February 3, 2025 • 28 mins
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This episode focuses on the importance of early introduction of allergenic foods in preventing food allergies in infants. Tune in to hear Dr. Hoyt discuss the LEAP and EAT studies, which illustrate how feeding babies common allergens early can significantly reduce their risk of developing allergies. You'll come away from the episode with a better understanding of:
• The rising rates of food allergies and changing recommendations
• The significance of early introduction
• The LEAP and EAT studies and their findings
• The safety of early introduction
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This podcast is the official podcast of the Hoyt Institute of Food Allergy. Information on, within, and associated with this site and Food Allergy and Your Kiddo is for educational purposes only and is not medical advice.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Hello and welcome to Food Allergy and your Kiddo.
I am your host, dr Alice Hoyt,excited to be here to talk with
you today about how to preventfood allergies.
I've talked about this in thepast, but there really is a lot
of strong movement now towardsreally helping families not get
(00:25):
into the food allergy pickle tostart with, and so if you're
listening to this episode andyou're the parent of a kiddo
with a food allergy, then youmay have done what's called
early introduction.
That's what we're going to talkabout today.
Or maybe you didn't do earlyintroduction, um.
Or maybe you know somebody whojust had a baby and is concerned
(00:46):
about how to feed their babyTotally legit concern.
Spoiler alert we haveover-medicalized how we feed
babies and so today's episode isall about how to feed babies to
prevent food allergies.
And, before we dive deep intothis episode, any of our
(01:09):
listeners who are pediatricians,pediatric nurse practitioners,
physician's assistants if youserve families who have food
allergies and you're interestedin learning more about food
allergies, then go over tofoodallergypedshubhoitalergycom.
I know it's a mouthful, we'llput a link in the show notes,
butfoodallergypedshubhoitalergycom
(01:31):
and that's where you can sign upfor this awesome weekly email
where I break down a um, a foodallergy article that I think is
super powerful and helpful formy general pediatric colleagues.
So go over tofoodallergypeethubhoidallergycom
to learn more.
Okay, now let's get into theshow.
(01:51):
And so really to kick off theepisode, what really is early
introduction?
Is it safe?
Early introduction is when wefeed a baby a food, really
earlier than six months.
(02:11):
So the term early is somewhatrelative to what the current
recommendations are for foodintroduction.
So what are those?
Well, in 2000, the uptick inpeanut allergy was first
identified, and in response, theAAP said well, you know what?
(02:35):
Let's have babies avoidcommonly allergenic foods until
their immune systems are readyfor them.
And so what that meant washaving babies avoid cow's milk
until they're one year old,having them avoid egg until
they're two and having themavoid peanuts, tree nuts and
fish until they're three yearsold.
Now, unfortunately, we did notsee a decrease in food allergy
(03:00):
after that recommendation, butwe actually saw the opposite.
We saw an even larger increasethan what we were already seeing
.
And so, in 2008, thoserecommendations were quietly
softened because there was notgood evidence that children,
especially babies, should avoidthese foods, should avoid these
(03:29):
foods, and so fast forward untilthe LEAP study.
If you're listening to thispodcast, chances are you have
heard of the LEAP study LearningEarly About Peanut.
That study was published in2015 by Gideon Lack and what it
very clearly demonstrated isthat babies who are at risk of
peanut allergy are less likelyto develop peanut allergy if
(03:50):
they are exposed to peanut earlyin life, and often.
So what does that really mean?
We're going to get into theLEAP study and its findings and
another study that also lookedat early introduction in babies.
But really, before we move outof this segment of the show,
(04:11):
wrapping up the timeline of foodallergy, that is sort of the
pathway in the world of feedingbabies.
Regarding foods, there's awhole other approach to feeding
babies that we in developedcountries we don't think a whole
lot about anymore, and that'sreally just how.
(04:33):
How do we feed babies safely?
When we look at recommendationsfrom the World Health
Organization, they have a veryexplicit recommendation that
really nothing should go intothat baby's mouth except breast
milk via breastfeeding untilthat baby is six months of age,
(04:57):
and I'll tell you that a lot ofclinicians, when we hear a big
organization give a veryexplicit recommendation, we
certainly take pause and weconsider that in our medical
decision making.
Now, should we only go off ofwhat an organization says as a
(05:19):
guideline?
No ifs, ands or buts.
No personalized medicine.
No ifs, ands or buts.
No personalized medicine.
No, of course not.
We should take theserecommendations into our
consideration whenever we arepersonalizing a treatment plan
or a management plan for afamily.
And so when we look at the WorldHealth Organization and we look
at their recommendations forexclusive breastfeeding until
(05:43):
six months of age, for exclusivebreastfeeding until six months
of age, how is thatrecommendation applicable or
less applicable to children indeveloped countries?
Well, the World HealthOrganization is trying to serve
especially the families incountries where they might not
(06:05):
have great access to clean water, they might have high rates of
HIV and other infectiousdiseases that, if the baby were
to catch, could be devastating,could be fatal.
