Why peanut allergies are plummeting

Would you like some good news about the United States? Peanut allergies, which are among the most dramatic and dangerous of all food allergies, peanut allergies are plummeting. Like the rate of new peanut allergies among little kids has dropped nearly in half over the last decade. This is according to a big new study from Children's Hospital of Philadelphia. Why? How? Well, apparently because public health awareness campaigns actually work. Because the public health bureaucracy, which the present US administration is setting on fire, the public health bureaucracy actually works, at least sometimes. Scientists found that feeding peanuts to babies and toddlers makes them much less likely to develop peanut allergy later in life. and public health professionals worked to inform people of this fact. Their efforts are now bearing fruit or nuts or beans. Actually, peanuts are technically beans, which are technically fruits. Actually, they're the seeds of fruits, which is also what nuts are. Anyway, we're going to cover this new research and the older research on which it is based, and we'll try to answer some basic questions about peanut allergies, including why they only seem to be prevalent in rich countries. Also, what even is an allergy? Let's start there. Actually, let's start by thanking the sponsor of this video, Create Creatine Gummies. You know that I generally avoid advertising health rellated products in health rellated videos but ethically I feel perfectly fine doing it in this case because I am advertising creatine and creatine is the most studied legal strength supplement that there is. We have really clear scientific consensus that this stuff actually works and I told you that long before I was ever paid to say it. Creatine is a compound that is naturally present in your muscles and in your brain already. It plays a key role in energy production at the cellular level. Study after study has found that supplementing extra creatine on top of what you already have just makes people stronger. Most people about 10% stronger on average. After I first started taking creatine years ago, within a couple of weeks, the weights at the gym just felt noticeably lighter, which allowed me to lift more. Also great for everyday energy, everyday physical tasks. What makes Create creatine different? It's a gummy. Instead of getting your creatine in a powder that you have to mix into a gritty drink, you can just get it in a candy, which is going to be better for a whole lot of people cuz you need to take it consistently for the best results and it's easy to have a treat every day. They're tasty as all get out, come in a bunch of flavors. Creatine supplements may have other benefits beyond just strength. Uh, notably for brain health. There may be some cognitive benefits that is less wellestablished than the strength benefits, but it's still exciting new research to watch out for. Use my link and code in the description to save 30% on your first Create creatine gummies, including subscriptions. 30% off with my link in the description. Thank you, Create. Anyway, peanut allergies. What even is an allergy? An allergy is your own immune system hurting you because it mistakenly freaks out over a harmless substance that you encounter. And this is true of all allergies, food allergies or otherwise. Like many people, maybe like a quarter of people, I am allergic to some kinds of pollen. the airborne powdery sperm of flowers. Technically, it's a group of two to five cells that produce the sperm. So, let's compare it to semen, which is the animal fluid that contains sperm, but is not exclusively sperm. Anyway, like many of you, I am allergic to certain kinds of flower semen. And stupidly, I moved to Knoxville, a warm, humid city with abundant flowering plants situated in a valley that traps air and keeps it from blowing away. Flower semen shoots straight up my nose where my immune system mistakes it for a dangerous invader. Pollen should be harmless at normal levels of exposure. But for some reason, my body doesn't know that. So my body sends in its immunog globulin E antibodies, Ig antibodies. A healthy person produces five basic kinds of antibodies. And Ig is the one that we use to attack uh tiny parasites that enter our bodies, including fun fact, the one that causes tchinosis, porkworm. My Ig antibodies bind with otherwise harmless pollen grains which triggers the mast cells in my connective tissues to release histamine which causes inflammation. Histamine kind of opens up the capillaries, makes them more permeable to white blood cells and proteins that flood into my tissues to attack the invaders. The mucous membranes in my eyes, my nose, my throat, they swell up. They close off a little bit and they get itchy. My eyes water and my nose runs because my body is trying to physically flush out the pollen that it does not know is actually harmless. And I sneeze as vomiting is to the digestive system. Sneezing is to the respiratory system. It's an explosive ejection of whatever outside substance I have recently taken in. Peanut allergy is another kind of Ig mediated allergy. It's that same parasite attacking antibbody that is involved here. Among like one or two% of westerners, their Ig antibodies bind to the particular kind of storage proteins found in peanuts. Storage proteins are exactly what they sound like in animals. The equivalent would be like the casein in milk or the albamin in egg white. Galiadin in wheat, one of the gluten proteins, that's a storage protein that seems to be involved in people with uh gluten sensitivity. The storage proteins in peanuts are called ericin and conerin. When people with the allergy eat these proteins or one of the other allergens that are in peanuts, there are many, or when they breathe in peanuts in the form of dust or they get it in their eyes, the Ig antibodies bind to those proteins which leads to the release of histamine which causes inflammation that can be dangerous or deadly like acutely deadly. Peanut allergy may not be the most dangerous food allergy. It depends how you define most dangerous. It's certainly not the most common food allergy among adults. The most common food allergy is shellfish and among kids these days it's it's eggs or maybe milk. But peanut allergy is a particularly bad