An About-Face on Peanut Allergies

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THE WALL STREET JOURNAL.
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Tuesday, February 24, 2015 | D1
Hidden Dangers
Peanuts are the most
common cause
of food allergies in
children.
More than 2% of
people in the U.S.
have a peanut allergy,
a rate that has
quadrupled in the 13
years ended 2010.
Peanut allergies are
the leading cause of
anaphylaxis and
death related to food
allergy in the U.S.
Some people
outgrow peanut
allergies. For about
80% of people
the allergies are
lifelong.
Sources: Pediatrics; Food Allergy Research
& Education; NEJM; Journal of Allergy and
Clinical Immunology
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An About-Face on Peanut Allergies
New research finds introducing peanuts in a baby’s first-year diet could help avoid the allergies later in childhood; upends earlier recommendations
BY SUMATHI REDDY
A diet that includes peanuts in the first year
of life may greatly reduce the chance of developing peanut allergies in children at risk for
getting them, according to a highly anticipated
new study.
The findings appear to be the most definitive
evidence yet to discount the medical community’s longtime recommendation that parents
avoid giving peanut products to young children.
That practice has failed to stem the growing
rate of peanut allergies. Some doctors now suggest that not eating peanuts may actually have
helped spur more allergies.
“We have had a whole ethos within the practice of pediatrics and pediatric allergy that the
way to avoid any allergy was avoidance,” said
Gideon Lack, a professor of pediatric allergy at
King’s College London and senior author of the
study, which was published online Monday in
the New England Journal of Medicine. “At least
with respect to peanuts, avoidance may actually
worsen the problem.”
Health experts caution parents not to suddenly start including peanuts in their babies’ diets. Some children are at increased risk for developing allergies and could react adversely if
they were to begin eating peanut products. An
allergy specialist can test for risk. The study
only looked at children at risk for peanut allergies, and some experts said it isn’t clear if the
findings apply to all children.
The growing prevalence of peanut allergies—
which have more than quadrupled in the U.S. in
the 13 years ended 2010—has puzzled and worried the medical community. More than 2% of
children age 18 years and younger have a pea-
nut allergy, according to a 2008 study. Peanut
allergies are the leading cause of death related
to food allergy in the U.S.
For years doctors advised parents of children
at risk for food allergies to avoid peanuts until
the child was 3 years old, based on guidelines
outlined by the American Academy of Pediatrics
in 2000. In 2008 the AAP revised its guidelines,
citing insufficient evidence that delays prevented the development of food allergies. But
the medical group didn’t say when and how
highly allergenic foods should be introduced.
The new study, which was also presented
Monday at the annual meeting of the American
Academy of Allergy Asthma and Immunology in
Houston, found that 17.2% of the children who
avoided peanuts until age 5 ended up with a
peanut allergy compared with 3.2% of those
who regularly ate peanuts, said George Du Toit,
a consultant in pediatric allergy at King’s College London and a co-investigator of the study.
“That’s an 80% reduction in peanut allergy,”
said Dr. Du Toit. “This is an extremely strong
effect.”
The study followed 640 children from the
United Kingdom at risk for developing peanut
allergies for about five years. The children were
enrolled in the trial between the ages of 4
months and 11 months. They were considered at
risk for peanut allergy if they had severe eczema or egg allergies.
The children were divided into two groups
based on the results of a skin-prick test to assess sensitivity to peanuts. About 85% of the
participants had negative test results, meaning
they showed no evidence of peanut allergy. The
rest had a minor reaction to the test, showing
Please see PEANUTS page D2
New Screening Tests for
Hard-to-Spot Breast Cancers
BY MELINDA BECK
Researchers say endurance athletes in events like the New York City Marathon, above, often drink more than they need.
Ease Up on Water for That Run
BY RACHEL BACHMAN
For years, the mantra was
drummed into endurance-sports competitors: hydrate, hydrate, hydrate.
Swig water at most marathon or triathlon fluid stations and drain your
bottles during a cycling race—
whether you’re thirsty or not.
Mounting research supports very
different advice. Athletes are more
likely to suffer severe harm by drinking too much during competition
than by drinking too little, the evidence shows. In extreme cases, people have died after drinking too much
liquid during a race.
Further, new studies suggest that
3% dehydration levels during competition, which experts once warned
against, don’t hurt performance and
might even help it. Increasingly, experts advocate a simple rule: During
competition, drink when you’re
thirsty.
Tim Noakes, a longtime sports
medicine physician and emeritus professor at South Africa’s University of
Cape Town, believes the body’s instincts are an athlete’s best friend.
“If you drink to thirst, you maximize
your performance,” he says. His 2012
book “Waterlogged” blames the
sports-drink industry for encouraging
athletes to drink more than needed.