And the World HealthOrganization is also really
focused on areas of the worldthat don't have access to great
(06:29):
nutrition, that can'tnecessarily go to the grocery
store and have all thesedifferent baby food products.
And so when we're looking atwhy is the World Health
Organization's recommendationnothing in the mouth except for
breast milk via breastfeedingit's because they're trying to
(06:49):
keep those babies safe.
And it does keep them safe.
It does keep them safe againstwashing a baby bottle, even if,
even if it's pumped breast milk.
Washing a baby bottle with, orpump parts with parts that are
with, water that is not clean,that could pass along a serious
(07:10):
illness to that baby.
Um, or trying to wean a babyfrom breastfeeding too early or
formula feeding too early.
Like I said, they don't likeanything other than breast milk
via breastfeeding.
Trying to wean babies too earlyand replacing breast milk with
(07:34):
something that is nowhere nearequal formula.
Infant formula is developed totry to be as similar to breast
milk as possible.
But if we wean babies too earlyto something that is not
equivalent to breast milk, thenthose babies can have serious
nutritional deficiencies.
So one of the one of thebarriers I hear from some of my
(07:59):
general pediatrician colleaguesas to why they're not as
aggressive in adopting earlyintroduction recommendations is
because there are still thesenothing except breastfeeding
until six months recommendationsfrom big organizations like the
World Health Organizations.
But when we sit down and wereally think about why does this
(08:22):
organization have thisrecommendation?
Then we can better tailor ourrecommendations to our patients
based on our specific patient'smedical needs and their specific
social situations.
(08:52):
So now that we have talked moreabout sort of the, the history
of when to feed babies.
That's a very abbreviatedhistory, by the way, um, but,
but since we have kind of like a, a starting point of like, okay
, before six months, some groupsconsider that early.
Well, what does any of thishave anything to do with food
allergies?
Well, as I talked about earlier, when that uptick was noted in
peanut allergy in 2000, which,by the way, we still don't know
(09:15):
why, why that uptick evenoccurred, but we noted the
uptick.
We made recommendations of ohwell, let's have kids avoid the
foods until their immune systemsare ready for it, and then
found out, wow, that wasabsolutely the complete opposite
recommendation we need to give.
And then, how did we really getgood data on that?
(09:36):
Because then, in 2015, we hadthe LEAP study.
Well, the LEAP study was thegood data, the beginning of the
good data.
The story behind the LEAP studyis really a lovely story.
The primary investigator,gideon Lack, and for my
non-science listeners, if you'rewondering who the primary
(09:57):
investigator is, like the seniorinvestigator, that's going to
be the person at the when, whenyou're reading the journal
article, at the very end, thelast name usually is a senior
author.
And then there's also the firstauthor, who is the author who
did a lot, of, a lot of work onthe study and and was a
absolutely a leader in the study, was a absolutely a leader in
(10:18):
the study, um Gideon Lacks, thesenior author of the LEAP study,
learning early about peanut,and he recognized that leading
up before, before he had donethe LEAP study.
The reason he the LEAP studycame to be is because he saw
that babies in Israel had foodallergies but they didn't have a
lot of peanut allergy.
And he said well, why is this?
Well, turns out, in Israel theyhad this little peanut puff,
(10:42):
kind of like a Cheeto but madewith like peanut.
They had this peanut puff thatlittle babies would gnaw on from
a really early age.
And so those little babies,four months, six months, one of
their first like teething foodswas these little peanut puffs.
And he hypothesized well, maybeif the baby start chewing on
(11:05):
peanut, they started ingestingpeanut protein early in life,
around four or six months of agemaybe that helps protect them
against peanut allergy.
And so that's where the idea ofthe LEAP study learning early
about peanut came about.
Was the research question reallywas does early and regular
ingestion of peanut prevent thedevelopment of peanut allergies
in babies who are at risk ofpeanut allergy.
(11:27):
So then you're probably likewell, who's at risk of peanut
allergy?
What does that mean?
Well, they had done some otherstudies prior to the LEAP study
that showed that kiddos who havesevere eczema and kiddos or
babies I should say babies umunder the age of one who have
severe eczema and or an eggallergy are at risk of
(11:49):
developing a peanut allergy.
So they enrolled babies withthose criteria.
Some of those babies hadpositive skin prick tests a
peanut and some of them hadnegative skin prick tests.
Now, if they had a skin pricktest that was five millimeters
or greater so they had like areasonable size skin prick test
they were excluded from thestudy.
(12:11):
But these were kiddos who hadsevere eczema and or egg allergy
and either were or were notsensitized.
I mean, either they had a lowpositive skin test or they
didn't have a positive skin testat all.
And these babies werestratified into one of two
groups.
They were either to strictlyavoid peanut or they were to
(12:33):
start consuming peanuts and whatwas.
And they continued this untiltheir fifth birthday, at which
time they had a peanut challengeand were determined whether or
not they were allergic to peanut.
And then they even, in theLEAP-ON study, which was the
(12:54):
subsequent study, they had thekids who were avoiding peanut
stop eating peanut for a yearand then challenged them after
one year with peanut.
And so what happened?
