And finally, monsieur, a wafer-thin mint.
March 7, 2013 1:42 PM Subscribe
What does a nine-year-old girl in Menlo Park, California have in common with a Russian Mystic, an Indian Emperor, a mythic legion of girl assassins, and an enemy of the Roman Republic? Mithridatism: Immunity through the measured ingestion of poison.
This part is freaking scary:
Until recently, one common explanation for the rise of food allergies was the so-called hygiene hypothesis — the idea that the modern obsession with sanitation prevents children from being exposed to the bacteria and the parasites that enable the immune system to develop. With the immune system underemployed, so to speak, it begins to attack harmless targets. This hypothesis, however, has fallen out of favor; among other things, it turns out that allergies are rising worldwide, from Rio de Janeiro to Shanghai, in Europe and Britain, across environments that have a range of sanitary conditions. Moreover, children who grow up on farms with exposure to dirt and parasites and animals do not appear to have lower rates of food allergies (although they do have lower rates of environmental allergies, like hay fever or reactions to animals)[...]
Epidemiologically, food allergies parallel the steep rise of other contemporary epidemics like asthma, diabetes and autoimmune diseases — a phenomenon for which there has been no convincing explanation. Emerging evidence suggests that food allergies, however, fall in the province of the new field of epigenetics: the science of how the environment can alter the genetic inheritance one generation passes on to the next. One focus of Nadeau’s lab is studying whether the toxins found in pollution, pesticides or tobacco smoke damage the genes in ways that make children more likely to have allergies and the intimately related disease of asthma. There is evidence that having a parent or a grandparent who smoked — even if the child was never exposed to smoke — is a risk factor for food allergies, as is living in an urban area with elevated pollution.
posted by showbiz_liz at 1:50 PM on March 7, 2013 [14 favorites]
Until recently, one common explanation for the rise of food allergies was the so-called hygiene hypothesis — the idea that the modern obsession with sanitation prevents children from being exposed to the bacteria and the parasites that enable the immune system to develop. With the immune system underemployed, so to speak, it begins to attack harmless targets. This hypothesis, however, has fallen out of favor; among other things, it turns out that allergies are rising worldwide, from Rio de Janeiro to Shanghai, in Europe and Britain, across environments that have a range of sanitary conditions. Moreover, children who grow up on farms with exposure to dirt and parasites and animals do not appear to have lower rates of food allergies (although they do have lower rates of environmental allergies, like hay fever or reactions to animals)[...]
Epidemiologically, food allergies parallel the steep rise of other contemporary epidemics like asthma, diabetes and autoimmune diseases — a phenomenon for which there has been no convincing explanation. Emerging evidence suggests that food allergies, however, fall in the province of the new field of epigenetics: the science of how the environment can alter the genetic inheritance one generation passes on to the next. One focus of Nadeau’s lab is studying whether the toxins found in pollution, pesticides or tobacco smoke damage the genes in ways that make children more likely to have allergies and the intimately related disease of asthma. There is evidence that having a parent or a grandparent who smoked — even if the child was never exposed to smoke — is a risk factor for food allergies, as is living in an urban area with elevated pollution.
posted by showbiz_liz at 1:50 PM on March 7, 2013 [14 favorites]
Every time this comes up in the news, I cringe a little bit. The amounts that are used in this application start so amazingly tiny. I always worry that someone will get the bright idea to save some money by not having a doctor supervise.
Maybe, but the first time you have to Epi Pen your kid because of something you intentionally gave him would probably shock most sane parents into stopping, right? From the article it sounded like it was hard enough physically and emotionally when it was supervised by a doctor.
posted by BungaDunga at 2:07 PM on March 7, 2013
Maybe, but the first time you have to Epi Pen your kid because of something you intentionally gave him would probably shock most sane parents into stopping, right? From the article it sounded like it was hard enough physically and emotionally when it was supervised by a doctor.
posted by BungaDunga at 2:07 PM on March 7, 2013
So it's sort of like Lamarckism that only works for bad things? Boo.
posted by qxntpqbbbqxl at 2:08 PM on March 7, 2013 [4 favorites]
posted by qxntpqbbbqxl at 2:08 PM on March 7, 2013 [4 favorites]
Nadeau and others, however, were having success with a trial of a treatment known as oral immunotherapy that could desensitize children with severe peanut allergies.
