Ron Sunog (1s):

The things you can do to prevent allergy include keeping your baby skin healthy and Katie, you're going to like this one, eat a diverse diet during pregnancy and feed your baby a diverse diet, including the allergens.

Katie Ferraro (14s):

Hey there I'm Katie Ferraro Registered Dietitian college nutrition professor and mom of seven specializing in baby-led weaning here on the baby-led weaning made easy podcast. I help you strip out all of the noise and nonsense about feeding, leaving you with the competence and knowledge you need to give your baby a safe start to solid foods using baby led weaning You guys Welcome back doing a What's new in food allergy Roundup update today with Dr. Ron Sunog. So if you've listened to the podcast for any length of time, you're probably very familiar with Dr. Ron Sunog, who is a pediatrician who happens to have a very special interest in using food to help prevent food allergy.

Katie Ferraro (1m 1s):

He's the author of a book called eat the eight using food to prevent food allergy and the imperfect art of medicine. One of my favorite books for really understanding why it's so important to introduce these allergenic foods early and often, he's been on the podcast a number of times in the past, Dr. Sunog and I teach a food allergen introduction course together. I just absolutely love working with him. And I don't know where he gets the time. And he's like, Katie, I just read all of these new articles about things that are new in food allergy. And I want to come on and talk about it. So you not only wrote the questions for the interview, wrote the answers. I mean, this is great. He read all the articles for us. You guys. So Dr. Sunog is here to give us a little bit of an update on food allergy in pediatrics, in particular, in babies, what's new and notable with no further ado.

Katie Ferraro (1m 50s):

Here is Dr. Ron Sunog MD author of Eat the Eight and pediatrician he's in the Boston area. And I just picture him like sitting in his office, reading all of these lengthy, really dense articles and then summarizing them for us. So thanks Dr. Sunog.

Ron Sunog (2m 7s):

Hello, Katie, yeah. Great to be back.

Katie Ferraro (2m 9s):

All right. Before we dive in with what's new and notable in pediatric food allergies real quick, give our audience some background on how you came to be so interested in and focused on using food to prevent food allergies.

Ron Sunog (2m 22s):

Okay. So I've been a pediatrician for over 30 years. I've seen the expert and official recommendations for how to feed infants change and change again, as, as anyone will over a period of time like that. And in 2015, there was a landmark study called the leap study that showed that feeding peanut to infants actually prevented food allergy. That was a groundbreaking earth shattering discovery. And the idea of being able to prevent food allergy simply by feeding a delicious and nutritious food to infants was just something that really was very exciting.

Ron Sunog (3m 2s):

And especially because we had been telling parents the wrong thing, and here was an opportunity to fix that and do the right thing.

Katie Ferraro (3m 10s):

All right. So we've chatted a number of times on the podcast in the past about some really specific things about food allergies. We did, you know, is it safe to introduce peanuts to babies during COVID? Actually, we did that right when COVID started, which feels so long ago now, but we did a few other episodes on what you do if your baby has an allergic reaction to food. And so I'm going to link to all the previous episodes that you've done on the show notes. Or if you guys just go to BLW podcast.com and type in Sunog S U N O G, all of Dr. Sunog's other episodes will pop up today. We're going to be talking about some new and notable things. Just kind of like a hodgepodge of what's going on in the world of food allergies. And I love this because you read prolifically. I can tell because you're always forwarding me emails, like do this on the podcast, do that on the podcast.

Katie Ferraro (3m 54s):

I love it. So let's start with the latest, newest allergenic food Sesame, any updates you can share on the newest major allergenic food, which is sesame

Ron Sunog (4m 4s):

Okay, so cave, you remember Sesame was added to the list of major food allergens, not that long ago. So I think people are thinking about a lot now. Good news about Sesame first, just last November, there was a study that showed if your child has Sesame allergy, they can actually safely eat small amounts of intact Sesame seeds. Now, the researchers discovered this, they did an oral food challenge. That's where you feed small amounts and slowly increasing amounts of food to a child. Who's allergic to see if they react. And they took 51 children when they actually pet them. These pretzels covered with Sesame seeds or about 20 seeds on each pretzel.

