Obviously everyone's mileage will vary, but I'm happy to see this treatment being more widely adopted

One detail in particular makes a huge difference: oral immunotherapy seems to be significantly more effective in babies (starting before age 2) with significantly better outcomes. Adults and young children have a much higher incidence of side effects (most common one is a constantly upset stomach) that makes avoidance potentially still better for overall quality of life, but our allergist told us that among their <2 year old cohorts they’ve seen zero out of [upper two digits] experience any of those side effects at all. We started our son when he was 1 year old.

In our case the kid started eating peanuts basically as soon as they started eating solid foods, so the allergy happened despite early exposure. Actually we caught the allergy early enough to start OIT early because of early exposure.

Kid is desensitized now after a year of oral immunotherapy, so add us to the chorus of voices saying "It works", but it can strike early and severely despite the parents' best efforts.

Careful, that's not really been proven. There's an enormously important difference between these two theories:

1. The individual human immune system needs to be calibrated by wider exposure to... actual pathogens.

2. The individual human immune system needs to be calibrated by wider exposure to... benign bacteria that we've co-evolved with. ("Old friends" [0].)

Those involve very different plan of treatment and associated risks, and there's no guarantee the riskier one will give better results.

[0] https://www.news-medical.net/health/Old-Friends-Hypothesis.a...

The original studies on peanut allergy and bamba in Israel came out many years ago.

It’s taken people so long in the US to learn about the value of introducing small amount to babies at a young age to protect them.

I can only think of the many families and children who have been negatively impacted due to the lack of awareness and understanding in America.

Trader Joe’s in the US has both regular Bamba and chocolate-dipped Bamba. These are sometimes in different parts of the store.

Makes me wonder if there is something we should be doing with baby formula.

Data will be scant at this time, because the full treatment takes a long time and needs to be adhered to closely. It's 30 weeks of OIT, followed by 2 years of a maintenance dose, followed by a 6-month hiatus to verify whether the maintenance dose can be stopped while still achieving remission, so data necessarily lags the start of any clinical trials by 3+ years.

[1] https://www.nih.gov/news-events/news-releases/oral-immunothe...

I realize as I write this that you are probably saying that for your own experience you can't disentangle correlational from causation, to which I would say -- correct!

As above, she presents excellent science in an approachable manner for non-science minded folks. She also has enough of the technical details for this with the knowledge to be confident she has done a strong analysis.

If you are a parent and haven’t checked her stuff out, please do. (Zero affiliation or connection)

I've been wondering if there's something else causing me to be allergic to them, like something I eat or so, idk. But I'll have to get tested again

Oral immunotherapy seems to be very effective but sticking with it is nontrivially hard.

What are they saying? They don't believe in oral immunotherapy?

You can pick from several public providers, but the price is basically fixed and deducted directly from your salary/payed by the state if you’re unemployed.

There is a 2nd system of private insurance providers. Those tend to get you preferential treatment at doctors because they pay them more than the public insurance which has fixed rates, but they will hike prices as you get older and you can’t go back to the public System.

To be fair, for hay fever the therapy was offered. And reading it up back then, the treatments against animal hair are often not successful, and they have a certain risk. Plus no standardized medication, so there are problems with keeping the exact dosage needed. All that combined made me conclude that not wanting to lead such a treatment is not a completely unreasonable position for a doctor. One would have to find a doctor specialized enough to do it anyway.

There are commercial products for this that have such egg powder.

If kids were left to get dirty and put the occasional thing in their mouth, which kids have been doing since the dawn of time, then there wouldn’t be such an allergy problem

I find that view to be overly pessimistic, and not reflective of what health care providers actually do. Practitioners of all sorts work hard to cure and prevent diseases every day. Every time a cancerous tumour is removed, it significantly reduces the chances of that person needing follow-up care. Every vaccine that is given reduces future hospital visits. Every piece of good advice to exercise and eat right keeps somebody away from the doctor, rather than turning them into a repeat customer.

Doctors aren't evil. They aren't scheming to lock patients in by offering suboptimal treatments. They provide the best care that they're able, within the limits of the knowledge and resources available to them.

