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The Pediatrician Next Door - Simple Advice on Parenting and Family Health
Ep. 129 Can Food Allergies Be Prevented? Early Peanut and Nut Introduction Made Easy with Mission Mighty Me
00:28:58
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- [00:04]
A
I have a friend whose daughter has a terrible milk allergy. You do not know how many products have milk in them until you are with someone with an allergy. The same goes for eggs. They hide everywhere. Nuts too. So my friend and her family were boarding a flight in Asia on their way back to the United States and they were in a rush because they had three kids in tow. You know how that goes. So they stopped quickly to get smoothies and the person behind the counter swore that the smoothies were non dairy fine. They got the smoothies, they board the plane and just as they finally settle into their seats, my friend looks at her daughter and her lips are swollen, she has hives all over her face and then she vomits. Classic anaphylactic reaction. So she grabbed her epinephrine injection because my friend is awesome and always has one nearby. She's a doctor too because that's how we rol now what does she do? Does she stay on the 13 hour flight? The doors on the plane were already closed. And how embarrassing is it to be the person that delays the flight? You know who can tell you, my friend, because that's exactly what she did. She told the flight attendants that she had a medical emergency and they opened the doors back up. They had to get their checked luggage off of the airplane. It was a whole thing. See, food allergies are terrible for the people who have them. And I'll spend much of this episode talking about that and what you can do to help the problem and how you cannot be the parent this happened to. Food allergies affect all of us. Sometimes it's by delaying a flight and sometimes it's that we can't bring anything fun to our kids classroom. If you're a new parent, you need to hear this episode. If you're an experienced parent. Do you remember how you felt the first time you gave your kid peanut butter? Was it a little scary? Have you had a food reaction out of the blue? You can be the most careful label reading parent in the world and still a food allergy can catch you completely off guard. I see it all the time in my office. Parents race to our office from a family picnic, a birthday party, or after a child innocently bites a piece of their sibling's protein bar. It happens all the time. One moment you're all having fun or rushing to board an airplane and the next you're covered in vomit calling 91 1. So if you've ever worried about a food allergy, you're not alone. Today we're going to talk about how you can lower the risk of food allergies before they even start. I'm Dr. Wendy Hunter and I'm the pediatrician next door. I'm that doctor friend you call for practical advice about your kid's health. I mix the science of medicine with the reality of parenting. Food allergies now affect 1 in 13 children in the United States. That's roughly two kids in every classroom. Have you heard about one of the most important shifts in preventing food allergies? It's that the early introduction of allergenic foods, especially peanuts, dramatically reduces the risk of developing a food allergy. My guest today is someone who has seen this and lived this from both sides. As a mother navigating the shock of her child's first allergic reaction, and as a co founder of a company that's trying to change this story for other families. Katherine Jackson is the co founder of Mission Mighty Me. It's a peanut and other nut puff snack designed for babies and kids from infancy through childhood. And, and it helps maintain safe, consistent exposure to nuts. She partnered with the famous, well, famous to me, Dr. Gideon Lack. He's the lead researcher behind the groundbreaking LEAP study, which is an acronym for learning early about peanut allergy. Cute, right? The study showed that early introduction of peanuts can prevent most allergies before they start. And it rocked our pediatric world and it rocked Catherine Jackson's world. Here she tells her story. Tell me the story of what happened when your daughter was first exposed. How old was she and what was the reaction? What happened?
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B
So she was almost three years old and had not had any tree nuts at that point. We were following the, you know, the common recommendations at the time. And we lived in New York at the time. We were in our apartment and my mom had a little bag, a little Ziploc bag of walnuts in her purse. And without saying anything to me or asking, she just handed Niall, my daughter, a walnut. And Niall popped it in her mouth and, you know, took a little bite and immediately she just, she just blew up like a balloon. I mean, it was like such a immediate reaction. Her eyes were swollen shut. She broke out in hives. We, I mean, we didn't even realize what was happening at the time. It all happened so quickly. She started vomiting. We should have absolutely gone to the emergency room because she had multiple systems reacting at once. Her reaction calmed down. But then we took her for allergy testing and learned that she was allergic to almost all nuts. And at the time I'm thinking, how could she be allergic to something she's never even had. Of course, what we didn't know at the time was that was exactly the problem. Her body had not learned to tolerate these foods because she had never had them.
- [05:43]
A
Katherine's experience is one that many people can relate to. That shock of watching your child have a serious allergic reaction and then wondering like, how could this happen? When I did everything I was told to do by my pediatrician to prevent. Turns out that exact question is what helped spark a groundbreaking shift in how we think about preventing food allergies. Here's Dr. Lack himself explaining how a simple observation led him to rethink and ultimately challenge the way we approach this controversial issue.