Ron Sunog (4m 44s):

And 80% of the children were able to eat three pretzels. That's a total of 60 Sesame seeds with no reaction. That's a very positive finding. What's important to understand from this study is that 20% did react. Okay? So the study does not tell you if your child has Sesame allergy, just go ahead and eat Sesame. And it's important also to know though that since some of the kids were able to tolerate Sesame, we now know, and we've always known, but this proves again that an allergic reaction to food, isn't an all or none thing. It doesn't mean if you're allergic to Sesame. If you have one Sesame seed, you're going to react.

Ron Sunog (5m 26s):

So it's very reassuring. If your Sesame allergic child accidentally eats a very few Sesame seeds, they're probably going to be okay at the same time. Of course, you know, you have to continue to be careful

Katie Ferraro (5m 38s):

Now for parents who have children with food allergies, if I can kind of interpret what you're saying, it kind of follows along what we know with milk, ladders and egg ladders that perhaps there's the potential for, even though you may have a diagnosed food allergy, it's not necessarily the case that lifelong avoidance of that allergenic food is like diagnosis or your death now, right? Like you might be able to safely eat this food later. Obviously some kids grow out a certain allergies, but does it look like Sesame might be one that kids grow out of?

Ron Sunog (6m 8s):

Yeah, that's exactly right. So perhaps unlike the or milk ladder at this point, there's no known, you know, Sesame ladder that may be coming someday. But what we do know, and this is again from another oral food challenge, the study looked at the number of children who had a reaction to Sesame at an average age are about 11 months. And about a third of those children had outgrown that allergy by five years of age. So the real take home message here. If your child is allergic to sesame, don't just put that on their medical problem list and forget all about it. Follow up with your allergist at appropriate intervals, get retested at some point, probably have an oral food challenge.

Ron Sunog (6m 52s):

There's a pretty good chance your child will outgrow it. And that's great news.

Katie Ferraro (6m 56s):

And then just reiterating the message that you and I always share, which is early introduction of these allergenic foods is advisable. There's no benefits to withholding the introduction of these foods. And what I think is interesting, Dr. Sunog when we were developing our course eat the eight, which is about helping parents safely feed food versions of these allergenic foods. We were looking at the statistics of Sesame allergy and they vary quite greatly around the world. And you see a much higher concentration and higher rates of Sesame allergy in the middle east Oh my gosh, why, what is it? Is something in the soil like, no, it's just the mere fact that Sesame usually in the form of tahini and hummus and different cultural foods in the middle east is a food that you're just more likely to be feeding to a baby in certain parts of the world than in others.

Katie Ferraro (7m 38s):

So it's not, you know, we, we want to be incorporating that food and we know that it has the potential to reduce the risk of allergy down the road. So would you agree that continued early introduction is still a good idea for Sesame?

Ron Sunog (7m 50s):

Absolutely. Again, as you were saying, you can't react to something you don't eat. And so if we live in a world where foods didn't travel across cultures and from country to country, you could potentially never eat a food. And then of course you could never react. But when that food does become part of the culture, not eating it during infancy may increase the risk of developing an allergy. So yes, absolutely eat it during infancy.

Katie Ferraro (8m 16s):

Let's talk about peanut allergy, Dr. Sunog, any new studies you're aware of that you can share with us in regards to peanut, you mentioned leap kind of the original landmark trial that really changed the way we look at peanut introduction in instancy and also change the guidelines about introduction of peanut allergy, but that was a while ago. So what's happening now.

Ron Sunog (8m 34s):

So a lot of the work now is on treating children who are already peanut allergic. So there is a treatment for peanut allergy, still row, relatively new it's called oral immunotherapy, or O I T. And it does have significant limitations, but it can also be very, very effective for some children. So a recent study looked OIT in younger children. This is different than previous studies did this study found that OIT can be effective for children ages one to four years. And it was actually most effective for children age one to two years, allergist David Stukus commented on the study and said, this doesn't say that the treatment is right for all children in this age group, but it does emphasize if you have a young child with peanut allergy, you should talk to your physician about the risks and benefits of this treatment.

Ron Sunog (9m 25s):

Because starting early, before age two years might increase the chance that OIT works for your child. Now, this study had limitations. It was limited by the fact that there were a small number of children aged one to two years in the study. Also the children in the study were all able to tolerate an average of 25 milligrams of peanut protein without reacting. 50% of people with peanut allergy will react to just three milligrams. So it's possible that the most sensitive peanut allergic young children were excluded from the study. That makes it hard to say, if it is safe or useful for those who are most allergic again, what do you should really know about this is it's going to possibly be available soon, and you should discuss it with your allergist.