combination of severe and common, which is why you've heard so much about it. Also, kids tend to not outgrow it. Most kids will outgrow their egg and milk allergies. Most will not outgrow their peanut allergies. About 80% do not outgrow it. Now, part of the peanut's bad reputation as an allergen is no doubt the result of media hype, but it is absolutely not all media hype. The reactions some people get are really awful and sometimes deadly. Why? Several factors, including, but not limited to number one, potency. Peanuts just have a lot of allergens in a very compact form. Number two, the effect of cooking. If you're interested enough in cooking to be listening to me, I don't need to tell you that heat changes proteins. Some proteins become less dangerous to allergic people when heated. The ones in peanuts become more dangerous, specifically when dry roasted, which is an extremely popular way to prepare peanuts in the Western world. Globally, wet preparations are more popular, and that may be one reason that peanut allergies are rare beyond the West. Roasting peanut proteins has been shown to create more binding sites for the Ig antibodies. That's unusual. And then there's three. How they are digested. One of our biggest defenses against dangerous food of all kinds is our digestive system. the acid, the enzymes, these break down our food into chunks that we can absorb through our intestinal lining, but they can also kill some pathogenic microorganisms. They can denature some toxins, etc. Peanuts along with some tree nut allergens can resist being broken down. And peanut allergens have been shown to actually inhibit the action of some digestive enzymes. What's more, they have this unusual ability to cross the gut lining and enter the bloodstream intact. They literally change the bonds between gut cells to squeeze themselves through. Thanks to the uh Australian molecular biologist Dwan Price for posting a very readable list of those factors with scholarly citations linked in the description along with all other sources. So what does all of this get us? It gets us a powerful allergic reaction that is systemic rather than localized the way my little nasal allergies are. The peanut allergens go all through your body. With a relatively minor reaction, you may feel itchy, get a rash. Then there's gastrointestinal effects, cramps, diarrhea. Respiratory effects, sneezing, fit, asthma attack, and the circulatory effects. Histamine causes your blood vessels to open up to supply extra white blood cells to fight the infection, which in the case of an allergy is imaginary. When your blood vessels open up wide, when they dilate, your blood pressure drops because you have the same amount of fluid passing through suddenly wider pipes. A really really severe allergic reaction is known as anaphylaxis. The Greek root phaxis means protection. Anna means a bunch of things depending on the context. In this context it means against or without protection or like the inverse of protection. The immune system is meant to protect you, but anaphilaxis is when it goes nuts as it were and does the opposite of protecting you. This is as opposed to prophylaxis which means for protection. A prophylactic drug is one that helps prevent a disease. For a mild allergic reaction, you can take an antihistamine like benadryil. for full-blown anaphilaxis. Basically, the only treatment is epinephrine, which is literally just another name for adrenaline. You inject the hormone adrenaline directly into your muscles, which has the effect of rapidly constricting your blood vessels. That's why people with severe allergies carry EpiPens for emergency injection. Without the EpiPen, a person with anaphilaxis can die from esphyxiation. The throat or the tongue swell up so much that they can't breathe. They can die from their drop in blood pressure. Not enough blood, not enough oxygen reaching the heart. Heart attack. This is called anaphylactic shock. The allergic reaction to peanuts usually happens really quickly, like within minutes. Sometimes it's delayed a couple hours or there's a second phase of the reaction a couple hours later when other biological pathways get involved. As always with this kind of content, I am massively oversimplifying the science to the extent that I can even comprehend the science. We don't know exactly how prevalent peanut allergies are. Some studies come up with 1% of people in Western countries. Some come up with two or three or 4% among kids specifically. Most studies have historically shown that the rate is rising rapidly in the west. Then came a study in 2008. Now, lots of medical research looks specifically at Ashkanazi Jews for a number of reasons. Genetically, they're relatively homogeneous and that can help you learn certain things. And then there is the existence of the modern state of Israel. Because Israel exists, you have large populations of Ashkanazi Jews living in the US and in Europe. And then you have a large population living way over in the Middle East. And these populations mostly did not diverge until relatively recent geopolitical events. So you've got lots of people with very similar genes living in two very different places, two very different environments, two different cultures, different food. In 2008, the British pediatric allergist George Dutis found that Jewish kids in the UK were 10 times more likely to develop peanut allergy compared to their counterparts in Israel. The biggest difference, he determined, is that Israeli kids eat this snack brand called Bomba as their first solid food. It's puffed corn like a Cheeto, but instead of being flavored with cheese powder, it's flavored with peanut powder. And like apparently everybody eats bomba in Israel, so it's always around. And parents found it to be a good first solid food for babies because they can like grab it easily and it kind of melts in your mouth even if you don't have teeth to chew it yet. George Dutis hypothesized that very early peanut exposure might train kids immune systems to not freak out. Little kids with uh eczema and egg allergies are way more likely than most to develop peanut allergies. So he looked at kids with eczema and egg allergies. Some of those kids got peanuts, some didn't. Overall, early exposure to peanuts was shown to prevent the allergy in like 80% of kids with