The End of Food Allergy by Kari Nadeau [Book Summary – Review]

There is good news for at least two categories of individuals right now: those with food allergies and those at risk of getting them. Right now, the headlines may seem like they were plucked from a dystopian novel.

They believe we are currently seeing a scientific and medical revolution. Our understanding of food allergies has drastically changed in recent years, and we’ve made significant strides in preventing and treating these disorders that affect millions of people worldwide.

Food allergies may perhaps disappear in the not-too-distant future. Particularly if you or any of your loved ones have food allergies, it’s a glimmer of hope at a time of despair. You’re going to hear some of the tales and science behind this exciting and inspirational advancement in modern medicine, even if you’re fortunate enough to be allergy-free.

One thing to note: if you have allergies, please don’t modify your diet without first talking to your doctor.

These chapters will provide information on

  • how a researcher’s experiment with a baby snack resulted in a novel theory;
  • why there is a surprise explanation why food allergies are increasing; why
  • how some illogical methods could be the answer to the issue.

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Chapter 1 – An innovative theory on food allergies was established by allergist Gideon Lack.

Gideon Lack, a British researcher, experienced a combination of worry and puzzlement in the late 1990s and early 2000s.

He has observed the prevalence of peanut allergies in the UK treble in only 10 years while working as a pediatric allergist at King’s College London. During this period, more British parents than ever were adhering to the accepted medical guidance. It came down to a piece of straightforward advice: don’t give your infant peanuts. By doing this, you’ll lower the possibility that they’ll become allergic to peanuts.

It seems sensible, but it didn’t seem to be working, and no one knew why.

Then, something took place. Lack encountered two facts while traveling to Tel Aviv that gave him a lightbulb moment. The conclusion would be a hypothesis that contradicted accepted knowledge about food allergies.

Lack had traveled to Tel Aviv to address a gathering of Israeli medical professionals about peanut allergy. Who in this room has treated at least one instance of peanut allergy in the previous year? he questioned the audience at one point during the lecture.

Nearly all of the hands would rise whenever he asked this question in the UK. However, just a few did in Tel Aviv. He later learned that the prevalence of peanut allergy among British children was 10 times greater than among Israeli children (1.85 vs only 0.17 percent).

That was the initial truth he discovered. What made sense of it? That gets us to the second fact, I suppose.

Lack was having lunch with some Israeli friends one day soon after his speech. One of them was a woman who was giving meals to her infant. His pals told him that in Israel, it was a highly popular infant food. He asked whether he may try it for himself out of pure curiosity.

The snack had a peanut butter flavor.

He later discovered that at the age of nine months, Israeli kids were eating food containing peanuts at a rate that was seven times higher than British babies’ (69 vs 10%).

Are the two facts related in any way? Could early peanut exposure possibly reduce a child’s risk of developing peanut allergies rather than the opposite? Was avoiding hence a bad idea? And may this also be said for other dietary allergies?

Lack had a hunch that each of these queries had a positive response. But formulating a hypothesis is one thing. It’s another thing to verify it, let alone test it.

There was a need for more study.

Chapter 2 – Food allergies are a major problem that affects both children and adults worldwide, and their prevalence is dangerously rising.

Later, when we return to Gideon Lack’s theory, let’s zoom out and take a broader view of the situation. You see, the increase in peanut allergy Lack reported in the UK wasn’t an isolated incident. It was a component of a much wider pattern.

On the other side of the Atlantic, the situation in the US was becoming worse at the same time. Less than 0.5% of American kids in 1997 had peanut allergies. By 2018, the proportion had increased by more than fourfold to 2.2.

However, the issue of food allergies extends well beyond peanuts and is not just a concern for kids in Western nations such as the USA and UK.

One of the eight most typical food allergens, or foods that make people with food allergies have allergic responses, is peanuts. Eggs, fish, shellfish, wheat, soy, milk, and tree nuts like almonds and pistachios are among the others. All eight allergens have been killing an increasing number of people in recent years.

This is particularly true in the US, where the number of kids with one or more food allergies increased by 8.5% between 1997 and 2011. However, other places have seen comparable growth. For instance, between 1999 and 2009, China observed a 7.7% increase in the proportion of babies with food allergies.