Ron Sunog (10m 12s):

If your child has peanut allergy, if you're going to do OIT, it may be best to do it with your child when they are younger.

Katie Ferraro (10m 20s):

So for OIT, besides peanut allergy, any other types of food allergy that we can treat with OIT.

Ron Sunog (10m 26s):

So interesting, they're looking at other foods now, and a recent studies show that hazelnut allergy can also be treated with lit. So they took a group of kids after one year of slowly increasing the amount of hazelnut about half the children could tolerate a single hazelnut like with peanut and any kind of therapy where you're giving a child, something that we know they're allergic to the treatment has risks. More than half of the kids in the study did experience a side effect during treatment. And two of them had severe reactions. Again, this treatment is not widely available this time, but if it becomes available, parents will have to ask themselves a question, is my child at greater risk from the treatment or from a possible accidental ingestion hazelnut.

Ron Sunog (11m 14s):

Again, these treatments are not curative. What they do is they make it possible to have a very small accidental ingestion and not have a severe reaction.

Katie Ferraro (11m 24s):

So just curious as a pediatrician, healthcare, professional author, what are your personal opinions on the effectiveness of these new treatments for food allergy? Are there better ways to treat or maybe better ways to prevent food allergies in children? Because this is like one of those things, like, it sounds really sexy and promising, but like, will it play out and really be effective for the general population?

Ron Sunog (11m 43s):

Yeah. So, you know, hopefully as these treatments get better, they'll offer more hope and promise, but the limitations of the treatment, the risks of the treatment and the fact that they're not a cure tells us once again, nothing's better than prevention and yes, as a pediatrician, I'm most interested in prevention, so great that we're doing these studies great that they may be useful and more useful with time to children who are already allergic. But if you have an infant take advantage of early intervention or early introduction of peanut and other foods to reduce their risk of developing allergies to food,

Katie Ferraro (12m 23s):

And then as far as prevention goes, can you just remind us? Cause like there are risk factors for food allergy, which you control, and then there's ones that you have no control over. So what can we do to help prevent food allergy that's within our control as parents?

Ron Sunog (12m 36s):

The major thing you can do is feed the foods early. But in addition to that, there was a study in 2020 group of leading allergy researchers. They included Dr. Gideon Lack. He's the lead author on the leap study. I mentioned at the beginning and they published a review that made a very strong case for the theory that the actual root cause the root cause of food allergy is sensitization through the skin and particularly through a damaged and inflamed skin barrier. So this is called the dual allergen hypothesis. And the hypothesis is that your immune system is meant to encounter food proteins, potential allergens through the mouth, through the gut.

Ron Sunog (13m 21s):

And when your immune system encounters these proteins through the skin first that's when you become allergic. Okay. So in addition to starting allergenic foods early, I always tell patients if your infant has damaged skin and that basically means eczema or really any level of dryness at all, that should be treated so that the skin barrier is intact and you prevent sensitization to a food through the skin.

Katie Ferraro (13m 48s):

I feel like compared to here that they hear well, I'm just going to go rub peanut butter all over my baby skin. So could you just remind us why we want to be feeding our babies, peanut butter protein and not like splattering it on their skin?

Ron Sunog (13m 59s):

Yeah. So in another study, March of 2021 and Dr. Gideon Lack, who seems to be involved in so many,

Katie Ferraro (14m 7s):

I mean, Dr. Lack is quite a prolific researcher

Ron Sunog (14m 9s):

he is, and this study showed that the more often parents use moisturizer on their infants, the more often they develop food allergy. So I hope everybody's hearing that, right. I just said, previously, you want to prevent sensitization through the skin by repairing the skin barrier by using moisturizer and potentially other treatments like cortisone creams. And this study showed that the more often parents use moisturizer, the more often they develop food allergies,

Katie Ferraro (14m 40s):

Why I thought the point of the moisturizer is to then help prevent the breakdown in the skin barrier, which in turn breaks down or reduces the risk of food allergy. Is that wrong?

