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New Studies Shed Light On Children And Allergies

New Studies Shed Light On Children And Allergies
New Studies Shed Light On Children And Allergies
New Studies Shed Light On Children And Allergies Kevin Tse allergist, Kaiser Permanente

THIS IS KPBS MIDDAY EDITION , I MAUREEN CAVANAUGH. TWO RECENT STUDIES ON ALLERGIES SEEM TO HAVE CONFIRMED WHAT SOME DOCTORS HAVE THOUGHT FOR YEARS. WE MAYBE TOO CLEAN AND CAREFUL FOR OUR IMMUNE SYSTEM'S OWN GOOD. ONE STUDY FOUND FEWER CHILDREN DEVELOPED ALLERGIES WHEN THEIR DISHES WERE HAND WASHED INSTEAD OF WASHED IN A DISHWASHER. AND ANOTHER STUDY FOUND THAT PEANUT ALLERGIES WERE LESS COMMON IN CHILDREN WHO WERE FED FOODS WITH PEANUTS AS BABIES. JOINING ME TO EXPLAIN MORE ABOUT THIS RESEARCH AND WHAT IT MEANS FOR PARENTS IS DR. KEVIN SAY. HE IS A BOARD-CERTIFIED ALLERGIST AT KAISER PERMANENTE IN SAN DIEGO. KEVIN, WELCOME TO THE PROGRAM. THANK YOU, MAUREEN. THE STUDY THAT IS THE MOST CONVINCING TO DOCTORS I BELIEVE SEEMS TO BE THE PEANUT ALLERGIES STUDY WHERE PARENTS BED CHILDREN WITH PEANUT PRODUCTS WHILE BABIES. WHAT DID THAT FIND ? THAT STUDY TOOK A GROUP OF AT RISK CHILDREN FOR ALLERGIES, ONCE IDENTIFIED THAT HAD EITHER ECZEMA, A PART OF WHAT WE CONSIDER AND ATOPIC OF ALLERGY AND ASTHMA. AN EGG ALLERGIES, THOSE AT RISK OF DEVELOPING PEANUT ALLERGIES AND TESTED THEM TO MAKE SURE THEY WEREN'T PEEL IT -- PEANUT ALLERGIC FIRST AND PREVENT THEM FROM DEVELOPING PEANUT ALLERGY. FEEDING THEM VERY SOMOZA PEANUTS FOR THE NEXT FIVE YEARS. AND FOLLOWING THEM PROSPECTIVELY. A GROUP RECEIVED PEANUTS ON A REGULAR BASIS AND THERE WAS A GROUP THAT WAS WITHHELD PEANUTS AND THE GROUP THAT RECEIVED THE PEANUTS HAD FAR FEWER ALLERGIES AT THE END OF THE 60 MONTH TRIAL. THAN THE GROUP THAT HAD THE PEANUTS WITH HELP. THAT IS SOMETHING WE PREDICTED WAS GOING TO HAPPEN PROBABLY FOR THE LAST 10 YEARS OR SO. WE THOUGHT THAT WAS GOING TO BE THE CASE AND THIS IS THE STUDY THAT SHOWED US THAT. HOW COULD EARLY EXPOSURE WAS THAN THAT CHANCES OF DEVELOPING AN INJURED -- ALLERGY LIKE THAT ? WITHIN THE BODY IS ABLE TO TOLERATE THINGS THAT IT TAKES ORALLY. THIS IS SOMETHING WE'VE KNOWN FOR ALL ALONG WHILE. IT'S DIFFICULT TO REPRODUCE AND HUMANS. WE HAVE BEEN ABLE TO FIND THEM AND MOUSE IN ANIMAL STUDIES. THE THOUGHT IS THE EARLY INTRODUCTION OF A FOOD ORALLY ALLOWS THE BODY TO HAVE TIME TO ADJUST AND TOLERATE THE FOOD THAT YOU ARE EATING. IF YOU INTRODUCE THE FOOD ANOTHER WAY, THERE HAVE BEEN OTHER STUDIES BY THE SAME GROUP THAT SUGGEST THAT