Well, spoiler alert, the kiddos, the babies, who were fed
peanut early and often weresignificantly less likely to
(13:19):
develop a peanut allergysignificantly less likely to
develop a peanut allergy.
So when we look at the kiddosagain high risk kiddos who had a
negative skin test going intothe study, and we look at the
per protocol analysis, meaningthe kiddos who were able to
really follow the study methods,meaning they were eating peanut
(13:41):
pretty regularly, then 0.4% ofthe kiddos who were eating
peanut developed a peanutallergy, compared to 13.9% of
kiddos who were avoiding peanutdeveloped a peanut allergy.
Of kiddos who were avoidingpeanut developed a peanut
(14:05):
allergy.
When we look at the kiddos whohad positive skin tests and we
look at the kids who followedthe protocol, meaning they were
either eating peanut or strictlyavoiding it, 0% of these kids
with positive skin tests whowere eating peanut developed a
peanut allergy, whereas 34% ofthe kiddos who were avoiding
(14:29):
peanut developed a peanutallergy.
So pretty robust data.
Also, what should be noted issort of my point number two.
Point number one what really isearly introduction and is it
helpful?
Early introduction is feeding ababy a commonly allergenic food
(14:49):
before six months of age.
Is it helpful?
If you look at the LEAP study,it was very helpful for peanut.
Other studies have come outsuggesting and demonstrating
that it is helpful for otherfoods such as egg.
Um, but really my point numbertwo is is this safe, right?
(15:13):
So I talked through the LEAPstudy and you might also be
asking well, you know like howmuch, how much did they eat?
These babies ate about sixgrams of peanut protein per week
.
So if, if you look on the backof a jar of peanut butter, most
jars of peanut butter have sixto seven grams of protein for
(15:36):
every two tablespoons.
So two tablespoons is oneserving size of peanut butter
usually and one serving hasabout six to seven grams of
protein in it.
So if you break that down, thenthese kiddos could have had
like one teaspoon of peanutbutter per day, because there's
three teaspoons and onetablespoon, and two tablespoons
(15:58):
would be six teaspoons.
And if they ate six grams perweek, then we're saying okay,
well, maybe they, they, they hadit every other day, something
like that, right, but on averagesix grams per week.
Um, I mentioned another studythat I'll talk briefly about,
the eat study, which enrolledbabies at three months of age.
(16:20):
These babies were exclusivelybreastfed, and foods were
introduced cow's milk first asthe allergenic food, and then
peanut egg, fish and sesame wereintroduced next, and they were
randomized.
The babies were randomized asto what was it peanut first, was
(16:40):
it sesame first, whatever?
That was randomized, and thenwere randomized as to what was
it peanut first?
Was it sesame first, whatever?
That was randomized.
And then the last we'dintroduced was wheat, and it was
introduced at around fourmonths of age or so, and by five
months of age though, sobetween three and five months
old, all of those foods neededto be in the diet twice per week
(17:04):
while still breastfeeding.
Now you're probably like, oh mygosh, like, first of all, it's a
, it's a relatively new littlebaby here, right, like I mean, I
remember when my littles werethat little and, um, trying to
just, you know, keep theirdiapers clean could be difficult
(17:25):
at times, much less try to haveall six of these foods twice
per week in a five-month-oldDifficult stuff sometimes, and
that's exactly what the studyshowed.
It showed like, wow, thefeasibility of this.
This is hard, like such robustearly introduction is hard.
But what this study also showedis that early introduction of
(17:47):
peanut and egg are very helpfulin preventing the development of
peanut allergy and egg allergyrespectively.
So these, the practice ofintroducing a food early and
again I say early, I'm doing airquotes and that whole term
(18:09):
early is based on sort of ourcurrent day thinking of well,
everybody says not everybody.
But you know, like World HealthOrganization says nothing
except breastfeeding until sixmonths.
But so early really is relativein my opinion, and this is
where I think we've reallysomewhat over-medicalized, um,
(18:34):
how we feed babies.
It's absolutely important thatbabies, especially in areas
where there's not clean water,where it's going to be difficult
to access good nutrition, aslong as breastfeeding can happen
, the better.
Breast milk is absolutely awonderful, like it's not magical
.
I mean God knew what he wasdoing, right, like that is what
(18:56):
grows babies.
So we don't want to undervaluebreast milk at all.
We also don't want to placesuch low bar for families
regarding how to safelyintroduce foods while making
(19:18):
sure your child has full accessand is fully being fed the
nutrition safely that they needTranslation.
In many developed countries, weare able to introduce foods
early to babies.
We're able to do it safelybecause we value breast milk, we
(19:42):
value formula as well, and weknow that those need to be the
primary sources of nutrition.
That being said, we can alsointroduce what's commonly called
complementary foods.
In this case, what this show isabout to prevent food allergies
, but also because you know,when you're five month olds,
(20:04):
looking at you and looking atwhat you're eating and is
sitting up, holding her head uphas really good trunk support
you know like she's able to situp on her own.
She's like grabbing for yourfood.
Yeah, it's time to give hersome food.
Now you want to do it.
You don't want to give her apeanut.
