Wednesday, September 20, 2017

Early Exposure to Allergens is a Good Thing - Let Those Babies Play in the Dirt, Eat Peanuts

A study released by NIH (National Institutes of Health) shows that infants that lived in dirtier conditions had a lower risk of asthma. From the release, "Higher concentrations of cockroach, mouse and cat allergens present in dust samples collected from the children’s homes during the first three years of life (at age 3 months, 2 years and 3 years) were linked to a lower risk of asthma by age 7 years." This is not surprising. Also recently, FDA recognized that the introduction of peanut allergies before the age of three reduced peanut allergies later in life.  So FDA "announced they would allow updated labels on some peanut-containing foods that they may reduce the risk of allergens.

So it is a delicate balance.  Introducing children to allergens early, but not particularly harmful agents such as the bacterial pathogens Listeria or Salmonella.  As parents, there is a tendency to keep infants from playing in dirty conditions, but the exposure to allergens in those dirty conditions is important for exposure.  Not exposing kids to allergens early means that when they are exposed to them later in life, they are more likely to have abnormal reactions to them in the form of allergies.

So let those little kids play in the dirt.  Buy them a puppy.  Visit a friend who has a cat, is less tidy and has roaches(ewww).  Have you ever considered the reason why there is an increasing percentage of children with allergies is nothing more than the fact that we are too risk averse to giving them certain foods or that we are too clean?

As the adage goes - The key to a healthy immune system is a constant challenge. But perhaps better stated - The key to a healthy immune system is an early challenge.

NIH Release
https://www.nih.gov/news-events/news-releases/exposure-pet-pest-allergens-during-infancy-linked-reduced-asthma-risk
Tuesday, September 19, 2017
Exposure to pet and pest allergens during infancy linked to reduced asthma risk
NIH-funded study may aid development of asthma prevention strategies


Children exposed to high indoor levels of pet or pest allergens during infancy have a lower risk of developing asthma by 7 years of age, new research supported by the National Institutes of Health reveals. The findings, published September 19 in the Journal of Allergy and Clinical Immunology, may provide clues for the design of strategies to prevent asthma from developing.

While previous studies have established that reducing allergen exposure in the home helps control established asthma, the new findings suggest that exposure to certain allergens early in life, before asthma develops, may have a preventive effect. The observations come from the ongoing Urban Environment and Childhood Asthma (URECA—pronounced “Eureka”) study, which is funded by NIH’s National Institute of Allergy and Infectious Diseases (NIAID) through its Inner-City Asthma Consortium.

“We are learning more and more about how the early-life environment can influence the development of certain health conditions,” said NIAID Director Anthony S. Fauci, M.D. “If we can develop strategies to prevent asthma before it develops, we will help alleviate the burden this disease places on millions of people, as well as on their families and communities.”

According to the Centers for Disease Control and Prevention, more than 8 percent of children in the United States currently have asthma, a chronic disease that intermittently inflames and narrows the airways. Asthma can result in missed time from school and work and is a major cause of emergency department visits and hospitalizations.

The URECA study investigates risk factors for asthma among children living in urban areas, where the disease is more prevalent and severe. Since 2005, URECA has enrolled 560 newborns from Baltimore, Boston, New York City and St. Louis at high risk for developing asthma because at least one parent has asthma or allergies. Study investigators have been following the children since birth, and the current research report evaluates the group through 7 years of age.

Among 442 children for whom researchers had enough data to assess asthma status at age 7 years, 130 children (29 percent) had asthma. Higher concentrations of cockroach, mouse and cat allergens present in dust samples collected from the children’s homes during the first three years of life (at age 3 months, 2 years and 3 years) were linked to a lower risk of asthma by age 7 years. The researchers observed a similar association for dog allergen, although it was not statistically significant, meaning it could be due to chance. Additional analysis indicated that exposure to higher levels of these four allergens at age 3 months was associated with a lower risk of developing asthma.

Evidence also suggested that the microbial environment in the home during infancy may be associated with asthma risk. A previous report from URECA that assessed the microbiome of house dust collected in the first year of life suggested that exposure to certain bacteria during infancy may protect 3-year-olds from recurrent wheezing, a risk factor for developing asthma. In the current report, researchers found associations between the abundance of certain types of bacteria in the house dust and an asthma diagnosis by age 7 years, suggesting that exposure to certain types of bacteria in early life might influence development of asthma. However, additional research is needed to clarify the potential roles of these microbial exposures in asthma development.