And not just children and newborns are affected. More than 10% of individuals in the US and the UK have one or more food allergies, and nearly half of them first experienced one of these allergies as adults. Throughout the world, a similar narrative is in progress. According to a study, up to 8% of children and 11% of people throughout the world are thought to have food allergies.

Now, the percentages differ from one nation to the next, as do the quantity and caliber of the data that is at our disposal. Although the specifics are intricate and even hazy, one thing is for certain: food allergies have grown to be a significant issue virtually everywhere. Estimated rates for children and adults range from 4 to 15% in a variety of countries, including Ghana, Tanzania, Japan, Taiwan, Colombia, Canada, Australia, Poland, and Bulgaria.

If there was ever a time for some innovative thinking on food allergies, it is right now.

Chapter 3 – There are several elements at work, and no one explanation can account for all cases of food allergies.

Before returning to Gideon Lack’s theory, let’s complete our larger picture with a few key disclaimers.

Although they have become more common in recent years, food allergies are not a brand-new problem. The urge to comprehend them is not either. The ancient Greek physician Hypocrites saw persons with cheese allergies as early as the fifth century BC. He hypothesized that they simply had “hostile” “constitutions” toward dairy products.

Since then, food allergy research has advanced significantly. Although it has achieved some significant advancements, there are still some equally significant riddles that need to be resolved. Science still has a lot to learn about the intricate mechanics of how and why food allergies develop. However, the fundamental facts are clear-cut and well-documented.

Fundamentally, allergic responses to a particular food type occur when the immune system of the body confuses the meal’s proteins for potentially harmful foreign substances. At that moment, the system’s alarm bells start to ring, and it enters defensive mode, causing several bodily reactions intended to fend off the onslaught it feels it is facing. Itchy skin, hives, shortness of breath, vomiting, and dangerously low blood pressure are just a few examples of allergic responses that might emerge from the ensuing inflammation, muscle spasms, and enzyme synthesis.

What then triggers the immune system to malfunction? And why is it occurring to more people now?

Numerous ideas have been proposed by scientists. Some of them mention genetics, while others discuss how our surroundings, meals, and lives have changed and how that has affected the bacteria in our guts.

All of these explanations have some merit and contribute to understanding the situation to varying degrees. However, none of these are sufficient on their own. One genetic explanation, for instance, focuses on the blood antibody Immunoglobulin E (IgE), which is critical in causing allergic responses to foods. Currently, IgE levels in patients with food allergies are frequently high. These levels in turn appear to be controlled by certain genes. However, not everyone with high IgE levels develops a food allergy, therefore this notion cannot be relied upon alone.

Food allergies are likely the consequence of a wide range of linked variables, including interactions between genes, surroundings, diets, and so on. The only straightforward explanation is that there isn’t one.

Therefore, bear that in mind when we concentrate on Gideon Lack’s theory. It’s only one component of a much larger jigsaw, although a very crucial one.

Chapter 4 – Neither genetics nor other medical problems can account for the high occurrence of peanut allergy.

Okay, let’s get back to Gideon Lack’s theory now. Does a child’s early exposure to peanuts influence whether they later acquire a peanut allergy?

After visiting Israel, Lack had an inkling that the solution was yes. It was still only a hunch at this stage. He initially had to rule out certain other hypotheses before he felt secure enough to propose it as a scientific theory.

Perhaps due to genetic differences, Israeli newborns experienced less peanut allergy than British babies. Maybe they just had lower incidences of other diseases like asthma that were linked to peanut allergy. It found out that neither justification could be verified.

Lack and his colleagues gathered information on 8,826 Jewish youngsters in Israel and the UK to get to the issue’s root. Why Jewish youngsters? Since all had the same genetic makeup, the researchers may be able to adjust for this issue.

Lack and his colleagues were able to account for that variable since asthma rates among youngsters in both nations were comparable. It would appear to rule out heredity and asthma if the two groups of kids still had varying percentages of peanut allergy despite having these characteristics.

