Conventional Approach to Childhood Allergies Wrong, Doctors Say

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In the February 7, 2011 issue of The New Yorker, Dr. Hugh Sampson, the director of the Jae Food Allergy Institute at Mount Sinai Medical Center in New York and Dr. Scott Sicherer, a pediatric allergist who is also at Mount Sinai, discuss the extensive research and studies they have conducted throughout the United States that show that the rate of allergy is rising sharply.

Sampson estimates that three to five per cent of the population is allergic to milk, eggs, peanuts, tree nuts, or seafood. “This increase in the incidence of food allergy is real,” Sampson said. He cannot say what is causing the increase, but he now thinks the conventional approach to preventing food allergies is misconceived. For most of his career, he believed, like most allergists, that children are far less likely to become allergic to problematic foods if they are not exposed to them as infants. But now Sampson and other specialists believe that early exposure may actually help prevent food allergies.

Dr. Sampson recalls that, in 1980, when he started researching food allergies, as a fellow in immunology at Duke University, “I approached the subject with the assumption that I would prove it didn’t exist,” Sampson said. Sampson watched as the incidence of food allergies rose alarmingly in the West while cases remained rare in Africa and Asia. He and other researchers began to investigate whether the problem could be prevented if Western mothers continued breast-feeding as long as possible. Laboratory studies reinforced the theory. In 1989, Dr. Robert Zeiger, a pediatric allergist and immunologist at Kaiser Permanente Medical Center in San Diego, published related results from one of the only controlled research studies on the subject. Sampson was influenced by the article, and most of the other leading thinkers in the field agreed with the findings.

In 1998, the Department of Health in the United Kingdom issued guidelines for doctors and families codifying these recommendations. In 2000, the American Academy of Pediatrics did the same. Describes how allergic reactions are produced in the human body. “From an evolutionary-biology point of view, food allergy makes no sense at all,” Dr. Sicherer said. “It seems pretty clear that food allergy is a condition that resulted from the environment we created.” Tells about the work of Dr. Gideon Lack, who questioned the guidelines written in 1998 and 2000. Lack believes that a child becomes tolerant to a variety of food proteins through exposure in the first six months of life.

Lack’s research has gradually gained influence with leading allergists, including Hugh Sampson. Sampson believes that some eighty per cent of infants who are allergic to eggs or milk will outgrow the allergy by their teen-age years, and that preventing them from being fed products with these foods may prolong the time that takes. In January, 2008, the American Academy of Pediatrics released a clinical report by Mount Sinai’s Dr. Sicherer and other researchers that overturned the expert advice of the past decade. Gideon Lack is disturbed by what families now face. “Basically, we are all in limbo,” he said. “Even the experts are not certain what to advise.”

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