PREVALENCE OF PEANUTS IN THE HOME POTENTIALLY EXPOSURE THROUGH THE SKIN IF THEY ARE EATING PIZZA BUTTER AND KISSING THE KIDS, AND EXPOSURE TO THE SKIN MAYBE SENSITIZING. YOU WANT TO INTRODUCE THE FOOD ORALLY BEFORE THE KID HAS A CHANCE TO BE EXPOSED TO IT THROUGH THE SKIN OR OTHER WAYS. THROUGH THE SKIN THE BODY TENDS TO REACT TO THE MOUTH THE BODY TENDS TO TOLERATE. THAT IS FASCINATING. OURO MINAS ABOUT HOW MANY KIDS HAVE PEANUT ALLERGIES NOW. HOW SERIOUS THEY CAN BE ? THE RATE OF PEANUT ALLERGIES IS INCREASED ABOUT -- BY DOUBLE. 3 TO 4% RATE OF PEOPLE WHO HAVE -- ALL KIDS. PRETTY SIGNIFICANT. ANY DISEASE THAT IS A 1% PREVALENCE OR HIGHER IS A MAJOR DISEASE AND THIS IS DOUBLING QUICKLY. THE REASON WHY WE SUSPECTED THERE MAY BE ENVIRONMENTAL OR BEHAVIORAL MODIFICATIONS THAT ARE AFFECTING THE RATE OF INCREASE MORE SO THAN GENETICS IS BECAUSE OF THE RAPIDITY WITH WHICH THIS IS HAPPENING. IF IT WAS A GENETIC ISSUE, YOU WOULD EXPECT MULTIPLE GENERATIONS TO GO BY WITH INCREMENTAL CHANGES OF THE TIME. THIS HAS BEEN TOO FAST IT SO WE THINK THERE MUST BE SOMETHING WE ARE DOING TO OUR KIDS THAT IS THE DISPOSING THEM TO PEANUT ALLERGIES AND WE THINK WE FOUND A MISSING LINK. IT IS THE WITHHOLDING OF CERTAIN SUBSTANCES IN THIS CASE PEANUTS EARLY ON IN LIFE AND NOT ALLOWING THE BODY TO TOLERATE THE THINGS THAT IS SUPPOSED TO TOLERATE. FOR KIDS WHO HAVE PEANUT ALLERGIES, THIS IS NOTHING TO FOOL AROUND WITH IT CAN BE SERIOUS. ABSOLUTELY. THIS IS WHY THERE'S SUCH A BIG HEALTH PUSH TO IDENTIFY THE SKIDS AND EDUCATE THESE KIDS AND PARENTS AND TO MAKE SURE SCHOOL SYSTEMS ANOTHER PLACES WHERE KIDS GATHER ARE VERY MUCH AWARE OF THE DANGERS OF PEANUT ALLERGIES FOR CHILDREN WHO HAVE ALREADY BEEN DIAGNOSED WITH PEANUT ALLERGY, THE STUDY IS NOT FOR THEM. ALTHOUGH THERE ARE STUDIES ALONG THE HORIZON THAT IN THE NEXT 5-10 YEARS GIVE US HOPE FOR THOSE WHO HAVE DEVELOPING OF ALLERGIES IN A SAFE WAY AND EFFECTIVE WAY. SO DOES THIS STUDY MEAN THAT PARENTS SHOULD INTRODUCE PEANUTS IN SOME FORM TO THEIR YOUNG CHILDREN ? I THINK WHAT THIS TELLS US IS THAT IF THERE IS A CHILD WHO IS AT RISK, IF THEY SEEM TO HAVE SOME SIGNS OF ALLERGY, ECZEMA, ASTHMA, WHEEZING, THINGS LIKE THAT HAYFEVER. OR IF THEY HAVE OTHER KINDS OF FOOD ALLERGIES ARE READY, AND THE STUDY THEY LOOK FOR KIDS THAT HAVE EGG ALLERGY, THEY SHOULD SEE AN ALLERGIST. THE ALLERGIST CAN SAFELY TEST THE CHILDREN FOR EVIDENCE OF PEANUT ALLERGY. IF THEY DON'T HAVE PEANUT ALLERGIES ARE READY, THE STUDY WOULD SUGGEST THAT THOSE KIDS WOULD BE GOOD TO HAVE REGULAR DOSE OF PEANUT ONCE IN