Ron Sunog (14m 48s):

Yeah. So this is the really important point in the study, and this is why I bring it up. And it's the finding they had is just the correlation and correlation is not causation. So I'm going to tell us just a little story to explain that there's a funny old movie and, and your listeners are moms with infants. So probably none of them have heard of it or seen it. Maybe they should. Funny old movie called all of me with Steve Martin and Lily Tomlin. And in that movie, there's a scene where a guru from rural India who lives a completely austere life. He's unfamiliar with even simple modern amenities. He finds himself in a hotel room and he sees a phone in a toilet for the first time in his life.

Ron Sunog (15m 30s):

And he has no idea what these things are. He goes into the bathroom and he starts to play with the toilet handle and he flushes the toilet and immediately after that, the phone rings. And so he flushes it again and the phone rings again. And he does that several times. And he's convinced that flushing, the toilet pressing that handle makes the phone ring. Now, anybody hearing this on this podcast, it's completely obvious that flushing the toilet is not what made the phone ring again. That's just a correlation and correlation is not causation, but when we hear scientific studies, that is not so obvious to us and to be fair without good analysis by really good experts, it's not so obvious even to train medical professionals.

Ron Sunog (16m 14s):

So now we understand correlation is not causation. So why did using moisturizer on infants in this particular study? Why was that correlated with a higher rate of developing food allergy? Well, some analysis showed that first of all, children whose parents use more moisturizer on them are likely to have worse eczema. And we know kids with worse eczema are more likely to develop food allergy. So to some extent you just seeing something that's expected, it's not because of the moisturizer. It's because of the infants who are getting all this additional moisturizers. So that's one reason in addition to that, not all moisturizers are the same.

Ron Sunog (16m 57s):

So certain oils while perfectly okay to use on non damaged skin can actually increase the risk of allergens, penetrating the skin, going back a few more years, there were studies that looked at common skin moisturizers called tri limpid creams. That's a cream that has components that are similar to the skin's natural barrier. And those studies found that it decreased the eczema and decrease the risk of developing food allergy. More recently, there was a pilot study. That's a study with a very small number of participants that actually showed that certain skin creams keep skin hydrated better than others. And that's one of the key points of repairing damaged skin, keeping the skin hydrated.

Ron Sunog (17m 39s):

And lastly, in terms of more, moisturization leading to more food allergies it's possible. And even likely that if you food allergens on your hands, when you touch your baby's skin, you're actually putting those allergens right on the damaged skin, along with the moisturizer you're using, but that could lead to more food allergy. So although the study did show that more moisturizer correlated with more food allergy, the conclusion that seemed obvious don't use moisturizer is absolutely wrong. What we actually learned from this study is use the right cream on your baby and wash your hands first.

Ron Sunog (18m 19s):

And so no, don't go rubbing peanut butter all over your baby.

Katie Ferraro (18m 23s):

All right, Dr. Sunog. Sometimes parents will ask us, okay, is there anything I can do when I'm pregnant to help prevent food allergy? Any, it's kind of hard question to answer. Cause you know, there's a lot of things that are going on when you're pregnant, but is there any links or research about maternal diet and risk of food allergy and infancy?

Ron Sunog (18m 41s):

Yeah, there are in may of 2021, a group of allergy experts did a big review looking at everything we know about food allergy prevention and the authors of this study included Carina Venter. And Dr. Ruchi Gupta both again, friends of yours and friends of the podcast and also Dr. Lee young, who I just mentioned, and of course, who else, Dr. Gideon Lack. And they emphasized that the things you can do to prevent allergy include keeping your baby skin healthy. And Katie you're going to like this one, eat a diverse diet during pregnancy and feed your baby a diverse diet, including the allergens. Okay. So this is somewhat repetitive, but again, they did a review and looked at all the information we have and found that there's just a lot of strong evidence for this.

Ron Sunog (19m 30s):

They also found that a healthy microbiome that's having the right friendly germs on the skin and in the digestive tract seem to play a role. But on that front, we need a lot more study to know really how we recommend that to families. In addition to that big review study and another study from 2021 on maternal diet showed that drinking milk during pregnancy and while breastfeeding correlated with a lower incidence of all kinds of food allergy, not just milk in the children of these mothers. Again, this is correlation. We don't know the actual reason that works. The researchers have a theory that it might be related to the kind of fat in the mother's diet and how this might affect the child's immune system.