I never went into shock, but as a kid who'd often end up in bed with my eyes swelled shut, sinus headaches that totally shut me down, severe rashes, sneezing fits that lasted until I was sneezing blood, and other not so fun stuff, desensitization therapy seemed to do a lot of good.
posted by weston at 2:27 PM on March 7, 2013 [3 favorites]
I never went into shock, but as a kid who'd often end up in bed with my eyes swelled shut, sinus headaches that totally shut me down, severe rashes, sneezing fits that lasted until I was sneezing blood, and other not so fun stuff, desensitization therapy seemed to do a lot of good.
posted by weston at 2:27 PM on March 7, 2013 [3 favorites]
And according to a newly published study, introducing rice and corn at 6 months, like Gerber’s rice cereal — “Baby’s first food” — increases the risk of food allergies . . .
Ah, corn. Miss Zea Mays, is there nothing you can't secretly ruin?
I used to suppose that kids who were allergic, in the past, simply died very young, and with infant mortality as it was, parents and doctors did not have the diagnostic tools to understand what happened or why. This is doubtless not correct of me, but I wish there were ways to find out exactly how wrong the hypothesis is. There is at least one pre-modern account of a lifelong near-fatal wheat allergy in an adult man of 18th-century Pennsylvania (cite, p. 491-92):
If he ate flour in any form or however combined, in the smallest quantity, in two minutes or less he would have painful itching over the whole body, accompanied by severe colic and tormina in the bowels. . . The mere smell of wheat produced distressing symptoms in a minor degree, and for this reason he could not, without suffering, go into a mill or house where the smallest quantity of wheat flour was kept. His condition was the same from the earliest times, and he was laid out for dead when an infant at the breast, after being fed with "pap" thickened with wheat flour. . . One of his female neighbors, not believing in his infirmity, but considering it only a whim, put a small quantity of flour in the soup which she gave him to eat at her table, stating that it contained no flour, and as a consequence of the deception he was bed-ridden for ten days with his usual symptoms.
posted by Countess Elena at 2:39 PM on March 7, 2013 [6 favorites]
Ah, corn. Miss Zea Mays, is there nothing you can't secretly ruin?
I used to suppose that kids who were allergic, in the past, simply died very young, and with infant mortality as it was, parents and doctors did not have the diagnostic tools to understand what happened or why. This is doubtless not correct of me, but I wish there were ways to find out exactly how wrong the hypothesis is. There is at least one pre-modern account of a lifelong near-fatal wheat allergy in an adult man of 18th-century Pennsylvania (cite, p. 491-92):
If he ate flour in any form or however combined, in the smallest quantity, in two minutes or less he would have painful itching over the whole body, accompanied by severe colic and tormina in the bowels. . . The mere smell of wheat produced distressing symptoms in a minor degree, and for this reason he could not, without suffering, go into a mill or house where the smallest quantity of wheat flour was kept. His condition was the same from the earliest times, and he was laid out for dead when an infant at the breast, after being fed with "pap" thickened with wheat flour. . . One of his female neighbors, not believing in his infirmity, but considering it only a whim, put a small quantity of flour in the soup which she gave him to eat at her table, stating that it contained no flour, and as a consequence of the deception he was bed-ridden for ten days with his usual symptoms.
posted by Countess Elena at 2:39 PM on March 7, 2013 [6 favorites]
I think this level of allergy has been with the human race all along, but earlier death-rates and ignorance of allergies keeps us from knowing how common these problems were.
posted by Katjusa Roquette at 2:46 PM on March 7, 2013 [1 favorite]
posted by Katjusa Roquette at 2:46 PM on March 7, 2013 [1 favorite]
Let them eat dirt.
posted by turgid dahlia 2 at 2:55 PM on March 7, 2013 [1 favorite]
posted by turgid dahlia 2 at 2:55 PM on March 7, 2013 [1 favorite]
The rate of food allergies has more than doubled over the past decade
Why?
posted by desjardins at 3:10 PM on March 7, 2013
Why?
posted by desjardins at 3:10 PM on March 7, 2013
sorry, reading fail. disregard.
posted by desjardins at 3:10 PM on March 7, 2013 [1 favorite]
posted by desjardins at 3:10 PM on March 7, 2013 [1 favorite]
I have a friend who has been slowly curing his severe egg allergy through a study like this ("I'm medically required to eat muffins!" he boasts). The sight of a grown man attempting to crack an egg for the first time in his life was completely adorable.
posted by katerschluck at 3:34 PM on March 7, 2013 [4 favorites]
posted by katerschluck at 3:34 PM on March 7, 2013 [4 favorites]
The earliest probable description of "celiac" is from the 2nd century author Aretaeus (I thought there was a bit in Galen too but I'm not finding a cite for it.) He doesn't really get at the root cause, but it was certainly a known issue. There's an interesting little table here of other allergy mentions through history.