I don't know why it's taken so long for this to gain broader acceptance.

You have to shop around for allergists willing to do it. Our first allergist told us they weren’t comfortable doing it but it was becoming an increasingly popular option and referred us to several allergists who did it. We’ve also spoken to allergists who were bearish on it. It’s because there’s very little published data.

We did it with Latitude [1], with the support of our allergist, who had sent his son through them with successful results. It's not covered by insurance, and is expensive in all of time, money, and attention. The field is very new and data is still sparse - our allergist actually was very curious to hear results because he's adapting his practice as new data comes out from actual treatment.

[1] https://latitudefoodallergycare.com/

I looked into oral immunotherapy for tree nut allergies. There's a paper from 2022: https://onlinelibrary.wiley.com/doi/10.1111/all.15212

They did it in a few stages:

1. First three days: test the child with increasing amounts of cashew protein, until the child has a reaction. Use the amount ingested for that reaction, to determine the single highest tolerated dose (SHTD = the maximal amount of cashew protein each patient could tolerate).

2. Next 24 days: the child ingests the SHTD daily.

3. After that: every month, the dose was increased (I think at an in-person visit), and taken at home for the next 30 days.

For #1, I looked at the amounts of protein they gave the child. Table S2 (in one of the supporting documents) shows how much they gave on days 1, 2 and 3. Of course they stopped increasing once the child had a reaction. If you convert the amounts of protein into equivalent numbers of whole cashews, then you get:

- day 1: start with 1/1800th of a small cashew, increasing up to a fifth of a small cashew.

- day 2: 1/5th small cashew, up to 2 small cashews

- day 3: 2 small cashews, up to 22 small cashews

22 small cashews is about equivalent to what they want to achieve by the end of the therapy, i.e. if you don't have a reaction after eating that many, you won't have a reaction to a greater quantity.

It seems a bit hard to DIY it, because:

- The first three days requires very small amounts of cashew protein. At home we don't have either (i) isolated cashew protein, or (ii) tools to measure such small amounts (starting with 0.1mg cashew protein, or 0.5mg cashew).

- For the first three days, we'd need to be very vigilant to watch out for a reaction. I don't know whether, in a supervised setting, they'd observe or measure other factors than just an apparent reaction, to make sure the procedure is safe.

I AM NOT A DOCTOR OR OTHER HEALTHCARE PROFESSIONAL

I have a tree nut "allergy" but doctors always call it more of a "hypersensitivity" because my reactions are usually involving terrible stomach cramps and pain accompanied occasionally by swollen throat (more so for almonds than cashews).

I've wondered if it's worth trying to do this myself.

They referred me to a throat doctor to make sure it wasn't anything in my digestive system. So ended up doing an endoscopy. No notable findings there either.

So never been given any kind of ideas of things to try other than keeping a food journal, which has been useless to me.

do you mean, if there is no reaction to 1/1800th within minutes(?) then try 1/900th, lather rinse repeat?

Seems like the treatment options are evolving pretty rapidly and these options aren't available everywhere. Or this is what I was told.

You were told wrong. Shots have a ramp-up period and then a five year maintenance period where you get one shot a month. Afterwards, you've effectively been cured.

At least, that was my experience, I blamed Cambridge, then moved back or even when I visited before that had it just as bad in the town I grew up in. (Cripplingly painful eyes, sometimes migraines. Nose generally fine, but steroidal nasal spray is the best I've found off prescription for my eyes. Eye drops only really seem to help by way of lubrication for me (even though they are active), and pills (best I've tried is fexofenadine) don't give that instant relief.)

One of our sons is 6/6 on peanuts and they were very hesitant to try oral immunotherapy, more or less saying they weren’t willing to given the risk of anaphylaxis.

https://www.food.gov.uk/research/food-allergy-and-intoleranc...

How is that proving the hypothesis?

> ... Early introduction of all the foods was not easy but it was safe. Among the infants who did manage to consume the recommended quantity of the allergenic foods there was a two-thirds reduction in overall food allergy.

