Science Vs - Peanuts: Public Enemy No. 1?

Episode Date: May 30, 2019

Peanut allergy in children has been on the rise since the 1990s. What’s to blame? We find a clue in a very unexpected place, and talk to pediatric allergist Prof. Gideon Lack. Check out the full transcript here: http://bit.ly/2rkEcqL Selected References: Gideon’s landmark 2015 study: https://bit.ly/2QsvOMvThe mouse rash study: https://bit.ly/2Mf6hZVCDC’s report on rising skin and food allergies (1997-2011): https://bit.ly/2XgjGlJ This episode was produced by Rose Rimler with help from Wendy Zukerman, along with Meryl Horn and Michelle Dang. Our senior producer is Kaitlyn Sawrey. We’re edited by Blythe Terrell. Fact checking by Diane Kelly. Mix and sound design by Peter Leonard. Music written by Emma Munger, Peter Leonard, and Bobby Lord. Recording assistance from Andrea Rangecroft. A big thanks to Dr. Andrew Dang, Professor Scott Sicherer, Dr. Marshall Plaut, Dr. Kristin Sokol, Dr. Robert Boyle, and others. As well as the Zukerman Family and Joseph Lavelle Wilson. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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And this is... Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st. Hi, I'm Wendy Zuckerman, and you're listening to Science Versus from Gimlet. This is the show that pits facts against anaphylaxis. Within the last few decades, it seems that the peanut has gone from one of America's favourite snack foods to public enemy number one. Milwaukee teenager has died after having an allergic reaction to peanuts. Peanuts have been banned on airlines and in schools. No peanut products in the classroom means lunchboxes are kept in the hall. According to the CDC, 1.4% of kids in the US have peanut allergies.

1.4%. It may not sound like much, but it's quadrupled since the mid-90s. According to the most recent data, several thousand kids a year end up in the ER because of a peanut. So, in today's mini-episode, we're asking... What is going on with all these peanut allergies? Is there anything parents can do about it? And what does this have to do with anything?

We'll get to all that, but let's start our story with Gideon Lack, who has a bit of a cold. I may have to blow my nose, embarrassingly. Gideon is a paediatrician and allergy researcher at King's College London. OK, thanks. Gideon told us that back in the 90s, he and other researchers were seeing more and more kids with peanut allergies. It was really very weird and very surprising. And it was also scary, because when the body has a severe allergic reaction...

It's a bit like a battlefield. The cheek swelling, diarrhoea, vomiting, swelling of the airways, difficulty breathing, loss of consciousness. And so in the late 90s, allergy researchers got together to try to work out what to do about all these kids getting these nasty peanut reactions. And they decided to start giving some parents

some very clear advice. Which was don't feed your babies peanuts. In the year 2000, the American Academy of Pediatrics came out with guidelines telling parents just this. A lot of babies just shouldn't be eating peanuts. No peanut butter, no peanut cookies until they're three years old. And Gideon says that this advice was particularly meant for babies with a high risk of getting peanut allergies, say, if they had other food allergies or even eczema. They have really bad rashes. We know that that's the group that goes on

to have a very high rate of peanut allergy. And eczema is common in babies, which meant a lot of parents were getting the advice to put the peanut butter on the high shelf. Our producer Rose Rimla asked Gideon about it. Were you telling your patients that? Yes, I was telling my patients that. I was giving that advice to my own family as well. It seemed intuitively true that by avoiding peanuts and by sort of cocooning the baby, we would prevent the development of allergies. And so after those guidelines in 2000 came out, doctors across the US and the UK were telling

parents, don't give your babies peanuts. And the world chugged along for a few years. Gideon's kids grew up. Harry Potter got made into movies. You're a wizard, Harry. Britney Spears shaved her head. Britney Spears. She's bald. Yeah, a lot happened during the 2000s. But one thing that didn't happen?

Peanut allergies didn't go away. The advice to banish nutter butters from the kitchen just didn't seem to be working. Studies were finding that kids who weren't eating any peanuts were still becoming allergic to them, and Gideon had noticed it too. My first inkling that this might be off base was really from listening to my patients.

What were they saying to you? Well, they were saying, I just don't understand. We avoided giving our child peanuts and yet the child has developed peanut allergy. So what was going on? Gideon found the answer somewhere unexpected. Here's what happened. He was at a conference in Israel giving a talk on peanut allergies

and he started his talk the way that he always did. He asked the doctors in the room, about 200 of them. How many of you in the audience have seen a case of peanut allergy in the last year? When Gideon did this in the US or the UK, he said practically every doctor would put their hand up. They just couldn't swing a dead cat without hitting a kid with a peanut allergy. But here, in Israel? I only saw just a couple of hands go up in the audience.

I counted something like two or three. I was startled and sort of had to question myself whether I was really seeing things correctly. Yes, they were seeing allergies in abundance. They were seeing asthma in abundance. But they were not seeing peanut correctly. Yes, they were seeing allergies in abundance, they were seeing asthma in abundance, but they were not seeing peanut allergy. Gideon went searching for more data. His team did a study of more than 10,000 kids in the UK and Israel, and he found that peanut allergies were 10 times more common in the British kids than the Israeli ones. Yeah, 10 times higher.

It was the very first clear clue that there was something going on here. And there was one curious thing that might possibly explain what was going on in Israel. And it had to do with a very particular Israeli snack. Puffs that contain peanut protein. What are these puffs? What are these puffs? They're a bit like, I think, what you would call cheese doodles.

These cheeseless cheese doodles are packed with peanuts and they're called bamba. Bamba is pretty much made for little kids. The mascot is actually a baby in a diaper. In fact, an Israeli parent actually told me that the first three words that an Israeli baby learns to speak are Abba, Ima and Bamba, which is Dad, Mom and then Bamba.