That’s exactly what they found, and sure enough. In reality, Lack and his associates were able to advance much further as a result of the findings of their study. They were able to eliminate a wide range of other hypotheses by gathering information and running the statistics, including variations in the children’s socioeconomic classes and how frequently they experienced other allergic illnesses that may be connected to peanut allergies. These included hay fever, eczema, and allergies to milk, eggs, sesame, and tree nuts. Eczema is characterized by red, itchy skin.

Having various food sensitivities may not seem unusual at this point. But what connection is there between an allergy to eating peanuts and a skin problem like eczema? The relationship is not readily apparent.

It does, however, undoubtedly exist. According to research, children who have severe eczema are much more likely to acquire peanut allergies. Why? Well, what Lack and his associates did next was heavily influenced by the answer to that question.

Chapter 5 – According to the dual-allergen exposure theory, one of the primary routes for the development of food allergies may be through our skin.

Remembering the purpose of having skin in the first place will help with understanding the relationship between eczema and peanut allergies.

From a biological perspective, our skin essentially serves as a barrier between the inside of our bodies and the outside environment. It stops alien entities like bacteria from entering our bodies and causing damage.

In any case, that’s what it’s meant to do. Unfortunately, skin problems like eczema can weaken it and make it more porous, which allows intruders to get through.

What relevance does this have to food allergies? The solution to that query, however, introduces us to a concept known as the dual-allergen exposure theory.

As a young child, imagine that your parents avoid giving you anything that contains peanuts since that is the accepted knowledge of food allergies. This strategy makes sense in theory: if eating peanuts might result in allergic responses, just avoid them, and you’ll also avoid any hazards associated with doing so.

The issue is that peanut proteins can also enter your body through your skin. If anyone in your family consumes anything that contains peanuts, some peanut crumbs will get up in your home’s dust. Additionally, it might stay for up to three hours in their saliva and on their skin after eating – plenty of time for them to touch you or kiss you and spread it to your flesh.

Once that occurs, there is a minor possibility that some peanut proteins will enter your body via your skin. This risk increases significantly if you have a skin disease like eczema.

Let’s assume that some peanut crumbs do find their way into your body. How will your immune system respond? Well, you won’t be familiar with their proteins if you’ve never eaten peanuts. This will raise the likelihood that it will perceive them as dangerous alien invaders that need to be repelled rather than as helpful nutrients that should be left alone. And as a result, there will be a higher possibility that the immune system would produce an allergic reaction to combat the perceived threat.

You have the beginnings of a peanut allergy at that stage. The dual-allergen exposure idea also states that this can occur with any other dietary allergen.

Chapter 6 – Gideon Lack proposed the hypothesis that eating food containing allergens might prevent food allergies in newborns and the converse.

So, is there any support for the dual-allergen exposure theory?

It does. According to one study, due to variations in their settings, babies with peanut allergies were exposed to peanut residue on their skin 10 times more frequently than their non-allergic peers. According to different research, children’s chance of acquiring peanut allergies by the age of five might be increased by as little as one drop of skin contact with peanut oil.

However, don’t just place the responsibility on the skin, any polluted lips, hands, or dust that may come into touch with it. The issue isn’t skin exposure per se; rather, it’s skin exposure in combination with the propensity to refrain from giving young children food that may contain allergies, sometimes known as allergic food. This brings up Gideon Lack’s theory once more.

Lack made two main points in his argument. On the one hand, consuming allergenic food could train a baby’s immune system to view them as allies rather than enemies. However, avoiding that dish can have the opposite effect. When the immune system ultimately came into contact with such allergens through skin contact or unintentional ingestion, it may learn to see them as foes.

The repercussions would be huge if everything there is accurate. Medical professionals have been recommending parents keep their children away from allergic foods for many years. Additionally, they had been advising mothers to abstain from eating that food while they were pregnant or nursing. In this manner, they would stop the allergens from being passed to the infants through the umbilical cords or breastmilk of their mothers.

This counsel permeated the public awareness of many parents over the years, and they obediently adopted the avoidance method it is recommended. Unfortunately, this does not affect preventing food allergies in infants. As we’ve seen, though, the prevalence of food allergies increased sharply.

If Lack was right, then those two things may be connected. Avoidance could exacerbate the issue of food allergies rather than addressing it. And in such a situation, the prevailing wisdom would be gravely flawed. 