- [06:19]
C
My name is Gideon Lack. I'm a pediatric allergist and researcher in London. Some 20 years ago, I spoke to my Israeli colleagues, pediatric allergists in Israel, and they observed that there was very little peanut allergy in Israel. We were then very astonished to discover very different feeding practices in Israel. Whereas we were withholding peanuts from the diets of babies and young children in the UK and in the US at the time, Israeli infants were being exposed to peanut rich containing foods as early as 4 to 6 months of age. The hypothesis was that early introduction of peanuts into infants diets or peanut products into infants diets would prevent the development of peanut allergy. In order to test this hypothesis, we conducted a randomized controlled trial where we enrolled 640 high risk infants with severe eczema or egg allergy. These babies, who were less than 11 months of age, had a very high risk of developing peanut and other food allergies. Half of these children received peanuts containing foods regularly over a five year period until they turned five and the other half completely avoided peanuts in their diet. We determined the rate of peanut allergy in both populations at the end of the study. The dramatic finding was that there was a greater than 80% reduction in the rate of peanut allergy in the babies who had been fed peanuts during this period. The LEAP study really changed the way I thought about food allergies, specifically peanut allergy. And I realized that we had been mistaken all these years in telling our patients to avoid peanuts. And indeed, we were doing the opposite of what we should be doing. The key finding was that we need to introduce foods such as peanuts very early on into baby's diet to prevent the development of peanut allergy.
- [08:41]
A
For Catherine, hearing the results of this study was bittersweet. On the one hand, it offered her hope that fewer families might go through what hers did. On the other hand, it came with a Little bit of guilt. She realized her daughter's allergy might have been preventable, that there was a window of opportunity that they never knew about. Catherine told me how powerful the study was.
- [09:05]
B
So our youngest, when he came along and we read about the LEAP study and we were trying to follow these guidelines, I mean, it was scary, of course, because here we are trying to give him something that we know would be harmful for his older sister to have. And that was another thought that we put into this product is it's like these mixed nut butters were very messy. I didn't like having them in the house and in the kitchen and sticking to everything where she could come into contact with them. So we really were trying to, like, get these foods into his diet, but do it quickly and do it safely and clean it all up as, you know, as fast as we could. Because she was still little at the time. Now she knows to, you know, she can advocate for herself and she. And she knows to avoid these foods. But it was scary. I think for a lot of parents, that early allergen introduction is scary. So we were just very frustrated. And I remember sitting in the kitchen one night talking to my husband JJ and we had a canister of those rice puffs that our kids loved, but, like, have no real nutritional value. Canister of those rice puffs and a jar of this very expensive, messy mixed nut butter that had a collection of nuts in it. And I said to jj, I said, someone just needs to take these two products and combine them, and then you'd have a puff that actually had nutritional value that did something for them that had plant protein. It wouldn't just be 99% rice, but it would also be such an easy way to help parents follow these food allergy prevention guidelines. To make a long story short, that's basically what we did. We ended up reaching out to Dr. Gideon Lack, who led the LEAP study and is really the doctor who discovered food allergy prevention as possible. And we partnered with Dr. Lack to form mission Mighty Me to create a line of foods that would help parents easily follow pediatric guidelines for including nuts in babies diets early and often.
- [11:15]
A
And that's how one determined mom took a classic kids puff snack mixed in peanut and tree nut flours and turned it into a game changer for allergy prevention. Stick around, because after the break, we're going to get into the nuts and bolts, literally, of when to start, how much to give, and how to keep it up so your child can keep eating nuts without. Oh, God, I have to go there without going nuts.
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- [12:26]
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Save up to 40% your first year@lifelock.com podcast terms apply. Parents today know the advice Start introducing allergenic foods like peanuts and eggs when you start solid foods. But knowing that and doing it are two different things. Honestly, I know it's scary. I have patients who will actually bring a new, potentially allergenic food to their baby's well, visit and give it to them right there in my waiting room just so they feel safer if there's a reaction. That's why the how matters just as much as the why. Katherine explains the difference it could make for families if giving kids allergenic foods earlier was easier, less scary, and something that parents feel confident doing.
