3 ms·

Does anyone know the history of why allergists assumed this just wouldn't work for decades? I'm assuming they initially tried this at the dawn of the allergist

by rhexs 9y ago

Does anyone know the history of why allergists assumed this just wouldn't work for decades? I'm assuming they initially tried this at the dawn of the allergist specialization but gave up due to bad practices / deaths? I only ask because it seemed to have been general knowledge that this was impossible / couldn't be done up until recently. As a outsider looking it, it seems quite obvious, but that's just due to naivete.

ljf 9y ago
I'm relatively 'new' to allergies, but from some of the conversations with doctors there was a fear that repeated reactions (even minor) could be priming the body for worse reactions. This obviously goes against the results we are seeing now, but don't forget this is a very new area of study - people were only first diagnosed with food allergies in the 60s. The original trial (I believe) came from a study that saw a certain Jewish community that eats a lot of powdered peanut, had a higher incidence of children losing their nut allergies. So the environment helped to prime these children. My kid has allergies, and over the last 2 years we've seen the advice change rapidly - from initial suggestions to keep him away from anything that might cause him hives (soft play centres etc) to now where they encourage that (though obviously we still keep him away from eating allergens. He had a laundry list of allergies that he responded to on his skin prick test last year, but his results yesterday were so much better - with the possibility that he only has 4 core responses left (peanuts, sesame, milk, egg) - with time still to lose those over time (he's only 3). We've been giving him loads of probiotics, namely Water Kefir - but no idea if he would have grown out of them anyway. Happy to have a stab at any questions people might have - but I'm no expert, just a (reasonably) well read dad - my wife know far more than me about this.
- throwaway5752 9y ago
  I don't think it's powdered peanuts. My understanding is that in Israel, a snack food called Bambas (peanut butter flavored corn puffs) is widely given to children and allergists noticed a huge difference in childhood peanut allergies. It's changed peanut exposure recommendations for infants completely.
  - ljf 9y ago
    Could well be - I read that article some time ago, so likely misremembed the detail. Cheers
kortex 9y ago
Medical momentum is a crazy thing. You should see how long it took hand washing to catch on. http://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives http://www.npr.org/sections/health-shots/2015/01/12/37566392...
alextheparrot 9y ago
When I was in school, allergens were taught as follows (This also explains why people presumed it would fail): 1) Your body "sees" this, meaning it has antibodies that react to it 2) Cells whose antibodies are activated replicate, as they are recognizing something that is, to the body, presumably foreign and bad 3) Because you now have more cells after the originals replicated, the effects of the allergy worsen as you are now more reactive than before I'd be interested to see some tests on this. I have a few hypothesizes that we could test: 1) If the children are still reactive to immunological tests (Meaning they still have the antibodies!), are those antibodies being blocked by another compound, another cross-reactive antibody? Another idea is that the actual immune response to antibody activation (Recognizing peanuts) might be handled differently within the cells that produce the actual response to the allergen (Swelling and stuff). 2) If the antibodies no longer exist, I would start looking in the areas where immune cells develop to see if cells producing reactive antibodies to the allergen are being killed off during development (This process is also why you don't kill yourself with antibodies recognizing yourself). If that isn't the case we need to track individual immune cells over the course of treatment.
- mljoe 9y ago
  IgG is usually implicated in fighting off pathogens like viruses and bacteria. It doesn't typically cause an allergic response. IgE is usually implicated in fighting off pathogens like parasitic worms or mosquito bites. It's the antibody that regularly get confused and binds to peanut proteins and pollen. There is speculation on why the IgE mediated immune response gets confused. One hypothesis is IgE evolved much more recently and "needs more work". The immune response to IgE binding is intense. Allergic reaction is an IgE response to a harmless antigen. However, IgE can be downregulated by repeated exposure to the antigen in question. If the body uses IgE too much (eg. from repeated exposure), it starts to replace IgE antibodies with the more subtle IgG antibodies. The immune system is very fascinating really. IgE might be the key to effective cancer immunotherapy. Imagine if we could program your immune system to fight a cancer as intensely as it fights a pollen grain or peanut in an allergic individual. There is a lot of research in this area these days.
  - 9y ago
dperfect 9y ago
This is especially confusing to me given the fact that immunotherapy (allergy shots) for hay fever has been used effectively since at least the 1930s[1]. I've heard that it may be due to the severity of a possible reaction to peanuts compared to that of (most cases of) hay fever, but I'm guessing that's probably not the full story. [1] https://en.wikipedia.org/wiki/Allergen_immunotherapy https://en.wikipedia.org/wiki/Allergen_immunotherapy
- rhexs 9y ago
  That's where my uncertainty comes from. I did the allergy immunotherapy for a few years, asked the Doc if they did anything like that for food allergies, and got the no, it doesn't work answer.
  - jwineinger 9y ago
    https://www.oit101.org/ https://www.oit101.org/
  - gehwartzen 9y ago
    The reason is actually answered in the paper ;) There have been many studies looking at introducing peanut allergens in small increasing doses over time. this does somewhat work but the effects ware off pretty quickly after stopping. The 'secret sauce' in this study is the use of the specific bacteria which somehow teaches the body to retain the non-immune response.