Instead of avoiding allergenic foods, parents should actively endeavor to incorporate them into their children’s diets; women should also not abstain from eating them when pregnant or breastfeeding.

Only if Lack was right, which is very large if.

Chapter 7 – The LEAP research supported Lack’s claim that early exposure to peanuts lowers the risk of peanut allergies in children.

The crucial issue is now at hand: was Lack’s theory true? Does early exposure to peanuts protect infants from acquiring peanut allergies?

Lack and a few coworkers started attempting to address that query in 2006. The LEAP research stood for Learning Early About Peanut Allergy, a clever abbreviation for a far less appealing statement.

The research, which was finally published in 2015, needed financing from three different organizations, the cooperation of hundreds of newborns and parents, and who knows how many peanuts. It also took nearly ten years to complete. But in the end, all of the efforts were worthwhile. It was discovered that Lack was in fact right. 

Lack and his colleagues enrolled 640 newborns in the LEAP research (along with their parents, of course). Some of the infants were already allergic to peanuts. The majority didn’t. They were all at a high risk of developing peanut allergies since they all either had severe dermatitis, an egg allergy, or both.

Following that, all of these newborns were divided into two groups by Lack and his associates. The majority of them would entirely avoid consuming any food items containing peanuts during the first two years of their existence. The other half would frequently consume foods containing peanuts in a method that was closely observed and controlled.

The researchers followed up with their little participants, who were now young children, five years later.

How many of them had allergies to peanuts? In comparison to the group who avoided eating peanuts, did the peanut-eating group have fewer allergies? In other words, did feeding peanuts to newborns assist them to avoid developing peanut allergies?

It turned out that the response was a resounding yes. There were astonishingly 86 percent fewer newborns that had peanut allergies than the babies who consumed peanuts before the trial began. There was an astonishing 70% decrease in peanut allergies, even among the infants who had them before the research started. To put it another way, consuming peanuts enabled these newborns to overcome their sensitivities to them!

Lack and his colleagues have achieved a significant advancement in the field of food allergies, thus it would appear that the name of the LEAP research was wisely chosen.

Chapter 8 – In general, it seems like a good idea to introduce allergic food to infants, but there are several crucial exceptions.

Following the LEAP study’s amazing success, food allergists from all over the world were motivated to investigate a variety of further lines of investigation. A whole alphabet soup of acronyms followed. There was the LEAP-ON research first. The EAT, PETIT, BEAT, STAR, STEP, and HEAP trials followed.

If this were a Hollywood film adaptation of the story, the subsequent section would discuss how further research expanded the LEAP study’s original conclusions concerning peanut allergies to include other food allergies.

And sort of, that is what transpired. But unlike the triumphant story of clear success in a feel-good movie, the reality of food allergy science is a little trickier.

The short version is that we won’t get into the specifics or even the acronyms of all those follow-up studies. The LEAP-ON research added support to the LEAP study’s conclusions regarding peanut allergy. The EAT research later demonstrated that within the first six months of life, infants may safely consume sesame, milk, fish, eggs, and wheat.

Therefore, the EAT research offered more proof that parents shouldn’t give their infants allergic foods, contrary to traditional knowledge. However, a different analysis of this study was unable to prove that providing them with such food had any positive effects. This raises the unanswered question of how much allergenic food is optimal and suggests that this failure may have been related to problems with the amount of food they were served.

The outcomes for the remaining experiments in the alphabet soup were likewise somewhat inconsistent. All of them were concerned with egg allergies, and most of them revealed findings similar to those of the LEAP study: giving eggs to infants seemed to lower their likelihood of developing egg allergies. The STAR research found little effect, whereas the HEAP study found the opposite. Additionally, several kids had to be admitted to hospitals as a result of allergic responses in both the HEAP research and the otherwise fruitful PETIT study.

Finally, a word of caution: if you are a parent of a child at risk for food allergies, don’t just feed them allergic food. Consult a physician beforehand.

Chapter 9 – Food allergies that already exist can be cured with oral immunotherapy.