Katie Ferraro (20m 15s):

Dr. Sunog whenever we're working with parents and they say, okay, well, how much of the allergenic food should we feed? And how often? Cause we're always advising them. Listen, the guidance is almost as we say, like intentionally ambiguous, but we need to introduce these allergenic foods early and often. And then, then we both have issues with some of the supplement products that are out there that claim that they have, you know, the magic amount of allergenic food, a mixed with B that you would sprinkle into your baby's bottle. And is that knowledge known about how much or the early and often messaging anything that's kind of maybe shoring up these ambiguous recommendations?

Ron Sunog (20m 50s):

Yeah. So what we don't know is exact precise amounts that an infant should eat that will definitely decrease their risk of developing food allergy. What we do know is it needs to be, let us call it real food amounts and what a lot of those supplements have is absolutely minuscule amounts because they're putting proteins from eight or 10 or 14 foods into one little powder packet. And the amount of protein of each of those foods is absolutely minuscule. Might that work. I can't sit here and tell you it can't possibly work, but we have absolutely no evidence for that.

Ron Sunog (21m 30s):

And I don't have a lot of confidence in it

Katie Ferraro (21m 33s):

And you make a good point too, sorry to interrupt. But that all the papers that have been researched that have been done on the protective effects of introducing allergenic foods against food allergy have been done using food, not very, very tiny amounts of supplements.

Ron Sunog (21m 47s):

That's exactly right. And exactly in line with that, there was a study last year that looked at children who ate egg before one year of age so early and how they had less egg allergy than those who started later. Now, simply that fact is not new, but what was new here is they looked at how much egg these children ate. And so they found that children who had egg allergy at six years of age, they looked back to see how much egg they'd eaten. And they had eaten about the equivalent of one egg every 10 weeks during infancy, the children at age six, who did not have egg allergy had been eating about an egg a week during infancy.

Ron Sunog (22m 31s):

So the real point here is early and often includes often. So how do you do that in practice? I'd simply tell my parents, frankly, would you tell yours, make it part of a regular healthy diet,

Katie Ferraro (22m 44s):

But don't feed the same food every day. Cause parents discovered actually like, oh, this is easy. It's the only iron food I'm ever going to feed the baby. So we don't do the same food every single day, but you do want to cycle them back in and to tack on to what you said. I just want to remind parents that's a lot of them will find the leap study and read it, which is great. And they'll see, okay. In the leap study, the intervention included six grams of peanut protein per week. So they're like, okay, fine. Then I'm going to find a supplement program that gives my baby exactly six grams of peanut protein per week. But as you always remind us, there's nothing to say that had the researchers done any more or any less number of grams of peanut protein per week, that it would have been any more or any less effective at preventing food allergy. That just happened to be the protocol in that one particular study. Right?

Ron Sunog (23m 23s):

That's correct. I would, again, caution against using minuscule powder amounts, which are micrograms

Katie Ferraro (23m 31s):

And expensive

Ron Sunog (23m 32s):

And expensive, and also cautioned against the idea that you need to use it. You need to feed some food every single day. Keep in mind the study. I just mentioned, we were talking about an egg a week being very effective. That's a real amount of protein. That's a real food. That's the way to do it. There's a big, happy middle between microgram amounts in powder and the, yeah. You have to eat something every single day.

Katie Ferraro (23m 60s):

Yeah. But the parents really, I mean, I understand a lot of parents, even like I know a number of pediatricians who recommend some of those programs and I'm like, well a or if you're an affiliate for them, you should be disclosing that. But on top of that, well, well peers just want an easy solution. And in my answers like, well, feeding children, real food is not easy, but it is something you have to do for the next 17 and a half years of that now baby's life. So it makes sense to teach babies how to eat food versions of these foods. And that's obviously all the work that I'm doing and you and I have done together in the allergenic world. But what do you say to parents who are just uneasy about the idea of introducing allergenic foods to their babies? And they're going to lean into these expensive supplement models or just even worse, not do them at all because they're scared of them.

Ron Sunog (24m 44s):

I would say that the studies show that it's the food that works. The studies do not show that these supplements work. And it's also really important to remember that even before we knew that starting these foods early can prevent food allergy. We knew that starting these foods early was safe.

