Journal of American Medical Association study: Consumption of nuts by pregnant woman may reduce nut allergies in their children

24 Dec

Moi wrote about allergies in Food allergies can be deadly for some children:
If one is not allergic to substances, then you probably don’t pay much attention to food allergies. The parents and children in one Florida classroom are paying a lot of attention to the subject of food allergies because of the severe allergic reaction one child has to peanuts. In the article, Peanut Allergy Stirs Controversy At Florida Schools Reuters reports:

Some public school parents in Edgewater, Florida, want a first-grade girl with life-threatening peanut allergies removed from the classroom and home-schooled, rather than deal with special rules to protect her health, a school official said.
“That was one of the suggestions that kept coming forward from parents, to have her home-schooled. But we’re required by federal law to provide accommodations. That’s just not even an option for us,” said Nancy Wait, spokeswoman for the Volusia County School District.
Wait said the 6-year-old’s peanut allergy is so severe it is considered a disability under the Americans with Disabilities Act.
To protect the girl, students in her class at Edgewater Elementary School are required to wash their hands before entering the classroom in the morning and after lunch, and rinse out their mouths, Wait said, and a peanut-sniffing dog checked out the school during last week’s spring break….
Chris Burr, a father of two older students at the school whose wife has protested at the campus, said a lot of small accommodations have added up to frustration for many parents.
“If I had a daughter who had a problem, I would not ask everyone else to change…. http://www.reuters.com/article/2011/03/22/us-peanut-allergy-idUSTRE72L7AQ20110322

More children seem to have peanut allergies. Researchers are trying to discover the reason for the allergies, but also asking the question of whether the number of nut allergies in children can be reduced.

Michael Pearson of CNN reported in the story, Study: Eating nuts during pregnancy may reduce baby’s allergy risk:

The children of women who regularly ate peanuts or tree nuts during pregnancy appear to be at lower risk for nut allergies than other kids, according to a new study published Monday.
The study, published in the Journal of the American Medical Association, is the first to demonstrate that a mother who eats nuts during pregnancy may help build up a baby’s tolerance to them after birth, its lead author, Dr. Michael Young, told CNN.
The effect seemed to be strongest in women who ate the most peanuts or tree nuts — five or more servings per week, according to the study, which controlled for factors such as family history of nut allergies and other dietary practices.
Peanut and tree nut allergies tend to overlap, according to the researchers.
What food allergies are costing families — and the economy
Earlier studies indicated that nut consumption during pregnancy either didn’t have any effect or actually raised the risk of allergies in children.
However, the authors of the latest study say those studies were based on less reliable data and conflict with more recent research suggesting that early exposure to nuts can reduce the risk of developing allergies to them.
There is currently no formally recognized medical guidance for nut consumption during pregnancy or infancy. http://www.cnn.com/2013/12/23/health/nut-allergy-study/

Citation:

Original Investigation | December 23, 2013 JOURNAL CLUB
Prospective Study of Peripregnancy Consumption of Peanuts or Tree Nuts by Mothers and the Risk of Peanut or Tree Nut Allergy in Their Offspring FREE ONLINE FIRST
A. Lindsay Frazier, MD, ScM1,2; Carlos A. Camargo Jr, MD, DrPH2,3,4; Susan Malspeis, MS2; Walter C. Willett, MD, DrPH4,5,6; Michael C. Young, MD7
[+] Author Affiliations
JAMA Pediatr. Published online December 23, 2013. doi:10.1001/jamapediatrics.2013.4139
Article
Tables
References
Comments
ABSTRACT
ABSTRACT | METHODS | RESULTS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES
Importance The etiology of the increasing childhood prevalence of peanut or tree nut (P/TN) allergy is unknown.
Objective To examine the association between peripregnancy consumption of P/TN by mothers and the risk of P/TN allergy in their offspring.
Design, Setting, and Participants Prospective cohort study. The 10 907 participants in the Growing Up Today Study 2, born between January 1, 1990, and December 31, 1994, are the offspring of women who previously reported their diet during, or shortly before or after, their pregnancy with this child as part of the ongoing Nurses’ Health Study II. In 2006, the offspring reported physician-diagnosed food allergy. Mothers were asked to confirm the diagnosis and to provide available medical records and allergy test results. Two board-certified pediatricians, including a board-certified allergist/immunologist, independently reviewed each potential case and assigned a confirmation code (eg, likely food allergy) to each case. Unadjusted and multivariable logistic regression analyses were used to evaluate associations between peripregnancy consumption of P/TN by mothers and incident P/TN allergy in their offspring.
Exposure Peripregnancy consumption of P/TN.
Main Outcomes and Measures Physician-diagnosed P/TN allergy in offspring.
Results Among 8205 children, we identified 308 cases of food allergy (any food), including 140 cases of P/TN allergy. The incidence of P/TN allergy in the offspring was significantly lower among children of the 8059 nonallergic mothers who consumed more P/TN in their peripregnancy diet (≥5 times vs <1 time per month: odds ratio = 0.31; 95% CI, 0.13-0.75; Ptrend = .004). By contrast, a nonsignificant positive association was observed between maternal peripregnancy P/TN consumption and risk of P/TN allergy in the offspring of 146 P/TN-allergic mothers (Ptrend = .12). The interaction between maternal peripregnancy P/TN consumption and maternal P/TN allergy status was statistically significant (Pinteraction = .004).
Conclusions and Relevance Among mothers without P/TN allergy, higher peripregnancy consumption of P/TN was associated with lower risk of P/TN allergy in their offspring. Our study supports the hypothesis that early allergen exposure increases tolerance and lowers risk of childhood food allergy.
Peanut allergy affects 1% to 2% of the population in most Western countries,1- 3 and in the United States, the prevalence of childhood peanut allergy has more than tripled, from 0.4% in 1997 to 1.4% in 2010.4 Typically, the onset of peanut allergy is in early childhood; 70% of reactions occur during the first known exposure.5 These IgE-mediated hypersensitivity reactions require prior allergen exposure and sensitization, implying that prior exposure to peanut had already occurred in utero or through unknown exposures in the diet or environment, such as through skin or respiratory routes.6 Because of frequent overlap between peanut allergy and tree nut allergy and their similar natural history, with 80% to 90% persistence of the food allergy into adulthood,7 these 2 allergies are often considered together as peanut or tree nut (P/TN) allergy.
For many years, pediatric guidelines have recommended the avoidance of P/TN for at least the first 3 years of life, with some experts also recommending that P/TN be avoided during pregnancy.8 These recommendations were rescinded recently when literature reviews showed little support for them.9,10 For decades, many investigators have posited that modifications of the maternal diet during pregnancy might prevent food allergies.11- 14 However, some studies on maternal avoidance of peanut during pregnancy actually demonstrated an increase in peanut sensitization in the child,15- 17 while other studies found no association.5,14,18,19 In related research, early exposure to allergenic foods in infant diets may decrease sensitization and increase oral tolerance to those foods.20- 24
Given the lack of clarity in the current literature, an important quandary exists: should the pregnant mother include or exclude P/TN in her diet? The goal of our investigation was to clarify the association between peripregnancy consumption of P/TN by mothers and the subsequent development of P/TN allergy in their offspring…. http://archpedi.jamanetwork.com/article.aspx?articleid=1793699

Resources:

Micheal Borella’s Chicago-Kent Law Review article, Food Allergies In Public Schools: Toward A Model Code
http://www.cklawreview.com/wp-content/uploads/vol85no2/Borella.pdf

USDA’s Accommodating Children With Special Dietary Needs http://www.k12.wa.us/ChildNutrition/pubdocs/SpecialDietaryNeeds.PDF

Child and Teen Checkup Fact Sheet http://www.health.state.mn.us/divs/fh/mch/ctc/factsheets.html
Video: What to Expect From A Child’s Physical Exam
http://on.aol.com/video/what-to-expect-from-a-childs-physical-exam-325661948

Related:
New federal guidelines for schools regarding student allergies
https://drwilda.com/2013/11/04/new-federal-guidelines-for-schools-regarding-student-allergies/

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