You know it's a choking hazard.
(20:25):
You want to give her a texturethat is safe for her, and I'll
talk a little bit about, like,how to introduce peanut butter
and such, because even peanutbutter is way too tacky for a
baby.
But the point being, or thepoint is, that foods can be
introduced before six months ofage and it absolutely helps
prevent the development of foodallergies, and that is food
(20:45):
allergies is absolutely aproblem in developed countries,
and so when we're thinking abouthow to feed babies, we need to
think about that because that isa problem for us in developed
countries and so we need to behelping families prevent that.
What about the safety?
So here's sort of the thirdpoint, right.
(21:07):
So we talked about sort of thetimeline of food allergies and
feeding babies and we talkedabout the safety.
Or we talked about how thisearly introduction stuff came to
be and what really is earlyintroduction and you know
sometimes being challenging thefeasibility, right, especially
if you're doing a lot of foodsreally early.
But is it safe?
(21:27):
In these studies there were nodeaths.
Also, looking at the LEAP study,the learning early about peanut
, the babies to get into thatstudy, if they were going to eat
peanut they needed, they hadwhat's called a peanut challenge
where they were fed peanut.
Epinephrine was not needed forany of those babies and so we
(21:56):
can really be as a pediatrician,as an allergist, I can feel
very comfortable in advisingfamilies to introduce peanut
early, as early as three to fourmonths of age, and not say, oh,
here's an EpiPen too, you mightneed this.
It would be highly unlikely forthat to happen.
(22:17):
Could it happen?
Yes, rarely do things happenright.
Never say never right.
But when we're looking at thesestudies, and the LEAP study had
kids who were at high risk ofhaving peanut allergy and there
were zero administrations ofepinephrine for these baseline
or entry study challenges.
(22:37):
That is incredibly reassuring,not just to me as an allergist
but to my general pediatriciancolleagues.
And it's really thepediatricians who are on the
front lines of this stuff,colleagues, and it's really the
pediatricians who are on thefront lines of this stuff.
And even in looking at the EATstudy, epinephrine was
administered to fourparticipants twice in one
(23:03):
participant on two separateoccasions but for choking, so
kind of a misunderstanding ofwhat was happening and it was
administered for choking washappening and and it was
administered for choking.
And then the other three.
The other three administrationsof epi occurred in the clinical
trials unit during ingestionchallenges.
So again, these are the in theEAT study was kiddos who were
(23:26):
not necessarily at high risk, um, as opposed to the LEAP study
which would, which were kiddoswho were at high risk of having
a peanut allergy.
The other important thing tonote there's you can look up the
EAT study, you can look up theLEAP study, um, and when you
(23:47):
find these studies.
There's so much supplementaldata and they've done a lot of
other analyses to findinteresting, interesting
findings.
Oh yeah, great use of language,dr Hoyt.
But one of the very coolfindings was actually that kids
who had early introduction theyslept a little bit longer.
(24:10):
They got, on average, 16.6minutes more sleep per night at
six months of age.
Look, I don't know how far awayyou are from having had a
little infant, but 16 minutes ofsleep like that's that's not
nothing, that is something, um.
But really more importantlyhere, this was all safe.
(24:34):
There were no deaths.
There was very limited epi.
Breastfeeding also huge pointhere.
Huge point the breastfeedingjourney was not negatively
impacted.
So by introducing foods early,that does not mean you're
(24:55):
weaning a baby off of breastmilk or even formula.
It means you're introducing,you're incorporating, but the
primary source of nutrition isstill the breast milk.
So that is, in a nutshell, badjoke.
Early introduction, especiallyof peanut.
(25:19):
Early introduction, to recap,is when foods are introduced,
really before six months of age,they need to be done.
Oh, I said I had mentioned this.
When foods are introduced itneeds to be done in a way that
clearly is safe for baby.
So baby has to be ready forearly introduction head trunk
(25:39):
control, baby's interested infood, bringing things to baby's
mouth, and that all is typicallyhappening around four months of
age in many babies and waysthat you can introduce foods
early, like peanut butter.
There are puffs for this stuff.
Younger babies typically aren'tready for puffs.
There's little powders, mix-ins, things like that.
(26:05):
We've had some some folks on thepodcast talking about their
early introduction products, andone of mine still my favorite
is going to be taking peanutbutter and mixing it with breast
milk and feeding that to yourbaby.
It is cheap, it is easy, um,but what?
(26:27):
What is so nice is that thereare there are options, um, and
there's more options, um, comingout, which which is really
great, um.
So if you have a baby on theway, congratulations.
Or if you have a little baby,congratulations.
I want to encourage you to talkwith your pediatrician about
(26:48):
early introduction and to lookat the early introduction of
commonly allergenic foods.
It can get kind of hairy whenyou do have a kiddo who has a
food allergy or if you yourselfhas a food allergy, and I
definitely want to encourage youto talk with your allergist
about how can you safelyintroduce food into your little
baby, even with having an olderbaby, a bigger baby or you or
(27:12):
your spouse having a foodallergy.