by rhexs 9y ago

ljf 9y ago

I'm relatively 'new' to allergies, but from some of the conversations with doctors there was a fear that repeated reactions (even minor) could be priming the body for worse reactions. This obviously goes against the results we are seeing now, but don't forget this is a very new area of study - people were only first diagnosed with food allergies in the 60s. The original trial (I believe) came from a study that saw a certain Jewish community that eats a lot of powdered peanut, had a higher incidence of children losing their nut allergies. So the environment helped to prime these children. My kid has allergies, and over the last 2 years we've seen the advice change rapidly - from initial suggestions to keep him away from anything that might cause him hives (soft play centres etc) to now where they encourage that (though obviously we still keep him away from eating allergens. He had a laundry list of allergies that he responded to on his skin prick test last year, but his results yesterday were so much better - with the possibility that he only has 4 core responses left (peanuts, sesame, milk, egg) - with time still to lose those over time (he's only 3). We've been giving him loads of probiotics, namely Water Kefir - but no idea if he would have grown out of them anyway. Happy to have a stab at any questions people might have - but I'm no expert, just a (reasonably) well read dad - my wife know far more than me about this.

throwaway5752 9y ago
I don't think it's powdered peanuts. My understanding is that in Israel, a snack food called Bambas (peanut butter flavored corn puffs) is widely given to children and allergists noticed a huge difference in childhood peanut allergies. It's changed peanut exposure recommendations for infants completely.
- ljf 9y ago
  Could well be - I read that article some time ago, so likely misremembed the detail. Cheers

kortex 9y ago

Medical momentum is a crazy thing. You should see how long it took hand washing to catch on. http://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives http://www.npr.org/sections/health-shots/2015/01/12/37566392...

alextheparrot 9y ago

When I was in school, allergens were taught as follows (This also explains why people presumed it would fail): 1) Your body "sees" this, meaning it has antibodies that react to it 2) Cells whose antibodies are activated replicate, as they are recognizing something that is, to the body, presumably foreign and bad 3) Because you now have more cells after the originals replicated, the effects of the allergy worsen as you are now more reactive than before I'd be interested to see some tests on this. I have a few hypothesizes that we could test: 1) If the children are still reactive to immunological tests (Meaning they still have the antibodies!), are those antibodies being blocked by another compound, another cross-reactive antibody? Another idea is that the actual immune response to antibody activation (Recognizing peanuts) might be handled differently within the cells that produce the actual response to the allergen (Swelling and stuff). 2) If the antibodies no longer exist, I would start looking in the areas where immune cells develop to see if cells producing reactive antibodies to the allergen are being killed off during development (This process is also why you don't kill yourself with antibodies recognizing yourself). If that isn't the case we need to track individual immune cells over the course of treatment.

mljoe 9y ago
IgG is usually implicated in fighting off pathogens like viruses and bacteria. It doesn't typically cause an allergic response. IgE is usually implicated in fighting off pathogens like parasitic worms or mosquito bites. It's the antibody that regularly get confused and binds to peanut proteins and pollen. There is speculation on why the IgE mediated immune response gets confused. One hypothesis is IgE evolved much more recently and "needs more work". The immune response to IgE binding is intense. Allergic reaction is an IgE response to a harmless antigen. However, IgE can be downregulated by repeated exposure to the antigen in question. If the body uses IgE too much (eg. from repeated exposure), it starts to replace IgE antibodies with the more subtle IgG antibodies. The immune system is very fascinating really. IgE might be the key to effective cancer immunotherapy. Imagine if we could program your immune system to fight a cancer as intensely as it fights a pollen grain or peanut in an allergic individual. There is a lot of research in this area these days.
- 9y ago

dperfect 9y ago

This is especially confusing to me given the fact that immunotherapy (allergy shots) for hay fever has been used effectively since at least the 1930s[1]. I've heard that it may be due to the severity of a possible reaction to peanuts compared to that of (most cases of) hay fever, but I'm guessing that's probably not the full story. [1] https://en.wikipedia.org/wiki/Allergen_immunotherapy https://en.wikipedia.org/wiki/Allergen_immunotherapy

rhexs 9y ago
That's where my uncertainty comes from. I did the allergy immunotherapy for a few years, asked the Doc if they did anything like that for food allergies, and got the no, it doesn't work answer.
- jwineinger 9y ago
  https://www.oit101.org/ https://www.oit101.org/
- gehwartzen 9y ago
  The reason is actually answered in the paper ;) There have been many studies looking at introducing peanut allergens in small increasing doses over time. this does somewhat work but the effects ware off pretty quickly after stopping. The 'secret sauce' in this study is the use of the specific bacteria which somehow teaches the body to retain the non-immune response.