> For those who fed their infant the recommended amount of peanut there was a significant reduction in peanut allergy, 2.5% in the standard introduction group compared to no cases in the early introduction group (0%).

> There was also a significant reduction for egg allergy- 5.5% in the standard introduction group compared to 1.4% in the early introduction group.

In other words, in the group as a whole when considering all food allergies, the difference was not statistically significant, but that can be attributed to a large number of families in the test group failing to actually perform the test. It sounds like when you control for actually following the instructions there is a statistically significant difference in overall food allergy incidence.

OP took a sentence out of context that said that overall food allergies across the whole group were not reduced by a statistically significant amount. But the authors go on to explain why that was and explain that if you control for real participation in the test then it is significant.

My 4 year old's favourite food is shrimp and sushi... Not sure whether it's related to her eating those when she was a toddler, but it's fun to see the reactions in restaurants when you don't order the children's menu.

> Among the 530 infants in the intention-to-treat population who initially had negative results on the skin-prick test, the prevalence of peanut allergy at 60 months of age was 13.7% in the avoidance group and 1.9% in the consumption group (P<0.001). Among the 98 participants in the intention-to-treat population who initially had positive test results, the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consumption group (P=0.004). There was no significant between-group difference in the incidence of serious adverse events. Increases in levels of peanut-specific IgG4 antibody occurred predominantly in the consumption group; a greater percentage of participants in the avoidance group had elevated titers of peanut-specific IgE antibody. A larger wheal on the skin-prick test and a lower ratio of peanut-specific IgG4:IgE were associated with peanut allergy.

https://www.nejm.org/doi/full/10.1056/NEJMoa1414850

What goes wrong if they're exposed before that? If the mother eats peanuts and eggs while breast feeding, does that confer desensitisation?

In our case diary products were an issue instead of nuts. My daughter would get very sick from anything that had diary in it, even if my wife ate diary products while breastfeeding. But at about 1.5 years one she got over that and now at 4 she is completely fine drinking normal cow milk.

So allergies in kids are not a permanent set in stone thing. They can get over some, and early exposure makes a difference.

That seems like overkill. I can't imagine having peanuts or peanut butter in the pantry is going to meaningfully affect a 2 month old infant.

If you're avoiding skin contact, then you might not have time to wipe the peanut butter mess off your hands as you rush to rescue your kid who's got into trouble.

Egg albumin is also interesting because the vast majority of kids outgrow it. My toddler has a peanut allergy but has already outgrown his egg albumin allergy.

Interesting point about the skin exposure, I’ll go back and review those comments. Evolutionarily/practically i would think it’s tough to get oral exposure to something prior to skin exposure (it hits your mouth/hands/face before your stomach), unless the breastmilk vector you mention is critical

Brilliant to hear it still works well in adulthood - if we can get peanuts, sesame and egg under control - so that he can eat 'May Contain' food, that would be a huge change for him.

I don't doubt this works for some people, but I also don't think it works for everyone. I had much better results with shots.

The big question for me is whether this is a permanent fix or if you have to keep taking their tablets (at $99-ish a month, it looks like?)

Unfortunately this doesn't look to be covered by my insurance as the at-home test is not administered by a doctor.

Fortunately, peanuts aren’t expensive. The expensive part is the trained allergist whose job is to keep up with the research, and in my case, who I suspect will be publishing interesting papers in the next few years.

Also, what about things like gluten and dairy sensitivity?

  * The Royal Children's Hospital in Victoria
  * Perth Children's Hospital 
  * Fiona Stanley Hospital in Western Australia
  * Queensland Children's Hospital
  * Women's and Children's Health Network in South Australia
  * Sydney Children's Hospital, Randwick
  * The Children's Hospital at Westmead
  * John Hunter Children's Hospital 
  * Campbelltown Hospital 
  * Royal Prince Alfred Hospital in NSW

Depends how emphatic you are to your fellow human being. Peanuts aren't as important in most people's lives as actual people.

The children who now have allergies, but wouldn't with past exposure levels, are more inconvenienced than the kid who can't eat a peanut butter sandwich at school.