And the fact that all these Israeli babies were chowing down on Bambas and not getting peanut allergies made Gideon think, could these peanut puffs actually be protecting these kids? So back home in England, his team decided to test it out on babies. They got more than 600 bubs who had a high risk of getting peanut allergies. They had some of the pipsqueaks avoid peanuts like the plague, you know, the usual strategy.

And then there was another group of babies who were fed peanutty snacks like Bumba on the reg. And after five years, Gideon found that the Bumba babies were way less likely to be allergic to peanuts. In fact, they were around five times less likely to get peanut allergies. This was a huge effect, and we didn't for a moment anticipate such an effect. So what was the mood when you crunched the final numbers? Did you pop the champagne?

If I'm not mistaken, we had a small glass of malt whiskey. But they couldn't party too hard because there remained the question of why. Why did eating peanutty bamba seem to protect the little kids? After all, this flew in the face of everything they thought they knew about allergies. Well, I scratched my head over a long time and I started to think back to animal model research that had been going on. Gideon cast his mind back to these studies done in mice, which had found that, like his Bumba study,

you could protect young mice from getting peanut allergies if you fed them peanutty things when they were little. And then there was another group of researchers who came at this from a different angle. And instead of trying to prevent allergies, they actually gave the mice peanut allergies. And it was all pretty mad scientist-y. Here's what they did.

They took young mice with basically rashes. Red, broken down skin. These mice have never eaten peanuts in their lives. And peanut is applied to that skin. These scientists rub peanut bits right into their mousy little rashes. After the mice get their weird peanut massage, scientists then feed them peanuts. And ta-da, these mice get nasty allergic reactions.

Exactly. Peanut makes its way through the skin. That seems to be enough to set up allergy. Thinking about these mouse studies, Gideon thinks, huh, maybe the key here is how babies are first exposed to peanuts. Like, if it's through their mouth with a friendly little bumper, then that's good. But if it's through their mouth with a friendly little bumper, then that's good. But if it's through their skin, that's bad.

Gideon has an analogy for this. If someone knocks on your door with a smile or, I don't know, carrying a bunch of flowers, you might think it's a bit strange, but you'll be polite to that individual and you'll talk to them. Whereas if you hear hear glass shattering upstairs in your bedroom and you see someone in a mask breaking through your window to one of your rooms upstairs, you might be less friendly inclined. So peanuts getting through our skin, maybe through an eczema rash, that's a bit like breaking a window and making our whole body angry. But our final question is this. How are peanuts getting through our skin?

Like, we don't have mad scientists rubbing peanuts into our rashes. Well, one idea is that over the years, we've been putting so many peanuts into so many foods and different products and then shipping them all around the world that we've ended up with tiny traces of peanuts all through our environment. Like, Gideon has found peanut bits in the beds of kids who don't eat them.

And he reckons that these peanut bits can then make their way into our skin. And if this idea is true, it means that what Gideon and other doctors were telling parents to keep babies away from peanuts... It turns out was exactly the wrong advice. ..because when babies didn't eat peanutty things, it increased the chance that the first time

their body was exposed to a peanut, it was through their skin. You know, there's an ironic twist there that we got it wrong and I was very much part of that process. I was giving what I perceive now to be the incorrect advice for quite a period of time. Now, the rising rates of peanut allergies probably aren't just due to this bum advice. So, for example, we're seeing all kinds of allergies going up,

even stuff like asthma and seasonal allergies. Achoo! And we can't blame a lack of bumber for that. So something else is going on here. But Gideon's surprising findings on peanuts were enough to convince other scientists that hiding peanuts away was the wrong call. Because in 2017, the American Academy of Pediatrics released a brand

new set of guidelines for doctors. They now say that most kids should be given foods with peanuts early, when they're still babies. But a note to parents out there, if your baby has severe eczema or some other allergies, take your squirt to the doctor before giving them peanuts, just to be safe. So in the end, medicine did a total backflip here, which might feel like this is a science failure. But maybe this is actually a science success story. After all, scientists like Gideon saw what they were telling parents wasn't working.

They tested a new idea and they changed the dogma. It all just took time and a little bit of unexpected inspiration. Oh, it smells like peanut butter. Hmm. Oh, damn, it's like chewy. It's like, it like sticks to every part of your mouth. It tastes just like peanut butter. It's pretty good.

Wow. Do you like it? Like is a strong word. I can tolerate it. That's science versus peanuts. We'll let the Bumba Baby play us out. Bumba Baby Next week, how an assassination changed medicine in America forever.

It's so perfect, it's like a sound effect. Hey, Rose Rimlam. Hey, Wendy. Producer of Science Fashes. We're going to be presenting these citations with Bumba. I think we should get a fistful of Bumba and shove it in our mouth. Yeah. It should melt in your mouth.

How many citations? This week's episode. 60. 60? 60. For? 60. For a mini only 15 minutes. Yeah, there's a lot in there. There's a lot. If people want to know more, where should they go?

They can click on the link in our show notes. Or go to our website. I have to keep shoving it in. It's like putting coal into a train. Buy this on Instagram. This episode was produced by Rose Rimler, with help from me, Wendy Zuckerman,

along with Meryl Horn and Michelle Dang. Our senior producer is Caitlin Sorey. We're edited by Blythe Terrell, fact-checking by Diane Kelly. Mix and sound design by Peter Leonard. Music written by Emma Munger, Peter Leonard and Bobby Lord. Recording assistance from Andrea Rangecroft. A big thanks to Dr Andrew Dang, Professor Scott Sitcher,

Dr Marshall Plout, Dr Kristen Sockle, Dr Robert Boyle and others. Plus, thanks to the Zuckerman family and Joseph Lavelle Wilson. I'm Wendy Zuckerman. Back to you next time.