Breastfeeding has many benefits. Medical students all over the world are told, “breast is best.” Paediatricians, family doctors and the World Health Organization all are looking at ways to extend the time that mothers breastfeed, to at least six months.
We are told that breastfed babies have less allergies. Do they?
Recently, while attending the American Academy of Pediatric’s Annual Meeting in San Francisco, I had the privilege to hear the world’s top expert on food allergies. While listening to Dr. Hugh Sampson’s lecture, I had the same experience as the little boy who told the famous baseball player Shoeless Joe Jackson, “Tell me Joe, it ain’t so.”
When it comes to breastfeeding always preventing allergies, it is simply a matter of “it ain't so.”
When a nursing mom eats peanuts, she variably transmits the tendency for a peanut allergy to the allergic-prone child. With the increase in the number of mothers who breastfeed their babies in North America, there also comes an increase in the incidence of peanut allergies. Currently, the incidence of peanut allergies officially stands close to 1%, but the number may be higher.
Perhaps it is time for doctors to tell nursing mothers to avoid any peanut exposure, although peanuts are such a ubiquitous part of our common diet. In North America, the average consumption of peanuts per year is close to 6 pounds per person. But in Scandinavia, children are given peanut butter for the first time at a much later age than in North America and the incidence of peanut allergies is much lower.
All allergic diseases are increasing worldwide. The same is true for peanut allergies, except in Asia. Dr. Sampson believes it may have something to do with the way the peanuts are prepared – in Asia they are fried or boiled, as opposed to dry roasted which makes them more allergenic.
The problem of peanut allergy is not a small problem to both the medical community and society at large, especially in the schoolyard and on commercial airlines.
Of all the cases of severe anaphylaxis (a collapse of the patient’s circulatory system induced by a severe allergy) that an emergency physician will see in an average month, most of them will be due to food. Of these, more than 50% will be due to peanut allergies and the risk of anaphylaxis grows worse as the child gets older. After the first exposure to peanuts, a peanut-sensitive child has a 27% chance of suffering a life-threatening event and it goes up to 71% after the second exposure to peanuts.
School boards struggle to decide whether to make their school a peanut free school or not. The matter becomes emotional. Even among allergists, there is disagreement on what to do. The debate is fuelled by parents who, understandably, worry about their child’s safety, versus those who argue it is unfair to punish all children to benefit a few.
Most airlines ban peanuts; however, the latest problem for patients is to be allowed to carry their Epi pen automatic injection needles into the cabin. As a result of the September 11 th terrorist attacks, airlines are hyper-vigilant and are asking for a doctor’s note to allow needles on board the aircraft.
Surely, preventing peanut allergies would be the best solution, but that is not possible. The hope now lies in coming up with a vaccine against peanut allergies and also modulating the way the immune system works by deliberately “tying” up the bad players (immunoglobulin E for one.) This may offer a glimmer of hope.
The million-dollar question remains, “Who outgrows their peanut allergy, if at all?” Dr. Sampson and a group of other allergists have conducted a collaborative study and looked at this question. Out of 223 patients aged 4 to 20 years, the vast minority outgrew their peanut allergy. The key factor was the absolute Immunoglobulin E level; if it was more than 14 Units, the odds for outgrowing the allergy were slim to none. The other concern is the allergy may be temporarily gone, only to return with a vengeance at a later date.
Teaching patients and society about this nasty problem is a never-ending task. The Food Allergy Network does a superb effort to educate us all at www.foodallergy.org. From Quebec, Dr. Weisnagel, a Canadian expert on the topic, runs another superb web site at www.allerg.qc.ca/peanutallergy.htm.
Meanwhile, when a nursing mom eats peanuts, breastfeeding may be worse than bottle-feeding, but otherwise breast is still best!.
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