Attempting to make life better for all has unexpected twists and turns

I'm allergic to peanuts and none of my schools banned peanuts. When I was in elementary school, another kid chased me around with a peanut butter sandwich for a couple of minutes before the teachers were able to stop them. I'm not saying this will happen to all kids, but the options for bullying get kinda scary when an everyday food can kill you. Kids at that age may not understand how serious allergies can be, so there's also the more mundane risk of a child with an allergy trying somebody else's food without knowing it contains allergens.

Later on in middle school there was a single peanut-free table, where kids were eating peanut butter sandwiches for lunch every day before I arrived. Fortunately they were willing to bring something else once I told them I actually needed the peanut-free table to be peanut-free.

One set being small is all it takes for the intersection to be small.

…although I do have some sympathy for those with such severe allergies. ‘The burden be[ing] on them’ does seem a bit harsh.

No doubt there were allergies back then but what on earth has made them so much more common these days?

Same with asthma. Something has gone terribly wrong.

- Nut Allergies in particular seem to be reduced with early exposure [0]. Maybe dietary trends have changed in a way that causes less early exposure? - Child mortality rate used to be much higher. Children with allergies used to be part of this mortality rate. This combined with parents with mild allergies that might have previously not survived to have children cause the incidence to increase. - People today are exposed to many more types of food. Many people who might have a particular allergy may not have ever been exposed to that allergen.

Another one I’d throw out there would be nearsightedness. Of course a lot of people wear contacts, but I’d imagine incidence of glasses is higher than it used to be.

Reported rates of nut allergies rates have definitely increased though. [1]

[0] https://www.nih.gov/news-events/news-releases/introducing-pe... [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477625/

Perhaps so, but I had a mother who was particularly fussy that we kids had good fresh food—I reckon she was a bit obsessed with it, yummy things like potato chips, sweets, etc. were discouraged and not a part of our normal diet—and at no time was anything ever mentioned about nuts, peanut butter, etc. being bad or 'suspect'.

In fact, I was encouraged to eat nuts instead of sweets as they were considered wholesome whereas sweets were not. We always had peanut butter at home (mother encouraged it over jam).

When we did have sweets it was often peanut brittle (and peanut toffee) which I and most kids loved.

Moreover, my mother always thought of herself as up to date, every week she read women's magazines such as the Women's Weekly, if nut allergies were a big deal back then she would have heard of it. But there was nothing said.

Likewise, I'd love to know the statistics. What I do know is that these days something has changed for the worse. If peanut allergies had been so prevalent when I was a kid then there'd have been no way that it could have been covered up so completely that no one would have been aware of it.

Incidentally, it's not as if allergies were unknown back then, we occasionally heard of some unfortunate people who were allergic to shellfish, or occasionally egg, or being near cats or horses—but never peanuts or other nuts.

They gradually introduce these foods later. Maybe too late, if the idea of early exposure is accurate, but it's very much a case of "can't be too safe" when I asked them.

Recognition of severe peanut allergies plus a common false hypothesis that early exposure increased the risk of such allergies developing led lots of parents in lots of places for a few decades to avoid their children having early exposure, leading to a huge increase in severe allergies (because it turns out, early exposure actually reduces the risk, which was recognized in large part because Israel, where the avoidance thing not only didn't catch on but where peanut-based puffed snacks remained a popular snack for kids from pretty much when they could eat solid food, was conspicuously left out of the major upswing in peanut allergies). Since the recognition that avoidance is counterproductive has worked its way into general advice in the last few years, we should see a noticeable drop in the incidence.

> Same with asthma. Something has gone terribly wrong.

Lots of stuff going on with asthma, I think: It's got a genetic component and treatment getting better probably increases the incidence, all other things being equal, there's a lot of known environmental factors, some of which are probably increasing in probability of exposure, and it’s also made more noticeable and more likely to be diagnosed by allergies and other co-occurring inflammatory conditions, which gets back to the allergy discussion...

Seems that common sense prevailed there.