A WHILE. FOR THE NEXT FOUR OR FIVE YEARS AND THAT THEY HAVE MUCH LESS CHANCE OF DEVELOPING ALLERGIES IN THAT TIME PERIOD IF THEY ARE GIVEN PEANUT. I WOULD SAY THE EARLY INTRODUCTION WOULD BE GOOD FOR THOSE KIDS WHO ARE AT RISK. FOR THE KIDS THAT ARE NOT GOING TO DEVELOP ALLERGIES ANYWAY, I WOULD SAY THIS DOESN'T MATTER. IF GENETICALLY YOU ARE NOT PREDISPOSED TO HAVING PEANUT ALLERGY WE TAKE IT OR LEAVE IT AND IT IS A MAKE A DIFFERENCE, FOR THE KIDS THAT ARE READY HAVE PEANUT ALLERGIES, THIS WOULD BE DANGEROUS. EXACTLY. SO STAY AWAY FROM PEANUTS IF YOU ARE ALREADY'S ALLERGIC TO THEM. HAND WASHED THIS STUDY IS INTERESTING. TELLS ABOUT THAT. THE HAND WASHED DISHES STUDY IS ONE OF A LONG LINE OF STUDIES PUT OUT IN THE LAST 20 OR 30 YEARS THAT ARE OBSERVATIONAL BASED ON SURVEYS ASKING PEOPLE WHAT THEY DO AND THEIR LIFESTYLES AND THE RISK OF HAVING ALLERGIES. THESE OBSERVATIONAL STUDIES HAVE POINTED IN DIRECTION THAT THE MICROBIAL EXPOSURE OR PATHOGENIC EXPOSURE WE HAVE EARLY IN LIFE IS ANOTHER MEANS OF EDUCATING OUR IMMUNE SYSTEM. AGAIN UP WITH ANOTHER FEATHER IN THE CAP OF THE IDEA THAT YOUR IMMUNE SYSTEM IS CHANGEABLE AND TEACHABLE AND THAT IT DOESN'T NEED TO GO THROUGH SOME RIGOROUS TRAINING EARLY ON IN LIFE. SO THE FUNCTION PROPERLY. THE IDEA IS IF YOU WASHED YOUR DITCHES -- DISHES IN THE DISHWASHER'S TWO CEMETERIES IN YOUR BODY IS NOT GETTING INTRODUCTION OF MICROBES, WHETHER PATHOGENIC OR NONPATHOGENIC. AND WITHOUT THAT INTRODUCTION OR EDUCATION, IMMUNE SYSTEM IS IN AN IMMATURE STATE DOING ITS OWN THING AND NOT ALWAYS DOING THE RIGHT THING. IT MAY CHOOSE TO GO IN AND ALLERGIC DIRECTION WHERE IF YOU HAD TAUGHT AT WHAT IS A REAL BACTERIA VIRUS PATHOGEN AND WHAT IS NOT, THEN IT MAY BE SMARTER THAN EXTREMITIES OF PEANUT AND KNOWS THIS IS NOT SOMETHING THAT IT SHOULD GO GETS. I BELIEVE THIS IS REFERRED TO AS THE HYGIENE HYPOTHESIS. THAT'S THE IDEA AS YOU SAY THAT IF YOU DON'T INTRODUCE SOME THINGS THAT CAN MAKE YOUR IMMUNE SYSTEM RESPONSE, IT SITS AROUND WITH NOTHING TO DO AND STARTS RESPONDING TO THE WRONG THINGS. EXACTLY. DID THE HYGIENE HYPOTHESIS COME ABOUT BECAUSE ALLERGIES ARE INCREASING IN COUNTRIES THAT HAVE A HIGHER DEGREE OF HYGIENE ? YES. SO THE OBSERVATION INITIALLY MADE 20 OR 30 YEARS AGO WAS THAT DEVELOPED NATIONS ACTUALLY HAD A HIGHER RATE OF INCREASE IN ALLERGIES. ASTHMA, HAY FEVER, AND FOOD ALLERGIES. AND THE PEANUT ONE IN PARTICULAR WE MENTIONED. THE LESSER DEVELOPED COUNTRIES, THEY HAD MORE INFECTIONS, DYING OF OTHER KINDS OF DISEASES. THEY DIDN'T SEEM TO HAVE AS MANY ALLERGIES. SOME