So that's the episode all aboutfeeding your baby to help
prevent food allergies.
That's the episode.
Thanks so much for tuning in.
Of course I'm an allergist, butI'm not your allergist.
So talk with your allergistabout what you learned on this
(27:33):
episode and visit us atfoodallergyandyourkiddocom where
you can submit your family'squestions.
God bless you and God blessyour family.
Hello and welcome to Food Allergy and your Kiddo.
I am your host, dr Alice Hoyt,excited to be here to talk with
you today about how to preventfood allergies.
I've talked about this in thepast, but there really is a lot
of strong movement now towardsreally helping families not get
(00:25):
into the food allergy pickle tostart with, and so if you're
listening to this episode andyou're the parent of a kiddo
with a food allergy, then youmay have done what's called
early introduction.
That's what we're going to talkabout today.
Or maybe you didn't do earlyintroduction, um.
Or maybe you know somebody whojust had a baby and is concerned
(00:46):
about how to feed their babyTotally legit concern.
Spoiler alert we haveover-medicalized how we feed
babies and so today's episode isall about how to feed babies to
prevent food allergies.
And, before we dive deep intothis episode, any of our
(01:09):
listeners who are pediatricians,pediatric nurse practitioners,
physician's assistants if youserve families who have food
allergies and you're interestedin learning more about food
allergies, then go over tofoodallergypedshubhoitalergycom.
I know it's a mouthful, we'llput a link in the show notes,
butfoodallergypedshubhoitalergycom
(01:31):
and that's where you can sign upfor this awesome weekly email
where I break down a um, a foodallergy article that I think is
super powerful and helpful formy general pediatric colleagues.
So go over tofoodallergypeethubhoidallergycom
to learn more.
Okay, now let's get into theshow.
(01:51):
And so really to kick off theepisode, what really is early
introduction?
Is it safe?
Early introduction is when wefeed a baby a food, really
earlier than six months.
(02:11):
So the term early is somewhatrelative to what the current
recommendations are for foodintroduction.
So what are those?
Well, in 2000, the uptick inpeanut allergy was first
identified, and in response, theAAP said well, you know what?
(02:35):
Let's have babies avoidcommonly allergenic foods until
their immune systems are readyfor them.
And so what that meant washaving babies avoid cow's milk
until they're one year old,having them avoid egg until
they're two and having themavoid peanuts, tree nuts and
fish until they're three yearsold.
Now, unfortunately, we did notsee a decrease in food allergy
(03:00):
after that recommendation, butwe actually saw the opposite.
We saw an even larger increasethan what we were already seeing
.
And so, in 2008, thoserecommendations were quietly
softened because there was notgood evidence that children,
especially babies, should avoidthese foods, should avoid these
(03:29):
foods, and so fast forward untilthe LEAP study.
If you're listening to thispodcast, chances are you have
heard of the LEAP study LearningEarly About Peanut.
That study was published in2015 by Gideon Lack and what it
very clearly demonstrated isthat babies who are at risk of
peanut allergy are less likelyto develop peanut allergy if
(03:50):
they are exposed to peanut earlyin life, and often.
So what does that really mean?
We're going to get into theLEAP study and its findings and
another study that also lookedat early introduction in babies.
But really, before we move outof this segment of the show,
(04:11):
wrapping up the timeline of foodallergy, that is sort of the
pathway in the world of feedingbabies.
Regarding foods, there's awhole other approach to feeding
babies that we in developedcountries we don't think a whole
lot about anymore, and that'sreally just how.
(04:33):
How do we feed babies safely?
When we look at recommendationsfrom the World Health
Organization, they have a veryexplicit recommendation that
really nothing should go intothat baby's mouth except breast
milk via breastfeeding untilthat baby is six months of age,
(04:57):
and I'll tell you that a lot ofclinicians, when we hear a big
organization give a veryexplicit recommendation, we
certainly take pause and weconsider that in our medical
decision making.
Now, should we only go off ofwhat an organization says as a
(05:19):
guideline?
No ifs, ands or buts.
No personalized medicine.
No ifs, ands or buts.
No personalized medicine.
No, of course not.
We should take theserecommendations into our
consideration whenever we arepersonalizing a treatment plan
or a management plan for afamily.
And so when we look at the WorldHealth Organization and we look
at their recommendations forexclusive breastfeeding until
(05:43):
six months of age, for exclusivebreastfeeding until six months
of age, how is thatrecommendation applicable or
less applicable to children indeveloped countries?
Well, the World HealthOrganization is trying to serve
especially the families incountries where they might not
(06:05):
have great access to clean water, they might have high rates of
HIV and other infectiousdiseases that, if the baby were
to catch, could be devastating,could be fatal.
And the World HealthOrganization is also really
focused on areas of the worldthat don't have access to great
(06:29):
nutrition, that can'tnecessarily go to the grocery
store and have all thesedifferent baby food products.
And so when we're looking atwhy is the World Health
Organization's recommendationnothing in the mouth except for
breast milk via breastfeedingit's because they're trying to
(06:49):
keep those babies safe.
And it does keep them safe.