the effect lasting as long as the observation continued into adolescence. That was published in 2015. So public health officials all over the Western world got the word out to pediatricians and to parents. They used to tell the parents of high-risisk kids to avoid eating peanuts. Kids with eczema or egg allergy. Now they were saying, "Sorry, we were wrong. Definitely do give high-risk kids peanuts early and often, starting around six months old, obviously under the supervision of their doctor. Give them peanut butter, peanut snacks, whole peanuts when they're old enough to chew. More recently in 2021, the advice was updated to cover all kids with or without particular risk factors, peanuts, early and often. Did this new advice have any effect? Yeah. According to this new study out of Children's Hospital of Philadelphia, the older study that we were just talking about was a clinical trial, which is kind of the gold standard for health research. This new one is an observational study where they're just analyzing the electronic health records of freel humans that allows you to study way more people in more realistic circumstances, but the evidence probably isn't as good. Like you can learn what is happening, but it's hard to nail down why it's happening with observational studies. So take this with the appropriate grain of salt. We will learn more as other studies come out. What they were able to show in this new study is that among little kids in the US since the introduction of these new public health guidelines that encourage people to feed babies and toddlers peanuts. Since the introduction of these guidelines, the rate of kids developing new peanut allergies has dropped almost in half. And you know what dropped by a third? Ig mediated food allergies generally, not just the peanut allergy. This is not all the food allergies, but it's a lot of them. In this last decade, peanut allergies have ceased to be the most common food allergies among Western kids. It's now egg allergies, which they are far more likely to outgrow. Were these new guidelines the cause of this drop? Can't say for sure, but there's no other obvious explanation. the timing works out. We'll know more as more work is done in more places. Peanut allergy is rare outside the West, but it is rising in Africa, in Asia, seemingly handinhand with economic development. Like Japan has some peanut allergy and Japan is rich has been for a while. Peanut allergy may be yet another disease of affluence which we here on the Regusia channel classify as good problems to have. They still suck. They're still problems. But it's better to have these problems than it is to lack the money that leads to these problems. Why don't the poor kids of this world get peanut allergy as much as the rich kids? Nobody knows. I've read through a bunch of the literature examining this phenomenon. Whatever the cause, it's probably multiffactorial. It's not just one thing. Kids in poor countries may be less likely to be diagnosed because they get worse health care. That's probably a factor. There might even be a little survivorship bias. You know, poor kids with food allergies are more likely to die before they even get a chance to be studied. That's an extremely sad way to put it. Appropriately sad. There's the thing about the dry heat peanut preparations being more popular in the West, whereas peanuts are often boiled in Africa, for example. Dry heat makes the allergen more potent. There's got to be big environmental factors at play. One study found that ethnic Asian kids born in the West are five times more likely to develop a nut allergy than their counterparts back in Asia. Whereas white kids born in Asia had a much lower risk than their counterparts back in the West. And when I say the West, I'm talking about Europe, the US, Canada, Australia, geographically far-flung places. So, it's probably not so much about the place, but rather the lifestyle. Actually, I take that back. There is some research looking at the place. In particular, the distance from the equator, how much sunshine you get, and therefore how much vitamin D you synthesize. That could be a factor. Per capita EpiPen prescriptions are four times more prevalent in the northern US than in the southern US. Could it be the sunshine? Kids born in the winter when the days are shorter have more tea cells in their cord blood compared to kids born in the summer when it's sunny. That could be relevant. And the reason you still see differences between ethnic groups even in the same place, the same latitude, same sunshine. That could be the result of genetic differences arising from their ancestors having gotten more or less sunshine. But the lifestyle has also got to be relevant. It is relevant. We know that diet plays a role. We've been talking about that this whole time. Parents in rich countries have the privilege to fuss over their baby's diets a little more, to feed only breast milk or formula for longer before introducing other foods. It's possible that may be a net benefit for health, but higher risk of food allergy comes along with it. We don't know. We must always be wary of explanations that seem particularly attractive to us because you'll generally find a way to substantiate them whether they're true or not. So, I probably shouldn't say this. I probably shouldn't even think it, but I am attracted to the hygiene hypothesis, which is basically that a a richer life is a cleaner life. It's a more indoor life. It's a life where you have the privilege of being a picky eater without starving to death. And you just get exposed to less stuff in your developmental years which could lead to allergies, could lead to type 1 diabetes and all kinds of other immune system related diseases. I suppose all diseases are immune system related, but you know what I mean. The hygiene hypothesis is also something that researchers in this area talk about. It's not just me bringing it up, but I do find it to be a really compelling idea. But let us finish by reminding ourselves once more about good problems to have. They are still problems, but they're generally better than the alternative. Still, I think I need to kick my kids outside more often and get them to eat more kinds of stuff. Thank God they've always eaten peanut butter at least. Make good choices. Talk to you next time.