OF THAT IS CHANGING AS SOME SANITARY MEASURES WE HAVE INTRODUCED IN OUR COUNTRY AND OTHER DEVELOPED NATIONS HASN'T MADE IT TO AFRICA WHICH IS GOOD FOR THEM. IT'S GOOD THEY ARE NOT HAVING AS MUCH DISEASE. BUT THE RATE OF PEANUT ALLERGIES GOING UP AND AFRICA AND SOUTH AMERICA SO YOU ARE TRADING ONE FOR THE OTHER. I THINK AS OUT -- AS WE LEARN MORE AND THE ALLERGY FIELD IS EXCITING. WE MAY BE ABLE TO MODIFY SOME THINGS WITHOUT REDUCING THE BENEFITS OF HYGIENE ALSO. SO DO YOU EVER TELL FAMILIES MAY BE DON'T USE THE DISHWASHER ALL THE TIME COURSE MAYBE THINK ABOUT HANDWASHING SOME OF THOSE DISHES FOR YOUR KIDS ? WE HAVE YET TO MAKE RECOMMENDATIONS LIKE THAT. THE REASON IS BECAUSE MOST STUDIES THAT HAVE BEEN PUT ON THE HYGIENE HYPOTHESIS ARE OBSERVATIONAL. THEY BASICALLY ASKED THE QUESTION TO PARENTS, HOW DO YOU WASH DISHES? AND YOUR KIDS WHEEZE OR HAVE ECZEMA. ALL THOSE STUDIES ARE USEFUL IN TERMS OF GENERATING HYPOTHESES, THEY ARE NOT AS RIGOROUS AS THE PEANUT STUDY WHERE YOU HAD A GROUP OF KIDS WERE UK PIECE IS TWO AND A GROUP THAT DID NOT SEE WHAT HAPPENED. THE OBSERVATIONAL STUDIES ARE GOOD FOR POINTING IN THE RIGHT DIRECTION AND IF THERE ARE SEVERAL THAT SEVERAL THAT POINT IN THE SAME DIRECTION AND MAKES YOU THINK THERE IS SOME TRUTH THERE. BUT WE SHY AWAY FROM MAKING HARD LINED RECOMMENDATIONS FROM OBSERVATIONAL STUDIES. SOME OF THOSE FINDINGS ARE SOMETIMES EXPERIENCE AND MAY OR MAY NOT BE RELEVANT OR EXPLAINABLE. SOME DON'T MAKE SENSE. SOME DON'T HAVE CAUSE-AND-EFFECT. EXACTLY JUST AN OBSERVATION. DOES THE EXPOSURE FACTOR, WITH THAT EVER WORKED FOR AN ALLERGY THAT A PERSON ALREADY HAS? LET'S SAY SOMEBODY'S ALLERGIC TO DOGS AND CATS ? INTERESTING THAT YOU MENTION THAT. FOR 100 YEARS BEFORE WE'VE DONE STUDIES ON THESE THINGS, ALLERGIST TO HAVE BEEN PROVIDING ALLERGY SHOTS FOR THE PATIENTS. WHETHER YOU'RE FAMILIAR OR NOT, I WILL GO OVER IT. YOU INJECT TINY AMOUNTS OF THE ALLERGEN THAT YOU ARE ALLERGIC TO INTO YOUR BODY. SUBCUTANEOUSLY. EVERY WEEK YOU GO BACK TO THE ALLERGIST AND INCREASE THE DOSE A LITTLE BIT. THE THOUGHT IS THAT YOU CAN INDUCE A STATE OF TOLERANCE BY LOW-LEVEL CONSTANT EXPOSURE TO AN ALLERGEN. THIS IS NOT THE SAFEST THING OF THE WORLD, NOT TO BE DONE AT HOME FOR EXAMPLE. DON'T TRY TO HOME. IF YOU INJECT TOO MUCH IS YOUR BODY YOU CAN HAVE ANAPHYLACTIC LIFE-THREATENING REACTION. IT SHOULD ALWAYS BE DONE IN AN ALLERGIES OFFICE UNDER SUPERVISION OF AN ALLERGIST AND NURSE WITH EMERGENCY MEDICINE A BILL. RATE OF REACTION IS LOW. IN TERMS OF LIFE-THREATENING REACTIONS BUT IT'S NOT THE FAITH