posted by jetlagaddict at 3:48 PM on March 7, 2013 [3 favorites]
posted by jetlagaddict at 3:48 PM on March 7, 2013 [3 favorites]
A related NPR story about the attempts to use a similar approach for poison ivy reactions. The naturalist Euell Gibbons wrote about the eating of poison ivy in the spring as a way to immunize himself from poison ivy reactions, in his book, Stalking the Wild Asparagus.
posted by Toekneesan at 3:50 PM on March 7, 2013
posted by Toekneesan at 3:50 PM on March 7, 2013
Celiac, while not the same as allergies is also increasing tremendously - also a NYT link. While the immediate consequence of consuming gluten are not as dire as the allergic reactions the kids in the first article go through the longer term consequences are dire and the nearer term ones are no fun at all.
posted by leslies at 3:54 PM on March 7, 2013
posted by leslies at 3:54 PM on March 7, 2013
showbiz_liz: "This part is freaking scary:
Until recently, one common explanation for the rise of food allergies was the so-called hygiene hypothesis — the idea that the modern obsession with sanitation prevents children from being exposed to the bacteria and the parasites that enable the immune system to develop. "
I'm very greatful you posted this quote, because until I read it, I was convinced that probably the way to solve my pollen allergies was to get some parasites in my feet. Thank goodness I never took that step!
posted by rebent at 4:16 PM on March 7, 2013
Until recently, one common explanation for the rise of food allergies was the so-called hygiene hypothesis — the idea that the modern obsession with sanitation prevents children from being exposed to the bacteria and the parasites that enable the immune system to develop. "
I'm very greatful you posted this quote, because until I read it, I was convinced that probably the way to solve my pollen allergies was to get some parasites in my feet. Thank goodness I never took that step!
posted by rebent at 4:16 PM on March 7, 2013
Humans have been exposed to tobacco smoke for thousands of years (hundreds in the west), without any apparent rise in allergies. (And the smoke from cooking fires goes back much further than that.) But the constant background of trace pollutants we encounter now is something that only entered the environment in the last hundred years or so, as a consequence of the Industrial Revolution. Maybe it's the epigenic effects of those substances that are beginning to become apparent.
In any case, the article in the first link is amazing. It sounds like Dr. Kari Nadeau is both saving children's lives, and making those lives better. I hope her research is a total success, perhaps even leading to a standardized therapy.
posted by Kevin Street at 4:38 PM on March 7, 2013 [5 favorites]
In any case, the article in the first link is amazing. It sounds like Dr. Kari Nadeau is both saving children's lives, and making those lives better. I hope her research is a total success, perhaps even leading to a standardized therapy.
posted by Kevin Street at 4:38 PM on March 7, 2013 [5 favorites]
Also, in the US, our food is nearly 'sanitary' - that is to say very little of it is 'alive' with any kind of culture. Cultured foods (aka 'fermented') are the oldest preserved foodstuffs known; there is evidence to suggest that the flora in our gut (or at least the flora that should be in our guts) developed in conjunction with early human eating of fermented food(s). There are some theories floating around that we've 'sanitized' our guts too much, and that could also bring about a rise in food sensitivity/allergies.
posted by dbmcd at 5:09 PM on March 7, 2013 [1 favorite]
posted by dbmcd at 5:09 PM on March 7, 2013 [1 favorite]
The food therapy they're using in that study is now the standard of care for single severe food allergies; the innovation here is trying to desensitize kids to more than one allergen at a time. Ever since I first heard about this a few years ago I've really loved the idea of muffins for science!
posted by The Elusive Architeuthis at 5:47 PM on March 7, 2013
posted by The Elusive Architeuthis at 5:47 PM on March 7, 2013
I've been tracking this sort of treatment for peanut allergy for years, through a forum for parents of highly peanut-allergic kids. One of the families on the forum enrolled in the Johns Hopkins study and the child, after starting out anaphylactic to something like 1/64th of a peanut, was more or less cured by the end of it.
I've been longing for the treatment to become more widely available for years, now.
My own peanut-allergic ten-year-old has recently expressed interest in doing it (after being terrified at the thought since she was 4 or 5.) She thinks it would be fun to be treated in secret and then freak her friends out by eating something peanutty in front of them.
posted by Andrhia at 5:50 PM on March 7, 2013
I've been longing for the treatment to become more widely available for years, now.