"Lots of stuff going on with asthma,…"

I grew up in a cold, damp mountain environment where mists and rain were commonplace (by the time Ventolin/salbutamol came onto the market in the late '60s I'd have left school), and I recall no kids that I knew who had asthma. I'm not saying that asthma was unknown, I'm just saying it wasn't as common as it seems to be these days.

Again, I'd like to know the stats, population versus reported incidents by year etc., so we had a handle on what's actually happened over this timeframe.

I’m like you re lunches as a kid. I never liked peanut butter as a kid, but it was a staple option among kids alongside Nutella and Vegemite. Now peanut butter and Nutella is banned in a lot of classrooms.

To me, that's very significant. It's almost a quintessential model. Splitting a population down the middle and changing the circumstances of one and not the other has to be pretty much the ideal situation for researchers. So what's the research say?

"In Australia it seemed to affect first generation descendants!… … “you tell someone in Malaysia your kids are allergic to satay and they just don’t understand”."

Reckon that'd be pretty disturbing for parents who'd consider satay a staple food. Again, I can only say that Australian kids of my generation who came of age in the late '60s—mid '70s and who were exposed to Asian foods including satay for the first time and loved it, never seemed to have problematic allergies with peanut sauces.

BTW, re swapping sandwiches, the trade at school often occurred with peanut butter and honey (or jam) with Vegemite and lettuce (sometimes cheese). I always preferred the latter, the former being a bit too sweet (perhaps I was a bit unusual). :-)

Then there's the genetic component, if you had allergies before epipens and ambulances it was pretty likely that you just, well, died, the first time you got exposed to the allergen. Today people with dozens of deadly allergies live relatively normal lives, and are able to make those genes propagate further. This goes for most genetic problems really, any ones we can treat will eventually become massively more prevalent than before.

It shows that east asian children, who very rarely have nut allergies in their home countries, develop nut allergies at a higher rate than non-asian children when born in Australia while east asian children who immigrate to Australia after their early infancy continue to maintain very low rates of nut allergies.

Or that there's something unusual about simply being in Australia as an infant that causes peanut sensitivity?

Or that infants in Australia have less exposure to nuts?

OK, but why now and not when I was a kid growing up in Australia?

We have to get to the root cause of this new problem. (Read my other posts here.)

And I've no known allergies.

1) Israelis come from all over the world, and the incidence of peanut allergies are lower in, say, Sephardic Jews living in Israel compared to Sephardic Jews living in Spain.

2) a very popular snack there for kids(but also adults) are these peanut butter corn-puffs called "Bambas"(like, literally 25% of the snack market is this one snack)

Edit: I guess I was just trying to say "surprising data needs detail." I should have just said that, instead of making light of how dangerous allergies are. Downvotes deserved, lesson learned.

With no knowledge about how i goes for babies, the question would be how a 2~3 month allergic kid [0] would react to peanuts, including when not directly ingested. If it had adverse effects it would go along the line of what parent is describing.

[0] can kids that age already be allergic to peanuts ?

Allergies are a subject I need to know a lot more about, so sadly at this point I don't have an explanation for anything.

I don't see how any of what I said is either insistant or limiting to a single cause.

I was facetiously pointing out that a population where everyone eats peanuts at a young age is likely to be allergy-free if only due to the fact that those with peanut allergies would die, and therefore would no longer be allergic to peanuts. A naive analysis of the data could lead to a conclusion that eating peanuts at a young age causes a favorable change in allergy outcomes later in life.

Notably,

> No deaths occurred in the study.

so it's not a "naive analysis" of the kind that I facetiously alluded to. I didn't mean to imply that I believed naivete was a a factor... I was just pointing out that the top-level comment of "I heard {country} doesn't have any peanut allergy, and they eat peanuts from a young age" (without any further detail) was illustrative of a particularly insidious fallacy.

apparently there was a follow up study called LEAP-ON where some of the subjects who had eaten bamba in the LEAP study were then asked to abstain from peanuts from age 5 to 6 and their tolerance to peanuts was then tested, and the results showed that infant peanut exposure reduced allergy levels even if they abstained later (you don't have to keep eating them, at least not within the time envelopes of the study).