- [13:30]
B
If there was mainstream adoption of the new peanut allergy prevention guidelines, we would see a huge reduction in food allergies. It would have such a big societal impact. But unless there's a consumer product that makes it easy and enjoyable and doesn't feel like medicine and doesn't feel like a pain for busy parents. No one's going to do it. And so that was really our goal with Mission Mighty Me was to create a product that made it easy but also tasty and enjoyable and something that you know your kids would want to eat that would make it easy to get nuts into their diet. And so that's basically what we did. We created a line of nut butter puffs and we have several different peanut butter puff flavors which are all more than 50% peanuts plus sorghum so they dissolve really quickly. Super clean ingredients, but they're more than 50% peanuts match the peanut protein amounts used in the research and the leap study. And then we also developed a mixed nut butter puff, which is the only puff on the market that has a collection of five nuts in it. The mixed nut butter puffs have peanuts, almonds, walnuts, cashews and hazelnuts, but yet they dissolve super quickly for babies and they just taste good. So whether someone's super focused on food allergy prevention and getting nuts in the diet or, or they're just looking for a better, healthier baby puff we kind of wanted or kids snack, we wanted to be able to kind of serve both purposes for parents.
- [15:22]
A
I love these puffs because they're so convenient, but I do have a number of patients who just won't eat a puff. I know they're kind of weird. Some of these kids are strong willed, others have oral aversion, and no matter how cute a snack looks, sometimes they're just not interested.
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B
So.
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A
So I asked Katherine what other easy ways has she found for parents to get these foods into their baby's diet. Here's what she shared.
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B
You can dilute nut butters, you can use peanut powder, you can dilute mixed nut butters. But for our puffs, there are several different ways you can modify them to make them work for an infant. If they're not quite ready for puffs, you can soften them with water or breast milk. You can crumble them over purees. We have a whole bunch of recipes on our website that incorporate puffs and really fun using them as sprinkles. You know, incorporate them in really fun ways. But you can crumble them into oatmeal. There are all sorts of ways that you can modify them to make them work for your baby wherever they are developmentally, they just need to be ready for solid foods.
- [16:33]
A
Those are some great practical ways to work the puffs into a baby's diet. But here's where things get a little more complicated. Not all babies have the same risk when it comes to developing food allergies. There's actually a big difference between high risk and low risk babies. And that's where the controversy begins. Exactly when, at what age do you need to introduce these foods? The tricky part is we don't actually know for sure.
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B
The AAP and the NIAID guidelines basically break babies into risk buckets. Highest risk being severe eczema or an existing food allergy. The current guidelines say that those babies need to have peanuts introduced between four and six months and probably after consultation with a doctor. That's what the current guidelines say. There is some debate over that the allergy colleges have all come out and said they do not think that families have to have consultation with the doctor or allergy testing first because it leads to a roadblock. But in a bottleneck. Those are the guidelines for high risk babies. Pretty much all the other babies according to the AAP can start peanut foods around six months and most babies are ready for solids around six months. But for the high risk babies, the guidelines say it's even more important that they start earlier. For the majority of babies, it's start when they're ready for solids, if they're ready for solids at four months and start at four months. If they're ready for solids at six months, they can start at six months.
- [18:10]
A
Tell me about how you developed, like, what were the challenges with developing a product because you had this idea and you literally had the idea of a puff and nut butter that was awesome because you already had the idea, but is there a dose or like, how did you come up with the product? What were the challenges there?
- [18:26]
B
We wanted to make sure that the product matched the research and could make it really easy for parents to follow the research without having to crunch numbers themselves or do math. Now, introduction is, I would always say, talk to your pediatrician about how to introduce Typically you're going to want to start with a tiny, tiny amount, right? And just watch and make sure everything is okay before you like continue feeding an infant size portion and then work up to higher amounts over the course of some time. But again, conversation to have with your pediatrician on the best way to do that. Some parents feel better doing it in office and some pediatricians are totally fine with that. And I think that's great if it helps parents just do it earlier and do it sooner in terms of keeping it in the diet regularly. And that was really our big focus in formulating mission Mighty Me Nutty Puffs. We wanted to create something that would make it super simple to just have at a regular part of the diet where parents weren't having to dose or crunch numbers or wonder if their child had gotten enough peanut protein. So the American Academy of Pediatric for high risk babies recommend 6 grams peanut protein per week. And that was based on the LEAP study. That was the average amount of peanut protein that babies in the LEAP study consumed. And so all of our peanut butter puff flavors, we have a peanut butter, strawberry, peanut butter, banana and classic organic peanut butter. Each of these pouches has about 7 grams peanut protein in the pouch. And so one of these a week meets the American Academy of Pediatrics weekly Recommendations for high risk infants because kids will drop a few of the puffs.
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A
On the ground.
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B
For a little waste. Right? I love that. And you know the guidelines focus on high risk babies. So there's not currently a recommendation for normal risk children for how much should be consumed. However, Based on the EAT study, which was also led by Dr. Lack, we know that about 2 grams in research has been shown to be protective of an allergen for most children. Pediatricians will say aim for about 2 grams peanut protein per week. But for high risk babies, it's 6 grams.