“Our observations imply that exposure to a broad variety of indoor allergens, bacteria and bacterial products early in life may reduce the risk of developing asthma,” said James E. Gern, M.D., the principal investigator of URECA and a professor at the University of Wisconsin-Madison. “Additional research may help us identify specific targets for asthma prevention strategies.”

In addition, the seven-year URECA results confirm previous research linking development of childhood asthma to recognized risk factors such as prenatal exposure to tobacco smoke and maternal stress and depression. Investigators found that the presence of cotinine, which results from the breakdown of nicotine in the body, in the umbilical cord blood of newborns increased their risk of developing asthma by age 7 years. Maternal stress and depression reported during the first three years of the child’s life also were associated with an increased risk of developing childhood asthma.

The URECA investigators are continuing to monitor the children. By dividing the children into groups based on characteristics of their allergies and asthma, the scientists hope to uncover additional information about which early-life factors influence development of allergic or non-allergic asthma.

This work was funded by NIAID under award numbers AI025496, AI25482, HHSN272200900052C, HHSN272201000052I, AI114271-01 and AI117870. NIH’s National Center for Advancing Translational Science provided additional support under award numbers RR00052, RR00533, RR025771, RR00071, RR024156, and RR024992-02, TR001079 and UL1TR000040. The URECA study is conducted at the Boston University School of Medicine, Johns Hopkins University in Baltimore, Saint Louis Children’s Hospital and Columbia University in New York. The URECA study is no longer recruiting, but more information is available at ClinicalTrials.gov using identifier NCT00114881.

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.


UPI News Release
https://www.upi.com/FDA-recognizes-NIH-health-claim-for-prevention-of-peanut-allergy-in-infants/6101504811702/
FDA recognizes NIH health claim for prevention of peanut allergy in infants

The agency acknowledged NIH guidelines announced last year after the LEAP trial suggested that giving certain high-risk infants peanut protein reduced development of the allergy by 81 percent.

Sept. 7 (UPI) -- The U.S. Food and Drug Administration said today that it will recognize the National Institutes of Health qualified health claim regarding peanut allergies and their prevention in high-risk infants.

The prevalence of peanut allergy has more than doubled in children from 1997 to 2008, and roughly 2 percent of children in the United States have a peanut allergy, but NIH research suggests the slow introduction of peanut proteins to high-risk infants may prevent the allergy from developing.

The FDA announcement means food labels will include advice about introducing peanuts to their children's diets, in addition to warning about the potential contamination of food with peanuts that packages now include.

"As the science governing allergies and diets continues to evolve, so do expert recommendations around how best to safely introduce babies and children to various foods," FDA Commissioner Dr. Scott Gottlieb, said in a press release.

"Perhaps one of the most challenging decisions for parents of my generation is when and how to introduce foods that pose a potential for a significant allergic reaction. These decisions are made more difficult as the prevalence of certain food allergies appear to be on the rise."

In response to the increase in cases of peanut allergy, doctors have for years advised parents not to introduce foods containing peanuts to children under the age of 3 who were at high risk for developing a peanut allergy due to severe eczema or egg allergy.

In 2016, however, the NIH sponsored Learning Early About Peanut Allergy, or LEAP, trial found infants who consumed 2 grams of peanut protein three times per week led to an 81 percent reduction in the development of peanut allergy.

The results of the trial led the NIH to issuing new guidelines recommending that parents of infants with severe eczema, egg allergy or both, who are at high risk of developing a peanut allergy introduce foods containing peanuts into a child's diet as early as 4-6 months of age.

The guidelines caution parents to check with their child's doctor or healthcare provider before feeding them any foods containing peanuts to determine whether an allergy test is needed, and advise to never feed whole peanuts to young children because they are a choking hazard.

"Along with the information that you currently see on food labels, which disclose when a food contains peanuts or peanut residue, the new advice about the early introduction to peanuts and reduced risk of developing peanut allergy will soon be found on the labels of some foods containing ground peanuts that are suitable for infant consumption," Gottlieb said. 

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