Peanut allergies are common and can be deadly.

For years, parents were told to avoid feeding them to their kids under three.

But in 2015, that all changed.

Research found that introducing peanuts as one of a baby's first foods actually cut the risk of developing food allergies.

The study, published in the Journal of Paediatrics this October, says this updated guidance has had a big impact.

I asked Josh Koenig, assistant professor in the Department of Medicine at McMaster University, about what the research shows and what it means for people who suffer from food allergies.

Josh, great to have you. How are you doing?

Doing very well. Thanks. Thanks for having me on.

Of course, as someone who researches food allergies, how groundbreaking is it that we are seeing peanut allergies plummeting in children?

I think it's a very promising sign.

As you know, the recommendation shifted to from basically avoiding allergens early on in life to early introduction and early feeding at about 4 to 6 months of age.

And this happened around 2017, which was the first recommendation.

And in 2021, there was a more expansive guideline.

And, you know, this is based on a large study called the LEAP trial, where they found that early introduction had a massive impact on becoming allergic to peanut, very particularly.

And I guess now is probably just around the time that we would be able to see the beginnings of that signal that, you know, we really are impacting the incidence of this of the disease.

And, you know, I won't say that the the data are, you know, as you know, there was like an 81% decrease in sensitisation in the LEAP trial.

That's not what we're seeing yet.

But the difficulty is, you know, that's a very controlled environment.

And in the real world, when you know you're in clinics and there's clinics all across the country, in the US, which is where this research was done, you know, uptake by patients, these are all questions that are, you know, still open, but it's a really positive sign that we are for the first time, I think, in modern history, seeing a decrease in the rate of peanut allergy.

In layman terms, can you help us break down the science here? Why does introducing peanuts and peanut products like peanut butter lead to a drop in allergies?

So for, you know, 98 to 99% of us, peanut isn't a problem.

It's only in a much smaller fraction, 1 to 2% where people become allergic.

What typically happens when we eat a food is we become what we call tolerant to it.

Our immune system works in tandem with our intestine to say, you know, those foods are okay.

We need to take those things in to get nutrients from them.

So we don't want to have a bad reaction.

But in 1 to 2% of people, that doesn't happen.

Instead, they mount an immune response against the allergen, and then that immune response can have, you know, the effects of an allergic reaction when they see the allergen again.

So what we think is going on is that by providing the allergen early on, at that 4 to 6 month time point, you're introducing allergen in a controlled way in a controlled environment such that the immune system hasn't had time to accidentally be exposed to the allergen in a negative way that would make you allergic.

So essentially, we're just taking advantage of what we know about how the immune system works and and using that to tolerize people before they have the opportunity to become allergic.

I can imagine there are people who are looking at this study and are quite excited. They may not be allergic to peanut products, but they might be allergic to something else. And I am curious, is it recommended that we try other allergens like tree nuts or eggs?

So I'm not a clinician, so I can't provide clinical recommendations.

But I can say that, you know, in speaking with my clinical colleagues, there are actually schedules that are recommended for early introduction of essentially all foods because they think that that really is the way that we are going to, you know, decrease the incidence of new peanut allergies.

But as clearly evident by the study, you know, it wasn't an 81% decrease that we saw, you know, in these patients.

It was it was much less than that.

So you know I think that, yeah, you know, following those schedules is a really important piece of this.

But another important thing is that people are still allergic and are becoming allergic.

And we do need to find ways to deal with those people as well.

So I want to clarify, so people can still be allergic to peanut products or other products, even if they've had them at a young age.

So you asked a very good question.

I suppose we don't know exactly the answer to that question.

What tends to happen is that people on that first introduction to the food, their child, have a reaction right away, and then they end up having to go to hospital and then they end up being diagnosed.

So essentially the thought process there is that they've already become allergic.

Before the early introduction.

Peanut allergies has been getting a lot of headlines, not only from this study. And you had mentioned the US. I actually want to pull a clip. This is from Robert F Kennedy Jr, who is, as we know, the US Secretary of Health and Human Services. He gave an interview recently talking about peanut allergies and exposing infants to peanut products. Let's have a listen to that.

To me, that is not a convincing hypothesis because number one, in my own personal experience was my house was so filled with peanut butter and I was eating peanut butter two meals a day.

And my wife, when she was pregnant, was eating peanut butter, and the kids were given peanut butter from as soon as they could chew food.

And yet we still had peanut allergies in our house.

We need to look at aluminum adjuvants and vaccines, which fit the timeline perfectly.

The increase aluminum in the is isn't lockstep, which began in 1989, which is in lockstep with the expansion of peanut allergies.

As a researcher, I have to ask, what is your response listening to that video?

Well, you know, on the one hand, anecdotal, you know, it's really unfortunate that Mr. Kennedy's children have peanut allergies.

But, you know, this study involved tens of thousands of people.

So this isn't a, you know, a much larger aggregate than an anecdotal study.

You know, there really isn't any evidence that was support the notion that alum or aluminum and vaccines is associated with allergy at all.

In fact, you know, there's been multiple what we call systematic reviews, which essentially looking at many different studies that have tried to look at this and essentially there's no connection between vaccination and becoming allergic as far as we can see.