Ultramarathoner Dean Karnazes
says he drinks gallons of water while
competing in events like the Badwater Ultramarathon, a 135-mile run
across California’s scorching Death
Valley. At November’s New York City
Marathon, however, where temperatures were in the mid-40s, he drank
only once: a half-cup of water near
the 15-mile mark.
Boston Marathon winner Meb Keflezighi drinks 28 to 32 ounces of
fluid during a 26.2-mile race, but
says via email that he knows runners
who have gone the distance without
drinking a drop. He says he loses 3%
to 4% of his 124-pound body weight
during a marathon, depending on the
climate.
In a study of 643 runners in a
2009 marathon in France, men and
women who finished with faster
times lost a higher percentage of
their body weight during the event
than slower runners did. Dr. Noakes
says he has measured dehydration
levels of 12% and 13% in Ironman triathletes. “It’s a huge advantage, because they get lighter,” he says.
Still, the notion of more water being better than less persists. Many
runners can recall the hot day at the
1982 Boston Marathon when American Alberto Salazar drank no water
and secured a narrow victory. He
needed intravenous fluids in the
postrace medical tent and observers
speculate the race wrecked his running career.
Current guidelines from the American College of Sports Medicine call
anything greater than a 2% loss of
body weight during exercise due to
dehydration “excessive.”
“At the point that you sense
thirst, your physical performance and
cognitive function are beginning to
decline,” says ACSM president-elect
Lawrence Armstrong of the University of Connecticut. He points to findings that even 1.5% dehydration can
affect performance, and says that
athletes should craft individual plans
based on their rates of sweat loss
and fluid intake per hour.
Yet recent studies suggest that
when athletes don’t know they’re dehydrated, they don’t perform worse.
A study to be published in June in
a supplement of the Scandinavian
Journal of Medicine & Science in
Sports had 11 cyclists dehydrated 3%,
then tasked with completing a 20-kilometer time trial in a 95-degree lab.
They showed no drop in performance. The athletes were equipped
with obscured intravenous lines so
they didn’t know how hydrated they
were, according to the research conPlease see WATER page D2
The Options: Mammogram to MBI
Mammogram: Takes X-rays of the breast, from side to side and top to bottom,
recorded either on film or digitally
Pros: Quick, inexpensive; can find very early cancers before they can be felt
Cons: Compression and dense breast tissue can hide tumors and generate false
positives
Cost: $50 to $200; fully covered by insurance
Tomosynthesis:Takes multiple X-rays from different angles to create a threedimensional image
Pros: Finds more cancers; fewer false positives
Cons: Uses more radiation; some cancers still obscured in dense breasts
Cost: $50 to $75 over mammograms; covered by Medicare, but few insurers
Ultrasound: Creates images using high-frequency sound waves
Pros: No radiation; widely available; can distinguish solid lumps from cysts
Cons: More false positives; can be hard to interpret
Costs: $50 to $200; some states require insurers to cover for women with
dense breasts
MRI (Magnetic resonance imaging): Uses magnets and radio waves to
provide multiple cross-section images mainly used for diagnosis, not screening
Pros: Can evaluate palpable masses not visible on ultrasound or mammograms
Cons: Costly; time-consuming; more false positives
Cost: $500 to $1,500; limited insurance coverage
MBI (Molecular breast imaging): A radioactive tracer makes tumor cells
highly visible with a special camera
Pros: Finds more cancers, with fewer unnecessary biopsies, than other methods;
faster than MRI
Cons: Some radiation; not yet widely available
Cost: $400 - $500; limited insurance coverage
P2JW055000-0-D00100-1--------XA
Zoran Milich/Getty Images
Millions of women in 21 states
will get an ominous note with their
mammogram results this year. Even
if everything seems fine, they’ll be
informed that they have dense breast
tissue, which can raise their risk for
cancer and hide abnormalities, making their mammograms less accurate.
The question is: now what?
A host of new breast-imaging
technologies promise to detect more
cancers in these
HEALTH
women. But many of
JOURNAL
the methods bring
more false alarms as
well, subjecting women
to additional tests and biopsies unnecessarily. Some are also more expensive than mammograms and haven’t been widely studied yet.
Laws in 21 states require doctors
to tell women they have dense tissue.
Similar bills are pending in eight
more states and a national bill was
introduced in Congress earlier this
month.
“It’s a very confusing time,” says
Emily Conant, chief of breast imaging
at the University of Pennsylvania
Medical Center. “This legislation has
happened before we have a medical
consensus about what to tell
women.”
Some experts say telling women
they have dense breasts would make
them anxious unnecessarily.
“Of course you might be anxious.
But I’d trade a false positive for a
false negative any day,” says Nancy
Cappello, who started the campaign
for density-notification laws and the
Please see SCREENING page D2
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