Despite the conflicting data and warnings, a new agreement is emerging in the field of food allergy research and the broader medical community: restricting a baby’s diet to allergenic foods is typically a bad idea, and introducing them to them early is a preferable strategy.

If you’re a parent of a baby who hasn’t yet experienced food allergies, that’s fantastic news. But what if you or someone you care about already has them? There’s good news for you too, though. A fascinating new method of treating food allergies has emerged in the medical landscape. Oral immunotherapy, or OIT for short, is what it is called.

The concepts behind OIT date back to earlier times.

Do not forget that a food allergy is essentially the consequence of your immune system being confused about which chemicals entering the body are beneficial proteins to allow pass and which ones are hostile foreign invaders to assault. If you give it some thought, that suggests re-educating the immune system as a simple solution to reverse food allergies.

But how exactly do you do that? The quick answer to that is very gradual. A little amount of the food the patient is allergic to, often in powdered and meticulously sterile form, is given to them as the first step in OIT therapy. The sum is then gradually raised over a considerable amount of time. Desensitization of the patient to the allergen is the aim. 

The patient’s immune system becomes less and less likely to see it as a threat as it grows accustomed to it. As a result, the patient can tolerate increasing amounts of the problematic meal.

The patient is free to continue this process as long as they would like. For other people, the goal is just to be able to tolerate traces of the allergen. They won’t have to be as concerned about it contaminating their food this way. For instance, food produced at a facility that also handles nuts might be consumed by someone with a nut allergy. Some patients wish to progress further and be able to consume more meals.

Why would someone want to stop the medication before that? OIT isn’t exactly a stroll in the park, as we’ll soon find.

Chapter 10 – OIT is getting less challenging, risky, and time-consuming.

OIT has both good and bad news for persons who have food allergies.

Let’s begin with some encouraging news. It works. It has been proven to be quite beneficial in several investigations and clinical trials. For instance, 84 percent of patients who got OIT in a significant 2019 trial that treated persons with peanut allergies were able to ingest peanut proteins safely by the conclusion of the treatment period.

They had to put in a lot of effort and go through some unpleasant, maybe dangerous situations to get to this stage, though. The bad news is that. Currently, OIT might be challenging to finish. Fortunately, there’s also more fantastic news on the way.

OIT’s duration varies depending on the patient’s objective. It takes roughly six months if she simply wants to avoid unintentional allergy exposure. It takes around two years for her to get entirely desensitized to the allergen and be able to consume full portions of the questioned item. In any event, a patient is required to attend a therapy session every two weeks or so, which might last a few hours or longer. In other words, a significant amount of time must be invested.

Additionally, each therapy session essentially entails the doctor deliberately attempting to push the patient’s immune system to the point of setting off an allergic reaction. Sometimes, though, that line is crossed, and the sufferer must deal with the fallout. In the early stages of OIT, this frequently meant having life-threatening allergic responses.

But those reactions are getting weaker and less common as OIT develops and gets more refined. Omalizumab, a medication that can speed up the entire process, has helped to reduce the total length of time it takes. Mepolizumab, reslizumab, benralizumab, and several other medications with “zumab” in their names might all contribute to making it even faster and safer.

A variety of complementary therapies are also under development, from vaccinations for food allergies to gene therapy, which tries to directly remodel the immune system. While other aspects of the future may be grim, for people who have food allergies, things are looking up.

The End of Food Allergy: The First Program to Prevent and Reverse a 21st Century Epidemic by Kari Nadeau, Sloan Barnett Book Review

Food allergies may soon be a thing of the past thanks to some recent developments in science and medicine. Early exposure to allergenic foods can aid in preventing the development of food allergies in newborns. Others who already have food allergies may be helped by oral immunotherapy. In both situations, it seems that judicious exposure—rather than avoidance—is the secret to success.

Consult your physician.

This is the first thing you should do if you or a loved one has a food allergy and is interested in attempting oral immunotherapy (OIT). Your doctor can send you to one of the numerous clinical studies taking place nearby if you’re in the right place at the right time. Remember that OIT can be extremely dangerous if not administered correctly, so you should never attempt to perform it on your own. OIT must be carried out in a hospital setting under the close supervision of a certified physician to be secure.

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