ON HEARD OF SO WE TALK TO PATIENTS ABOUT RISKS AND BENEFITS. THIS IS BEEN KNOWN FOR 100 YEARS INNUMERABLE FOR SAFETY PANELS IN RESEARCH STUDIES AND BIG UNIVERSITIES. THEY HAVE DONE THIS FOR 100 YEARS. WE KNOW IT WORKS AND THE RESEARCH IS CATCHING UP ON HOW IT WORKS. WHEN IT COMES TO SAN DIEGO AND THE ALLERGIES PEOPLE HAVE GENERALLY HERE, WHERE DO WE COMPARED TO THE REST OF THE COUNTRY? I KNOW BECAUSE WE DON'T HAVE A WINTER, WE DON'T HAVE A SUCCESSION IN THE AMOUNT OF THINGS GROWING IN THE POLLEN IN THE AIR, WE HAVE YEAR-ROUND ALLERGIES DON'T WE ? IS COMMON TO SAN DIEGO TO THAT PERENNIAL ALLERGIES EVEN THOUGH THE ALLERGENS THAT PEOPLE ARE ALLERGIC TO MAYBE WHAT WE CALL SEASONAL ALLERGIES AND OTHER PARTS OF THE COUNTRY. THIS TREE SEASON IS IN THE SPRING, GRASS IN THE SUMMER, AND WE IN THE FALL. SO YOU WOULD ARGUE SOMEONE SHOULD HAVE SEASONAL INSTANCE BUT IN SAN DIEGO THERE IS SOMETHING BLOOMING. YOU END UP WITH PERENNIAL ALLERGIES EVEN THOUGH THE ALLERGENS YOU ARE ALLERGIC TO MAYBE SEASONAL NATURE. AND WHAT KINDS OF ALLERGIES BESIDES POLLEN DO YOU SEE MOST HERE ? WE SEE A LOT OF DUST MITE ALLERGY. THAT TO BE CONFUSED WITH US. PEOPLE GET ANXIOUS ABOUT DUSTING AND CLEANING THEIR HOUSE. DUST MITES ARE SPECIFIC MICROSCOPIC ORGANISMS. THEY LOOK LIKE FLEAS BUT YOU CANNOT SEE THEM. THEY'RE NOT DANGEROUS THEY DON'T BITE A CRAWLING TO YOU UNLESS YOU'RE ALLERGIC. IF YOU ARE ALLERGIC, WHEN THEY PUT, YOU BREATHE IN THEIR POOP. AND YOU HAVE ITCHY, WATERY EYES. SOMETIMES ASTHMA SYSTEMS -- SYMPTOMS. IT'S COMMON IN SAN DIEGO BECAUSE THEY LIKE TEMPERATE COUNT -- CLIMATES LIKE WE DO BEING NEAR THE BEACH AND OCEAN WHERE HUMIDITY IS 50% OR HIGHER AND NOT CHANGE IN TEMPERATURE. THE OPPOSITE WOULD BE COLORADO WHERE YOU GO TO THE MODERATE -- MOUNDS WHERE IT'S COLD. THEY ARE NOT THERE. IN SAN DIEGO THEY LOVE IT JUST AS MUCH AS WE DO AND WHERE PEOPLE LIKE TO BE THERE LIKE TO BE AS WELL. WE DO KNOW THAT IF YOU SNEEZE A LOT WHILE YOU WERE ASLEEP OR IN BETTER SOMETHING ? EXACTLY. ONE OF THE TELLTALE HISTORICAL FINDS WE TALK TO PEOPLE AND GAIN THEIR MEDICAL HISTORY, WE ASK IF THEY HAVE SYMPTOMS ESPECIALLY FIRST THING IN THE MORNING WHEN THEY WAKE UP ABOUT A BED. THE FIRST THING IN THE MORNING WHEN THEY WAKE UP IS USUALLY A GOOD INDICATION THAT SOMETHING IN THE BED IS CAUSING THE PROBLEM AND SADLY OR FUNNY THAT THE DUST MITES LIKE TO LIVE IN YOUR BED WITH YOU BECAUSE THAT IS WHERE A LOT OF YOUR DEAD SKIN CELLS AND UP AND THAT'S WHAT THEY EAT. YOU ARE MAKING MY DAY. [ LAUGHTER ] DO THESE RECENT STUDIES, THE ONES WE WERE TALKING