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A
One thing that added another layer to Catherine's story was her husband has a shellfish allergy. Family history can matter when it comes to developing food allergies. Not because allergies to different foods automatically run in families, but because the tendency to develop allergic conditions can we call this an atopic tendency. And it can include things like food allergies, eczema, asthma, or seasonal allergies. So if a parent or a sibling has any of those conditions, it can raise a child's risk of developing a food allergy themselves. That doesn't mean a shellfish allergy in a parent is necessarily gonna cause a shellfish allergy in a child, but it does mean that child is more likely to have some type of allergy. That's why Katherine's daughter would have been considered higher risk from the start if we had known.
- [21:52]
B
I think what is important for parents to know and of course preface this with always discussion any feeding questions with your pediatrician and follow your pediatrician's specific advice for your child. But the risk is actually greater in waiting. So the sooner you know, once a baby's ready for solids, the sooner you can get peanuts or tree nuts or allergenic foods into the diet, the lower the risk that they have a reaction. And if they are going to have a reaction, the younger they are, the less severe a reaction is. But that window is so small. Four to six months is really like the sweet spot for prevention. But by age 1, 2/3 of peanut allergies have already developed.
- [22:46]
A
So here's what we do know. There's no official guideline for how long to keep up an exposure. In the LEAP study, kids were followed until age 5. So that's the benchmark we use. And now those same children have been followed into their teenage years and they're still not allergic. It's evidence that early intervention can have a lasting protective impact. Catherine shares her final thoughts and a.
- [23:12]
B
Little advice for food allergy parents. You're just, you're always worried when they go to a birthday party, when they go to a spend the night, especially when they're little, when they're not reading ingredient labels and not really able to advocate for themselves. And you know, for a lot of kids with food allergies, like so much of our celebrations revolve around food, right? It's how we connect, it's how we commune, it's how we celebrate birthdays. And a lot of kids with severe food allergies can't partake of most birthday cakes, most cupcakes. I think that's just hard for kids with food allergies. Like schools have gotten a little bit better trying to either make sure there are safe treats for everybody or maybe make food not so much the focus. You know, have the focus be more of the celebration and less of the food.
- [24:13]
A
Her daughter is now 15 and food allergies unfortunately are still a part of her life. Just recently she accidentally ate a cracker made with cashew flour and she had to use her epinephrine injection. It's a reminder that for families who live with food allergies, the burden is constant. This is a chronic condition, but here's the hopeful we now know that many of these allergies can be prevented from happening in the first place. That's why I love what Mission Mighty Me is doing. Their mixed nut butter and peanut butter puffs are really thoughtfully designed and not just based on the published studies, but on the deep knowledge and the passion that both Dr. Lack and Catherine bring to this issue. They've even made some decisions based on what's not yet in the research, like leaving out pistachio and pecan. There's likely some cross reactivity since pistachio often pairs with cashew and pecan with walnut. But that's a rabbit hole that I'm going to leave for you to explore when you try the products yourself and see what you think. If you'd like to give them a try, Mission Mighty Me Nutty Puffs are available@missionmightyme.com I'll put the link in the show notes and you get a discount. Use code doctorhunter D R H U N T E r and get 15% off one time purchases or 30% off a subscription through the end of this year. You can also find them on Amazon, Thrive Market, Target Sprouts and other retailers. Catherine, thank you so much for sharing your story and doctor Lack for sharing your expertise for the work you're doing to help the next generation grow up with fewer food allergies and to grow up with a lot more peace of mind for their parents. And if today's conversation has you wondering what's possible beyond prevention, I'd love for you to go back and listen to episode 42. It's called Food Allergy Treatment Finding a Cure. In that episode, I talk with food allergy researcher Dr. Stephanie Leonard, who's on a mission to free families from their constant worry. We talked about groundbreaking treatments that could help make eating out or even trying a new food feel safe again. If you enjoyed today's episode, please take a moment to leave a rating and review on Apple Podcasts and share it with another parent who might need to hear this. For more from the Pediatrician next door, find me on the web@ pediatriciannextdoorpodcast.com if you've got a question about the weird things kids do, send an email to helloediatriciannextdoorpodcast.com for a chance to hear your voice on the show. I'm Dr. Wendy Hunter and I'm the Pediatrician next Door. This show is produced by Red Rock Music. Make sure to subscribe and leave a review wherever it is you're listening. I'll be back next time with more. You say you'll never join the Navy, that living on a submarine would be too hard. You'd never power a whole ship with nuclear energy, never bring a patient back to life.
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B
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A
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