My own peanut-allergic ten-year-old has recently expressed interest in doing it (after being terrified at the thought since she was 4 or 5.) She thinks it would be fun to be treated in secret and then freak her friends out by eating something peanutty in front of them.
posted by Andrhia at 5:50 PM on March 7, 2013
These food allergies are so scary!
posted by limeonaire at 6:06 PM on March 7, 2013
posted by limeonaire at 6:06 PM on March 7, 2013
dbmcd: "Also, in the US, our food is nearly 'sanitary' - that is to say very little of it is 'alive' with any kind of culture. Cultured foods (aka 'fermented') are the oldest preserved foodstuffs known; there is evidence to suggest that the flora in our gut (or at least the flora that should be in our guts) developed in conjunction with early human eating of fermented food(s). There are some theories floating around that we've 'sanitized' our guts too much, and that could also bring about a rise in food sensitivity/allergies."
Does that mean beer can make me invincible? :D
posted by capricorn at 6:19 PM on March 7, 2013
Does that mean beer can make me invincible? :D
posted by capricorn at 6:19 PM on March 7, 2013
I kept rereading the phrase 'mythic legion of girl assassins', I feel like I need to write a poem or something just to include it.
posted by variella at 7:00 PM on March 7, 2013 [4 favorites]
posted by variella at 7:00 PM on March 7, 2013 [4 favorites]
I always worry that someone will get the bright idea to save some money by not having a doctor supervise.
(Europe here.) After years of keeping him on a strict exclusion diet, our allergologist suggested de-sensitization for our son's severe wheat allergy. Until age eight he was on a regimen of no gluten ever. The strategy the doc gave us - starting with half a maccherone of Kamut per week, then a whole one, then two, etc., then eventually graduating through other archaic wheat cultivars - required no more than a phone call every now and then to relate on progress. That's not to say it's all easy DIY, especially, I imagine, in multi-allergy situations - but there can be workable scenarios that aren't so hyper-clinical. The perceived threat-level in allergies is, of course, very tricky to come to terms with.
posted by progosk at 8:02 PM on March 7, 2013
(Europe here.) After years of keeping him on a strict exclusion diet, our allergologist suggested de-sensitization for our son's severe wheat allergy. Until age eight he was on a regimen of no gluten ever. The strategy the doc gave us - starting with half a maccherone of Kamut per week, then a whole one, then two, etc., then eventually graduating through other archaic wheat cultivars - required no more than a phone call every now and then to relate on progress. That's not to say it's all easy DIY, especially, I imagine, in multi-allergy situations - but there can be workable scenarios that aren't so hyper-clinical. The perceived threat-level in allergies is, of course, very tricky to come to terms with.
posted by progosk at 8:02 PM on March 7, 2013
I got tired of reading this so please excuse me for not RTFA completely, but how is this different from allergy shots?
I have asthma and took allergy shots for several years as a kid, which I feel were a waste in that I was given shots for things that didn't really cause my asthma. Both my parents were smokers and that was probably a bigger factor than say milk.
I do know of others, though, that found allergy shots really effective.
posted by shoesietart at 9:11 PM on March 7, 2013 [1 favorite]
I have asthma and took allergy shots for several years as a kid, which I feel were a waste in that I was given shots for things that didn't really cause my asthma. Both my parents were smokers and that was probably a bigger factor than say milk.
I do know of others, though, that found allergy shots really effective.
posted by shoesietart at 9:11 PM on March 7, 2013 [1 favorite]
I wonder if the sheer variety of foodstuffs we consume these days and, increasingly feed to very young children, contributes?
posted by fshgrl at 10:59 PM on March 7, 2013
posted by fshgrl at 10:59 PM on March 7, 2013
I'd heard that the age of the father was a factor. In developed countries, steadily increasing ages for parents correlated to some issues, I forget what.
posted by Pronoiac at 11:20 PM on March 7, 2013
posted by Pronoiac at 11:20 PM on March 7, 2013
OK, and what about adults? I have a really... inconvenient allergy to cannabis. While I champion the civil liberties approach to decriminalizing marijuana (and other drugs), the "more legal" it gets, the more events I can't attend, streets I don't dare walk down without a friend to sniff for me for me first, foods I hesitate to try due to hemp, products I can't use (Dr. Bronner's, how could you fail me after so many years?!)... I will only be able to get my allergy considered by an allergist in my state this year, as acquiring and possessing the allergen has just been legalized. Maybe I'll even learn to like the Grateful Dead and Phish!