It does keep them safe againstwashing a baby bottle, even if,
even if it's pumped breast milk.
Washing a baby bottle with, orpump parts with parts that are
with, water that is not clean,that could pass along a serious
(07:10):
illness to that baby.
Um, or trying to wean a babyfrom breastfeeding too early or
formula feeding too early.
Like I said, they don't likeanything other than breast milk
via breastfeeding.
Trying to wean babies too earlyand replacing breast milk with
(07:34):
something that is nowhere nearequal formula.
Infant formula is developed totry to be as similar to breast
milk as possible.
But if we wean babies too earlyto something that is not
equivalent to breast milk, thenthose babies can have serious
nutritional deficiencies.
So one of the one of thebarriers I hear from some of my
(07:59):
general pediatrician colleaguesas to why they're not as
aggressive in adopting earlyintroduction recommendations is
because there are still thesenothing except breastfeeding
until six months recommendationsfrom big organizations like the
World Health Organizations.
But when we sit down and wereally think about why does this
(08:22):
organization have thisrecommendation?
Then we can better tailor ourrecommendations to our patients
based on our specific patient'smedical needs and their specific
social situations.
(08:52):
So now that we have talked moreabout sort of the, the history
of when to feed babies.
That's a very abbreviatedhistory, by the way, um, but,
but since we have kind of like a, a starting point of like, okay
, before six months, some groupsconsider that early.
Well, what does any of thishave anything to do with food
allergies?
Well, as I talked about earlier, when that uptick was noted in
peanut allergy in 2000, which,by the way, we still don't know
(09:15):
why, why that uptick evenoccurred, but we noted the
uptick.
We made recommendations of ohwell, let's have kids avoid the
foods until their immune systemsare ready for it, and then
found out, wow, that wasabsolutely the complete opposite
recommendation we need to give.
And then, how did we really getgood data on that?
(09:36):
Because then, in 2015, we hadthe LEAP study.
Well, the LEAP study was thegood data, the beginning of the
good data.
The story behind the LEAP studyis really a lovely story.
The primary investigator,gideon Lack, and for my
non-science listeners, if you'rewondering who the primary
(09:57):
investigator is, like the seniorinvestigator, that's going to
be the person at the when, whenyou're reading the journal
article, at the very end, thelast name usually is a senior
author.
And then there's also the firstauthor, who is the author who
did a lot, of, a lot of work onthe study and and was a
absolutely a leader in the study, was a absolutely a leader in
(10:18):
the study, um Gideon Lacks, thesenior author of the LEAP study,
learning early about peanut,and he recognized that leading
up before, before he had donethe LEAP study.
The reason he the LEAP studycame to be is because he saw
that babies in Israel had foodallergies but they didn't have a
lot of peanut allergy.
And he said well, why is this?
Well, turns out, in Israel theyhad this little peanut puff,
(10:42):
kind of like a Cheeto but madewith like peanut.
They had this peanut puff thatlittle babies would gnaw on from
a really early age.
And so those little babies,four months, six months, one of
their first like teething foodswas these little peanut puffs.
And he hypothesized well, maybeif the baby start chewing on
(11:05):
peanut, they started ingestingpeanut protein early in life,
around four or six months of agemaybe that helps protect them
against peanut allergy.
And so that's where the idea ofthe LEAP study learning early
about peanut came about.
Was the research question reallywas does early and regular
ingestion of peanut prevent thedevelopment of peanut allergies
in babies who are at risk ofpeanut allergy.
(11:27):
So then you're probably likewell, who's at risk of peanut
allergy?
What does that mean?
Well, they had done some otherstudies prior to the LEAP study
that showed that kiddos who havesevere eczema and kiddos or
babies I should say babies umunder the age of one who have
severe eczema and or an eggallergy are at risk of
(11:49):
developing a peanut allergy.
So they enrolled babies withthose criteria.
Some of those babies hadpositive skin prick tests a
peanut and some of them hadnegative skin prick tests.
Now, if they had a skin pricktest that was five millimeters
or greater so they had like areasonable size skin prick test
they were excluded from thestudy.
(12:11):
But these were kiddos who hadsevere eczema and or egg allergy
and either were or were notsensitized.
I mean, either they had a lowpositive skin test or they
didn't have a positive skin testat all.
And these babies werestratified into one of two
groups.
They were either to strictlyavoid peanut or they were to
(12:33):
start consuming peanuts and whatwas.
And they continued this untiltheir fifth birthday, at which
time they had a peanut challengeand were determined whether or
not they were allergic to peanut.
And then they even, in theLEAP-ON study, which was the
(12:54):
subsequent study, they had thekids who were avoiding peanut
stop eating peanut for a yearand then challenged them after
one year with peanut.
And so what happened?
Well, spoiler alert, the kiddos, the babies, who were fed
peanut early and often weresignificantly less likely to
(13:19):
develop a peanut allergysignificantly less likely to
develop a peanut allergy.