Also another study that measured the different peanut allergens in bamba and compared it to peanut flour that concluded allergen levels were lower and more uniform in bamba making it useful for this purpose.

truthfully I don't need an excuse to eat bamba. If you like peanut butter its basically peanut cheatos (without the cheese) and is amazing, even though its super processed and definitely not healthy to eat compared to real food.

We evolved to be constantly dirty, and we live in an extremely clean society. When your immune system has a lot to fight, it doesn't worry to much about dumb shit like pollen and peanuts.

I get some weird skin issues sometimes which are almost magically fixed if I visit a natural body of water... it's clearly an issue of my immune system interacting unfavorably with a microbiome which is out of whack.

The facebook group for DIY helminth therapy is a fascinating place, let me tell you. But there are several possible species of helminths to try. It's all a bit overwhelming.

We sure aren't exposed to the same things as 4 centuries ago, but I can't imagine we're living a what anyone would call a "clean" environment.

People in the olden days got their hands dirty chopping down trees and building solid wood tables while today we keep our hands clean by buying flat-pack furniture that out-gasses formaldehyde into our homes and our lungs.

We're much dirtier than the people were a long time ago, only it's mostly on the inside. The filth in our bodies doesn't wash off with soap.

We're vastly more sterile from a germ perspective. The term "hygiene hypothesis" is apt.

https://en.wikipedia.org/wiki/Hygiene_hypothesis

The human genome didn't evolve in a sterile environment, it evolved in an incredibly hostile environment and developed some nasty defenses as a result. If you don't expose children to pathogenic microbes at an early age to train the immune system on what to attack, it will find other things to attack. Allergies are the result. Stop the constant use of antibacterial hand gels and surface sanitizers and for bonus points get a dog.

I know this sounds extremely insensitive, but I genuinely think the answer is simply that the vulnerable die.

I spent 3 years moving through 35 different African countries and 2 years through Latin America.

I honestly believe it is simply the harsh reality of life that many more infants and young children die than in developed countries.

This is just speculation, I don't know of any evidence one way or the other.

I've also personally cured my cat allergy. We adopted a cat that was supposedly of hypoallergic breed ("supposedly" because there's really no science behind it, it's just people reporting less reactions from this breed). I still got a mild allergic reaction to her initially, but after a few months, it stopped. Now, a few years later, we are still happily living with her and it seems that I've ceased being allergic to other cats also.

It is not worth wasting the time of professional help, but coffee is important to me personally. I used to drink 3-5 cups per day, most socially.

Could someone please explain how I can use Zyrtec and doses to coffee to cure this akin to how other people in this thread are curing peanut allergies?

My original symptoms were severe nausea and throwing up.

I have been taking Zyrtec and drinking (fractions of a cup of) coffee for some years now and this has gradually reduced the reaction. I recently came off the Zyrtec and I can drink 1 coffee per day with only minor itching and some swelling in the throat, but I think with a better method I could increase the number of coffees per day and alleviate the remaining itching/swelling.

I am careful about using Zyrtec for long periods because I noticed other side effects from cetirizine such as lethargy when on it and chronic (seemingly incurable) insomnia when I came off it. Ideally if I go back on, I would want to come off after not more than 1 year. 6 months off cetirizine and the insomnia is starting to go away.

Also, EoE is real and can cause permanent narrowing of your esophagus if you are reckless. Please find an allergist who can give you advice.

He was about 13, and said when he was little they did that scratch allergy test on his arm and he was in a coma for six months. He carried and Epipen around but told me not to stress. If someone ate a snickers then touched a door knob, and he touched it days later he would be dead on the ground before I had the cap off the pen anyway.

Cool kid, he just took it in stride.

---

In terms of 'cause' - we don't know, one or two other children of my sons generation in our family have food allergies, and an older brother thought he was allergic to fish though never tested.

We noticed the reaction after he had a round of antibiotics after he had infected eczema, quickly followed by my wife needing antibiotics which we are sure got to him through her milk, as he'd groan after breast feeding - before that we had plenty of nuts, sesame, milk and eggs in the house, without noticing an issue for him. But that is just a pet theory.

Is this true?