But first, can adult immune systems adapt the way children's apparently can?
posted by Dreidl at 12:33 AM on March 8, 2013 [1 favorite]
But first, can adult immune systems adapt the way children's apparently can?
posted by Dreidl at 12:33 AM on March 8, 2013 [1 favorite]
shoesietart, they tried the allergy shot approach with peanut some years ago and there was a fatality in the clinical trial. The way the body reacts to oral exposure and blood serum exposure are not the same.
There's also an issue of safe dosage -- the safe amount for each allergen has to be very carefully chosen and delivered. Getting a shot of the wrong amount of cat dander for asthma isn't generally going to kill you dead in minutes. And the amounts in question start out so very, very small for a food allergy.
posted by Andrhia at 4:39 AM on March 8, 2013
There's also an issue of safe dosage -- the safe amount for each allergen has to be very carefully chosen and delivered. Getting a shot of the wrong amount of cat dander for asthma isn't generally going to kill you dead in minutes. And the amounts in question start out so very, very small for a food allergy.
posted by Andrhia at 4:39 AM on March 8, 2013
My experience with the shots was that an allergist prescribed the shots, to be given on a weekly schedule by the patient's family doctor's office or local clinic. Any nurse/medical tech outside of the allergist's office looked up the dose on the schedule and gave you the shot. If you missed a week, or had a reaction, they were supposed to move you back to a lower dose and carry on. In practice, a lot of them would say "Oh, you have to start again at the beginning", because they were afraid to be responsible for having caused an allergic reaction. The nurses in the allergist's office didn't worry so much - but in my case they were a lot farther away.
I asked my allergist about this, and he said, "No, we want to provoke a small reaction, just not a life-threatening one. If you never have a reaction, we're not accomplishing anything." But the whole point of doing this in a controlled environment is that they can give you adrenaline/diagnose the reaction/provide support.
I gave up, because dealing with the fears of doctor's office staff is more difficult than dealing with allergies. (Having said that, I'm someone who is able to reliably manage his allergies, and has only had to go to the hospital twice in the last 40 years. YMMV.)
posted by sneebler at 4:59 AM on March 8, 2013
I asked my allergist about this, and he said, "No, we want to provoke a small reaction, just not a life-threatening one. If you never have a reaction, we're not accomplishing anything." But the whole point of doing this in a controlled environment is that they can give you adrenaline/diagnose the reaction/provide support.
I gave up, because dealing with the fears of doctor's office staff is more difficult than dealing with allergies. (Having said that, I'm someone who is able to reliably manage his allergies, and has only had to go to the hospital twice in the last 40 years. YMMV.)
posted by sneebler at 4:59 AM on March 8, 2013
I could not read the whole article, as someone who works in a related field there was far too much hype and filler to really understand exactly what was going on. I went and looked up some primary papers. I have a hard time thinking that this really lives up to the novelty and drama the article cooks up. Oral tolerance has been a big topic for over a decade. There is a lot of data to support the mechanism, it is not fully understood, hence the disconnect with a reliable effective treatment that works in practice.
Allergy shots are a whole different deal. The tolerance concept is to redirect or even suppress the immune response to a particular antigen at the level of recognition. Allergy shots you are not really addressing the allergy response, you are trying to overwhelm it with a different type of response, basically a vaccination. The molecular concept is to elicit a huge IgG response so that they encounter the allergan/antigen before the IgE do. The difficulty is that IgE receptors on mast cells bind with insane affinity - essentially permanent and antibodies are very stable. It clearly is not going to be effective for all types of allergies.
I hope that is clear enough to follow. I have not had my coffee yet this AM and my brain is not on track.
posted by oshburghor at 5:08 AM on March 8, 2013 [1 favorite]
Allergy shots are a whole different deal. The tolerance concept is to redirect or even suppress the immune response to a particular antigen at the level of recognition. Allergy shots you are not really addressing the allergy response, you are trying to overwhelm it with a different type of response, basically a vaccination. The molecular concept is to elicit a huge IgG response so that they encounter the allergan/antigen before the IgE do. The difficulty is that IgE receptors on mast cells bind with insane affinity - essentially permanent and antibodies are very stable. It clearly is not going to be effective for all types of allergies.
I hope that is clear enough to follow. I have not had my coffee yet this AM and my brain is not on track.
posted by oshburghor at 5:08 AM on March 8, 2013 [1 favorite]
There does seem to be some kind of beneficial response from the enzymes of hookworms (Necator americanus or Ancylostoma duodenale) - if these critters aren't harmful or lethal then they may provide enough stimulation of an appropriate level of autoimmune response, preventing the system from being 'bored.'
posted by Monkey0nCrack at 2:52 PM on March 10, 2013
posted by Monkey0nCrack at 2:52 PM on March 10, 2013
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