So when we look at the kiddosagain high risk kiddos who had a
negative skin test going intothe study, and we look at the
per protocol analysis, meaningthe kiddos who were able to
really follow the study methods,meaning they were eating peanut
(13:41):
pretty regularly, then 0.4% ofthe kiddos who were eating
peanut developed a peanutallergy, compared to 13.9% of
kiddos who were avoiding peanutdeveloped a peanut allergy.
Of kiddos who were avoidingpeanut developed a peanut
(14:05):
allergy.
When we look at the kiddos whohad positive skin tests and we
look at the kids who followedthe protocol, meaning they were
either eating peanut or strictlyavoiding it, 0% of these kids
with positive skin tests whowere eating peanut developed a
peanut allergy, whereas 34% ofthe kiddos who were avoiding
(14:29):
peanut developed a peanutallergy.
So pretty robust data.
Also, what should be noted issort of my point number two.
Point number one what really isearly introduction and is it
helpful?
Early introduction is feeding ababy a commonly allergenic food
(14:49):
before six months of age.
Is it helpful?
If you look at the LEAP study,it was very helpful for peanut.
Other studies have come outsuggesting and demonstrating
that it is helpful for otherfoods such as egg.
Um, but really my point numbertwo is is this safe, right?
(15:13):
So I talked through the LEAPstudy and you might also be
asking well, you know like howmuch, how much did they eat?
These babies ate about sixgrams of peanut protein per week
.
So if, if you look on the backof a jar of peanut butter, most
jars of peanut butter have sixto seven grams of protein for
(15:36):
every two tablespoons.
So two tablespoons is oneserving size of peanut butter
usually and one serving hasabout six to seven grams of
protein in it.
So if you break that down, thenthese kiddos could have had
like one teaspoon of peanutbutter per day, because there's
three teaspoons and onetablespoon, and two tablespoons
(15:58):
would be six teaspoons.
And if they ate six grams perweek, then we're saying okay,
well, maybe they, they, they hadit every other day, something
like that, right, but on averagesix grams per week.
Um, I mentioned another studythat I'll talk briefly about,
the eat study, which enrolledbabies at three months of age.
(16:20):
These babies were exclusivelybreastfed, and foods were
introduced cow's milk first asthe allergenic food, and then
peanut egg, fish and sesame wereintroduced next, and they were
randomized.
The babies were randomized asto what was it peanut first, was
(16:40):
it sesame first, whatever?
That was randomized, and thenwere randomized as to what was
it peanut first?
Was it sesame first, whatever?
That was randomized.
And then the last we'dintroduced was wheat, and it was
introduced at around fourmonths of age or so, and by five
months of age though, sobetween three and five months
old, all of those foods neededto be in the diet twice per week
(17:04):
while still breastfeeding.
Now you're probably like, oh mygosh, like, first of all, it's a
, it's a relatively new littlebaby here, right, like I mean, I
remember when my littles werethat little and, um, trying to
just, you know, keep theirdiapers clean could be difficult
(17:25):
at times, much less try to haveall six of these foods twice
per week in a five-month-oldDifficult stuff sometimes, and
that's exactly what the studyshowed.
It showed like, wow, thefeasibility of this.
This is hard, like such robustearly introduction is hard.
But what this study also showedis that early introduction of
(17:47):
peanut and egg are very helpfulin preventing the development of
peanut allergy and egg allergyrespectively.
So these, the practice ofintroducing a food early and
again I say early, I'm doing airquotes and that whole term
(18:09):
early is based on sort of ourcurrent day thinking of well,
everybody says not everybody.
But you know, like World HealthOrganization says nothing
except breastfeeding until sixmonths.
But so early really is relativein my opinion, and this is
where I think we've reallysomewhat over-medicalized, um,
(18:34):
how we feed babies.
It's absolutely important thatbabies, especially in areas
where there's not clean water,where it's going to be difficult
to access good nutrition, aslong as breastfeeding can happen
, the better.
Breast milk is absolutely awonderful, like it's not magical
.
I mean God knew what he wasdoing, right, like that is what
(18:56):
grows babies.
So we don't want to undervaluebreast milk at all.
We also don't want to placesuch low bar for families
regarding how to safelyintroduce foods while making
(19:18):
sure your child has full accessand is fully being fed the
nutrition safely that they needTranslation.
In many developed countries, weare able to introduce foods
early to babies.
We're able to do it safelybecause we value breast milk, we
(19:42):
value formula as well, and weknow that those need to be the
primary sources of nutrition.
That being said, we can alsointroduce what's commonly called
complementary foods.
In this case, what this show isabout to prevent food allergies
, but also because you know,when you're five month olds,
(20:04):
looking at you and looking atwhat you're eating and is
sitting up, holding her head uphas really good trunk support
you know like she's able to situp on her own.
She's like grabbing for yourfood.
Yeah, it's time to give hersome food.
Now you want to do it.
You don't want to give her apeanut.
You know it's a choking hazard.
(20:25):
You want to give her a texturethat is safe for her, and I'll
talk a little bit about, like,how to introduce peanut butter
and such, because even peanutbutter is way too tacky for a
baby.