ABOUT, THE PEANUT ALLERGY STUDY, DO THEY POINT TO A NEW DIRECTION PERHAPS IN TREATING ALLERGIES ? YES. I THINK THEY DO. THE HYGIENE HYPOTHESIS AND THESE NEW PEANUT STUDIES ARE SUGGESTING THAT ENVIRONMENT PLAYS A ROLE. THAT THE GENETIC STRUCTURE WHAT ARE THE MAJOR FACTOR. BUT FOR THOSE THAT ARE BORDERLINE, THOSE THAT CAN FLIP EITHER DIRECTION, IT WOULD BE NICE TO SYSTEMATICALLY COME UP WITH A WAY TO TRAIN THEIR IMMUNE SYSTEM TO IGNORE OF THE THINGS IT'S SUPPOSED TO IGNORE AND TO GO AFTER THE THINGS IT WAS SUPPOSED TO GO AFTER. THE HYGIENE HYPOTHESIS SUGGESTS ONE OF THE WAYS THAT WE CAN DO THAT IS TO TRAIN IT BY SHOWING IT MORE -- MICROBES OR PATHOGENS. THE CNET STUDY SUGGESTS EARLY INTRODUCTION OF FOODS THAT MIGHT BE HIGHLY ALLERGIC IS HELPFUL FOR TRAIN COMMUTING THE SYSTEM. WE ARE COMING INTO A NEW ERA OF ALLERGY TREATMENT. LOW-LEVEL EXPOSURES MAY BE HELPFUL. I'VE BEEN SPEAKING WITH KEVIN TSE -- DOCTORATE KEVIN TSE AND ALLERGIST AT KAISER PERMANENTE IN SAN DIEGO. THANK YOU. THANK YOU.

Two recent studies on allergies seem to have confirmed what some doctors have thought for years: We may be a little too clean and controlled for our immune system's own good.

One study found fewer children developed allergies when their dishes were hand-washed instead of washed in a dishwasher.

Another study found that peanut allergies were less common in children who were fed foods with peanuts as babies.

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Kevin Tse, an allergist with Kaiser Permanente in San Diego, said it's an exciting time for his profession.

"It's actually something we predicted would happen," Tse said on KPBS Midday Edition on Tuesday about the peanut allergies study. "This was the study that monumentally showed us that."

Though Tse said Kaiser has been recommending early introduction of highly allergic food for the last 10 years, these studies suggest there is an environmental factor that clinicians can focus on in order to help people.

"The body is able to tolerate things that it takes orally," he said. "The thought is that an early introduction of a food orally allows the body to have time to adjust and tolerate the food."

He said in another few years there may be studies that can help children who have already developed allergies to peanuts.

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"In allergy we can make a difference through education," Tse said. "The studies coming out now have solidified our understanding of some topics that we have been wishy-washy on in recent years."