Katie Ferraro (25m 5s):

And I think it's important to remind parents that the only risk factor for food allergy that you control is your ability to introduce allergenic foods during that protective window. And we have fairly good research to indicate that that protective window closes at around 11 months of age. So you have from the time your baby turns six months of age, when the baby is safe to be eating anything except breast milk or formula until 11 months of age, to introduce at least the nine allergenic foods early and often on lots of different foods do because the allergenic foods are just nine foods, but you have a lot of time. You don't have to do it every day, but our recommendation is if you do at least one a week and do it early and often you can get all those allergenic foods in during that important, critical window where you still can prevent food allergy.

Ron Sunog (25m 49s):

That's exactly right. And, and I'm just go ahead and mention another study looked at more than 2000 infants because you, you mentioned introducing the nine allergenic foods and of course your program talks about introducing a lot more foods and studies are showing that simply a diverse diet. So simply introducing more foods, not just the allergenic foods reduces the risk of allergy. So in this particular study, this was published just a few months ago. And again, 2000 infants, those who eat more food groups by six months and 12 months of age had less allergy, including a runny nose, cough, eczema and food allergy, all those allergies at one to two years of age, really important here too speaks to exactly one of the things you said just a couple of minutes ago.

Ron Sunog (26m 38s):

So children who started solids before four months of age were excluded from this study. So you do not need to get the idea that you need to get like a headstart before a child is ready to eat solids

Katie Ferraro (26m 51s):

'cause, that's important. It's definitely not been born out in the research that starting any earlier is more protective. And again, we want to reiterate from the leap study for children who are at high risk for peanut allergy, that is only children who already have an established egg allergy and or severe eczema. And we're not talking about the normal eczema that all your babies have, egg allergy and or severe eczema. Those are the only two high risk criteria for peanut allergy. There's is the only babies who should even consider doing peanut before six months of age. And then you really want to do that under the guidance of your pediatrician, or you're already working with an allergist in many cases, to make sure that you're doing it safely, the rest of you, which is almost literally, so the vast majority of other babies, there's no benefit to starting before six months of age.

Katie Ferraro (27m 33s):

And at six months of age, babies can start eating real food. So you don't need any of these expensive subscription supplement models. Your baby can learn to eat real food. They have to learn how to eat real food. And you can use food as a way to introduce the allergenic proteins to your baby at six months of age, between six and 11 months of age and get that protective benefit by using real food.

Ron Sunog (27m 54s):

And let me just add to what you just said. So you're exactly right about which infants are high risk, but risk just means risk. It does not mean that they are already peanut allergic. Correct. So it's recommended that you speak to your pediatrician about being tested for peanut allergy. If you have a high risk infant to see if it is safe for you to just go ahead and start peanut and 90% of the high-risk infants. Again, those with severe eczema or egg allergy will be safety peanut. Now the other 10% may react. And this is a more involved discussion. You should talk to your pediatrician about what to do, but just because your infant is high risk, that's a reason to be cautious, not a reason not to introduce the food early.

Katie Ferraro (28m 41s):

And for those of you who are like, well, this sounds scary. I'll just go test for every single allergen under the sun. Don't do it. It's important to note that 50% of positive results in food allergy tests are false positive. So again, we had Dr. Stukus on, if you are interested in this topic, episode 125 is why are Stukus, false positive results in food allergy testing. So common with David Stukus, MD. And that's an important conversation because blanket testing and pediatricians myth managing food allergy testing is a huge problem. You should never test your baby for an hour genic food that the baby has not yet reacted to unless your baby already has egg allergy or severe eczema. At which point we're concerned about peanut allergy risk.

Ron Sunog (29m 24s):

Yes, that's exactly right. That's a great episode with Dr. Stukus. I enjoyed myself. And since we're talking about peanut, let's talk a little bit about if you don't mind another, some new information about how has early introduction actually changed things. So we've had enough time now to see some results in that a very recent study looked at the rates of food allergy anaphylaxis at three specific periods of time in Australia. So the three periods they looked at is the time when doctors used to advise parents to keep the big a foods from their infants. Then there was that period of time when they said, well, you don't have to keep these foods away from infants. You can give it to them if you want, but it's not necessary or important.