But the point being, or thepoint is, that foods can be
introduced before six months ofage and it absolutely helps
prevent the development of foodallergies, and that is food
(20:45):
allergies is absolutely aproblem in developed countries,
and so when we're thinking abouthow to feed babies, we need to
think about that because that isa problem for us in developed
countries and so we need to behelping families prevent that.
What about the safety?
So here's sort of the thirdpoint, right.
(21:07):
So we talked about sort of thetimeline of food allergies and
feeding babies and we talkedabout the safety.
Or we talked about how thisearly introduction stuff came to
be and what really is earlyintroduction and you know
sometimes being challenging thefeasibility, right, especially
if you're doing a lot of foodsreally early.
But is it safe?
(21:27):
In these studies there were nodeaths.
Also, looking at the LEAP study,the learning early about peanut
, the babies to get into thatstudy, if they were going to eat
peanut they needed, they hadwhat's called a peanut challenge
where they were fed peanut.
Epinephrine was not needed forany of those babies and so we
(21:56):
can really be as a pediatrician,as an allergist, I can feel
very comfortable in advisingfamilies to introduce peanut
early, as early as three to fourmonths of age, and not say, oh,
here's an EpiPen too, you mightneed this.
It would be highly unlikely forthat to happen.
(22:17):
Could it happen?
Yes, rarely do things happenright.
Never say never right.
But when we're looking at thesestudies, and the LEAP study had
kids who were at high risk ofhaving peanut allergy and there
were zero administrations ofepinephrine for these baseline
or entry study challenges.
(22:37):
That is incredibly reassuring,not just to me as an allergist
but to my general pediatriciancolleagues.
And it's really thepediatricians who are on the
front lines of this stuff,colleagues, and it's really the
pediatricians who are on thefront lines of this stuff.
And even in looking at the EATstudy, epinephrine was
administered to fourparticipants twice in one
(23:03):
participant on two separateoccasions but for choking, so
kind of a misunderstanding ofwhat was happening and it was
administered for choking washappening and and it was
administered for choking.
And then the other three.
The other three administrationsof epi occurred in the clinical
trials unit during ingestionchallenges.
So again, these are the in theEAT study was kiddos who were
(23:26):
not necessarily at high risk, um, as opposed to the LEAP study
which would, which were kiddoswho were at high risk of having
a peanut allergy.
The other important thing tonote there's you can look up the
EAT study, you can look up theLEAP study, um, and when you
(23:47):
find these studies.
There's so much supplementaldata and they've done a lot of
other analyses to findinteresting, interesting
findings.
Oh yeah, great use of language,dr Hoyt.
But one of the very coolfindings was actually that kids
who had early introduction theyslept a little bit longer.
(24:10):
They got, on average, 16.6minutes more sleep per night at
six months of age.
Look, I don't know how far awayyou are from having had a
little infant, but 16 minutes ofsleep like that's that's not
nothing, that is something, um.
But really more importantlyhere, this was all safe.
(24:34):
There were no deaths.
There was very limited epi.
Breastfeeding also huge pointhere.
Huge point the breastfeedingjourney was not negatively
impacted.
So by introducing foods early,that does not mean you're
(24:55):
weaning a baby off of breastmilk or even formula.
It means you're introducing,you're incorporating, but the
primary source of nutrition isstill the breast milk.
So that is, in a nutshell, badjoke.
Early introduction, especiallyof peanut.
(25:19):
Early introduction, to recap,is when foods are introduced,
really before six months of age,they need to be done.
Oh, I said I had mentioned this.
When foods are introduced itneeds to be done in a way that
clearly is safe for baby.
So baby has to be ready forearly introduction head trunk
(25:39):
control, baby's interested infood, bringing things to baby's
mouth, and that all is typicallyhappening around four months of
age in many babies and waysthat you can introduce foods
early, like peanut butter.
There are puffs for this stuff.
Younger babies typically aren'tready for puffs.
There's little powders, mix-ins, things like that.
(26:05):
We've had some some folks on thepodcast talking about their
early introduction products, andone of mine still my favorite
is going to be taking peanutbutter and mixing it with breast
milk and feeding that to yourbaby.
It is cheap, it is easy, um,but what?
(26:27):
What is so nice is that thereare there are options, um, and
there's more options, um, comingout, which which is really
great, um.
So if you have a baby on theway, congratulations.
Or if you have a little baby,congratulations.
I want to encourage you to talkwith your pediatrician about
(26:48):
early introduction and to lookat the early introduction of
commonly allergenic foods.
It can get kind of hairy whenyou do have a kiddo who has a
food allergy or if you yourselfhas a food allergy, and I
definitely want to encourage youto talk with your allergist
about how can you safelyintroduce food into your little
baby, even with having an olderbaby, a bigger baby or you or
(27:12):
your spouse having a foodallergy.
So that's the episode all aboutfeeding your baby to help
prevent food allergies.
That's the episode.
Thanks so much for tuning in.
Of course I'm an allergist, butI'm not your allergist.
So talk with your allergistabout what you learned on this
(27:33):
episode and visit us atfoodallergyandyourkiddocom where
you can submit your family'squestions.
God bless you and God blessyour family.
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