Why are we so upset by the LEAP study?

Not long ago, we all heard about the landmark LEAP study, which found that if we introduce peanut products to at-risk babies early, we may be able to prevent peanut allergies in the majority of them.  But far from celebrating this breakthrough, much of the response from the food allergy community has ranged from lukewarm to downright hostile towards the study.  Many cautioned that feeding peanuts to babies was far too dangerous, or even doubted the study results because it couldn't have applied to their own children.

Any time a study on food allergies gets published, the media latches on to it like a pit bull, but only onto the most sensational details.  Probiotics help OIT therapy have a higher success rate?  "News Flash!  Yogurt cures peanut allergies!"  Feeding peanuts to high-risk babies lowers their chances of developing a peanut allergy?  "Feed Peanuts to Your Infants Now and they'll Never Have Allergies!"  Or worse yet, "Eating Peanuts Cures Peanut Allergies!"

The backlash from these headlines hits the food allergy community every time.  Well-meaning (and not-so-well-meaning) friends, family members, neighbors, churchgoers, school parents, and random strangers on the playground want to share the great news with us, or just tell us how we did it wrong.  When their understanding is incomplete or skewed, that can do a lot of damage.  We worry that the parent volunteer in the classroom may give our child a peanut just to "prove" that we have nothing to worry about. We worry that we'll receive less sympathy because people think we're withholding The Cure from our kids.  We get tired of hearing about how everybody who doesn't have an allergy did things the "right" way, and we should have done it that way too.

I think this is one of the big reasons we've been so upset by the LEAP study:  everybody who saw a news story or read a headline is now an expert on peanut allergies.  They can't resist sharing their voluminous knowledge-base with us.  Dealing with food allergies is hard enough, we don't want lectures from the uninformed on how allergies work.

Even more irksome than the media backlash, though, I think is the heavy dose of guilt that came with the LEAP study.  If feeding peanuts to infants can prevent peanut allergies and we didn't try it, the implication is that we caused preventable peanut allergies in our children.  Some media outlets and blogs went farther, outright stating that parents are to blame for peanut allergies.  Our population is already vulnerable--we're always wondering if we did something wrong with our children.  (Should we have avoided peanut during pregnancy?  Eaten more peanut during pregnancy?  Avoided peanut while nursing?  Washed our peanut-contaminated hands before handling our infants?  Vacuumed better or more often?  Done all our dishes by hand?  Used less antibacterial soap?  Let our babies eat dirt?)  The implication that yes, we did do something identifiably wrong and caused our children's allergies rubs us the wrong way. And understandably so.

But how about those who did expose their infants to peanut, whether intentionally or unintentionally?  There seems to be an equal amount of malice there, and I think it may be part indignation that the system didn't work for them.  I stated before, and I will repeat it now, that nothing is ever one-size-fits-all.  Some babies were eliminated from LEAP because skin tests showed that they likely already had severe peanut allergies, and LEAP was looking for a way to prevent allergies.  What this shows is that while early introduction of peanut has now proven beneficial, it cannot work for everyone.  And it is ONLY a preventative measure and does nothing for those who already have an allergy. Unfortunately, some people are going to develop allergies no matter what.  I'm not interested in speculating about what the causes are, although I am sure they are many and varied.  As always, I see the LEAP study as one piece of a very complicated puzzle.

I think our biggest beef with the LEAP study is that it isn't a cure.  It's a groundbreaking discovery, but it doesn't benefit anybody currently in the food allergy community.  And the people who are spared won't even appreciate it.  They will never know the terror of rushing their swollen child to the ER while watching him struggle for breath, so they'll never understand what pain they've been spared.  They might say "I'm so happy that my child doesn't have any food allergies," but that's nothing compared to the relief a food allergy parent would feel if their child were magically cured.  Those who may best appreciate this are limited to the food allergy parents who are still having babies.  And those parents are naturally wary of feeding one child's poison to their new child.

And poison is how many people have come to think of peanuts.  We get offended any time the peanut industry introduces a new product.  When considering that peanuts may kill our children, we become accustomed to seeing peanuts like this:

The peanut is our child's enemy, and so it becomes our enemy.  And anyone working in the industry becomes a minion of that enemy.  It's natural to feel this way, and to feel conflicted about our previous enjoyment of this nefarious substance.  But I encourage our community to remember that to most of the world, the peanut is just another food.  If you think back to your pre-allergy days, you didn't see anything harmful in a peanut, either.

I've seen a lot of the sentiment "Wait!  Don't try this at home!" in regard to the LEAP study, and I think it's largely because of this image.  Everyone is advocating for how dangerous peanuts can be to babies, but let's think about that.

First of all, peanuts and peanut butter are definitely choking hazards for infants.  So if peanuts are to be fed to babies, we need a safer delivery method.  The Bamba snack used in the study seems to fit the bill for babies ready for finger foods, and I can think of a handful of other items that could be used for the same purpose.  Those wishing to feed peanut as one of the earliest foods would have to get more creative in finding a way to incorporate it into a baby-safe puree--that is, until the peanut industry creates their own line of peanut baby food, which I'm sure they will.  I just hope that baby food companies will keep it in dedicated facilities, keeping other baby foods clear of cross contamination. Many babies will still develop allergies, after all.

So should people start feeding peanuts to babies?

I won't kid you, I'm not a doctor.  I am neither pediatrician nor allergist, and I will leave infant feeding guidelines in the hands of experts.  But I will mention that I discussed this study with our allergist days after it was released.  She reminded me that they've found no benefit to avoiding peanuts and other allergenic foods in babies who are not considered to be at risk for allergies, and they have not recommended avoiding in those populations for a few years.  My kids were automatically at risk because they are my kids, so they had the genetic strike against them already.  But in families with no risk factors, and where the infants have not developed eczema or other allergies, there's nothing to indicate that parents should wait.  Allergies do crop up among populations that had no risk factors, however, so it's wise for all parents to be aware of the symptoms of an allergic reaction and be prepared to act.

As for babies in higher risk categories, our allergist seemed to think that the recommendation of early testing and possibly supervised feedings might be in the forecast.  Absolutely, everyone should consult with their individual doctors regarding feeding advice.  But I hope that people, particularly parents whose older children already have allergies and who are having more babies, won't dismiss this study.  It has huge implications for a future with fewer allergic children. J