Ron Sunog (30m 8s):

And then finally more recently when physicians and other experts started to advise parents to feed these foods during infancy, the bad news is that the rate of food allergy actually is still going up. But the good news is the rate is going up much more slowly since the recommendation of early introduction. To be fair, I have to point out again, this correlation doesn't prove cause and effect, but with everything else we know about early introduction at this point, it supports early introduction. Here's another really important finding from that study. The rate of anaphylaxis in children under the age of one year actually went up faster. That can sound a little frightening, but it actually makes sense previously when infants weren't eating certain foods, because parents were delaying the introduction of those foods to infants, they couldn't react to it.

Ron Sunog (30m 59s):

You can't react to something you're not eating. Okay. Here's the thing to remember about why that really isn't as scary as it sounds early, introduction decreases your child's overall risk of developing food allergy also. An anaphalactic reaction during infancy is less likely to be severe than if it occurs when your child is older. So remember to start early, the younger your infant is when they start a food, the less likely that they are already allergic, but do not start before they are actually ready for solids.

Katie Ferraro (31m 34s):

All right, Dr. Sunog, all of this is predicated around with pediatrician, actually talking to parents about this. If they don't hear it from other credentialed healthcare professionals like you and me, tell us about your book, if you can, because I know it's something that's of interest to both pediatricians and to parents who maybe are confused by these messages or are aren't clear on exactly why we use food to introduce allergenic foods to babies,

Ron Sunog (31m 57s):

Right? So after the leap study in 2015, I got really interested in early introduction to foods to prevent allergy. The leap study again was just about peanut, but I did a lot of research of previous studies and articles and discovered that although there was nothing that rose to the level of leap in terms of the strength of the evidence, there was a lot of reasonably good evidence that early introduction of foods was helpful. Based on that, I went ahead and wrote a book a few years ago, Eat The Eight, and I've been trying to encourage the parents of my practice to adopt that since that time.

Ron Sunog (32m 40s):

And unfortunately like most things. And I addressed this in the book to some extent, it's understandable, new ideas, changing how we do things not easy, and it's been slower to catch on. Then we would hope, but it is catching on.

Katie Ferraro (32m 56s):

It's called job security. It's slow to catch on, but they need us to keep reminding them of the message because literally routinely I'll have parents who are like, my pediatrician says don't introduce egg until after one. I was like, well, that's 20 year old advice. So maybe you should consider getting a new pediatrician because there unfortunately still are practitioners who are not getting the message or recognizing, okay, the guidelines have changed dramatically. This is all evidence-based and we not, we don't wait. Withholding is actually increasing the risk of food allergy, not the opposite.

Ron Sunog (33m 26s):

That's exactly right.

Katie Ferraro (33m 27s):

All right, Dr. Sunog thank you so much for joining us today. I really appreciate this Roundup. I feel like you're sitting there in your office, like reading all of these dense articles and then just summarizing them for us. So thanks for saving us a lot of time, but also helping to get many of these messages and this research clear so that parents can utilize it and put it into practice inside of their own families.

Ron Sunog (33m 44s):

Pleasure to do it.

Katie Ferraro (33m 45s):

Okay. Would have taken me like weeks to find those articles, read those articles that I probably would have like have to ask him what most of the data and the mean anyway. So I really appreciate Dr. Sunog summarizing some of the things that are new in food allergy. And then we were talking after the interview too. Like sometimes it's really frustrating because like you think you have something nailed down and then something changes and kind of joke around like, oh, that's job security. Like I know for me as a dietician, like one week eggs are bed. Next week eggs are good. It's like, Hey, no one knows about eggs. Why they need dietitians to help interpret the research. I'm really glad for Dr. Sunog to interpret the research for us in food allergy, because stuff is changing. It's actually, you might not think this, but it's a very exciting time to be introducing solid foods to your babies because we do have this real, an emerging body of evidence that supports the use of food and the introduction of food early and often to prevent food allergy.

Katie Ferraro (34m 34s):

And so I think of it as my job to help you guys know how to make those foods safe, because you certainly can use food to prevent food allergy. So I'll go ahead and link to all of the research articles that Dr. Sunog mentioned today, as well as some of his other resources, he's been on the podcast a number of times, and we also mentioned some other food allergy related episodes. So if you want to like go down your own rabbit hole of food, allergy prevention research, I'll put that all on the show notes for you guys, which you can find at blwpodcast.com/ 2 1 6. Thanks so much for listening. Bye now.