prevent the development of PA.
In other words, bad U.S. regulations likely caused more American kids to have peanut allergies because parents who followed them duly withheld peanut products from their babies — which in fact made their kids more likely to become allergic to peanuts.
The Government’s Food Recommendations Affect All of Us
After the many iterations and versions of what we used to call the food pyramid—which, in my childhood, boasted recommendations of 6-11 servings (!) of carbohydrates at its base—one would think the government would have learned its lesson about preaching food science recommendations as settled science gospel.
Unfortunately, governmental recommendations about food has far reaching impact: from school cafeterias to advice given in pediatrician’s offices nationwide to recommendations made to those on public assistance. Mistakes made on the federal government level have the potential to negatively impact millions of Americans, and as evidenced by the booming numbers of children with life-threatening peanut allergies here versus those in Israel.
So the next time you’re making a sunflower seed butter sandwich for your kid whose class is nut-free, or throwing down hundreds of dollars for an EpiPen—if your kid is one of the unlucky ones for whom those rules were made—thank Uncle Sam for, once again, making our lives less healthy and more expensive.