And I suppose I have a small issue with the timeline there, because I'm pretty sure that alum was first introduced in like the 1930s and has been in scenes for the better part of 70 years or something like that.

And, you know, the prevalence increases that he's talking about generally are from the 1990s onward.

So I'm not really I, I'm not sure I buy that as a, as an explanation.

You know, we really don't know why the prevalence of allergy has been on the rise.

And I think that that's a major issue.

And, you know, I don't think, you know, in contrast to what doctor-- I'm sorry, Mr. Kennedy's saying there.

I think, you know, there are many fantastic researchers that are trying to figure this out.

They're trying to figure out what what's been causing the increase in these allergic diseases.

And, you know, really consensus hasn't come about on that.

But I really I don't see any evidence that it would be anything related to vaccination.

And in fact, the opposite, I would say studies are kind of suggesting that, you know, for example, if you get a vaccine, you're less likely to have eczema.

Well, I want to pick up on that in terms of the research that's being done, are we any closer to identifying the what like what causes food allergies?

Well, you know, unfortunately not really.

You know, again, not for lack of trying.

The difficulty with this is people become allergic very, very early.

So think about how we could know this piece of information.

Most times we know that someone's allergic when they've eaten an allergen, had a bad reaction and gone to hospital.

So trying to figure out what happened before that is difficult because we don't know of the, you know, out of 100 people, maybe 1 or 2 might become allergic to peanut, right?

And it's been very difficult for us to pin those down.

And the things that we have found that have made some associations, for example, like peanut oils in baby oil, those things resulted in changes.

So you won't find peanut oil in baby oil anymore because of the possibility that you might be sensitised.

And researchers found that out.

And we enacted changes to avoid that potential issue.

So I think these large epidemiological studies are likely to reveal new things in the future.

But for right now, I think the bigger issue is how can we engage in prevention and then how can we engage when people are allergic to basically stop them from being allergic and give them the opportunity to live a regular life?

All right. I want to change gears a little bit. I want to talk about we're in an age of disinformation and misinformation, particularly when we talk about healthcare. And I want to talk about a Facebook post that claimed there was a vaccine for peanut allergies. And I have to imagine that you and your colleagues who are deep in this research in allergies would probably be one of the first people to know that this was in the works. And so this was not the case. Of course, you and several of your colleagues at McMaster put out a statement to say it wasn't true. But people are curious. Is there a vaccine in the works for peanut allergies?

So, yeah, I mean, I think that that was an unfortunate situation of AI hallucinating based on on some potentially truthful information and then a lot of essentially gibberish.

You know, we are engaged in, in multiple studies testing potential therapeutics in food allergy and, you know, trying to figure out what what options are available and what's going to be effective.

You know, early in development, we do have some studies looking at what would essentially be vaccines.

But, you know, they're nowhere near the point where we're giving them to humans and seeing an impact in the human.

And, you know, it's very unfortunate because I would absolutely love to say to everyone here, you know, I have the solution.

I don't, but I can tell you, I don't sleep very much because I'm on the case and I'm always trying.

I'm always working towards it, and so are all of my colleagues.

So we're we're working really hard towards this.

And, you know, we have multiple lines of inquiry to try and do this, as well as trying to figure out, you know, what causes allergy, what makes allergy persistent in people.

And we're hoping through those research programs, we'll be able to find good interventions that will have an impact on people.

Well, let's stick on that point about sort of battling the misinformation. Disinformation as as a researcher, how has that battle what do you do?

You it's a really fantastic question.

And, you know, I think engagements like these are good opportunities.

You know, I definitely know that my colleagues and I were, you know, overwhelmed by the amount of work that we have to do, both within the research program and then beyond.

So, you know, the notion of doing engagement is, is we don't do it as much as we would like to.

So I think one piece that we need to do is engage more with the community.

And, you know, when I engage with community members, which we do quite a bit through Food Allergy Canada, which is a partner organisation, a fantastic partner organisation.

You know, I find that people tend to go, oh, okay, well now here's a face to a name.

But the difficulty is that the disinformation process is so fast and it's really hard for us to, you know, cut off everything that comes out and, you know, make statements about everything when the statements are, you know, very clearly false and very clearly about us.

It's a little easier, like in this disinformation campaign or this disinformation AI post situation.

But, you know, I think that this is an open question.

How do we, as researchers, demonstrate what we're doing to try and impact this problem and, you know, get the trust of the general community back?

Because I think there's been a pretty large erosion of trust in the research process, and I don't think any of us are working any less hard towards solution.

I think maybe we've just lost in translation somewhere along the way.

We have about 30 seconds left, but I do want to ask, there's some really exciting stuff in your own research that you're doing.

You found a new cell that remembers allergies. Help us explain that, but also the implications for people who, too, suffer from allergies.

Yeah. So, you know, this this came out and we did some media on this a couple about a year ago.

We found a new type of cell.

It's a special memory cell that essentially remembers how to produce these IgE antibodies that make us allergic.

And you know, we defined what those look like and found out that they're the ones that are responsible for this.

What the implication of this identification is is that, you know, we now are working with and there are many other pharmaceutical companies as well, working on trying to target these cells.

And our hope is that if we can get at this cell and, you know, change its mind or eliminate it, we can have an impact on the disease and hopefully it's curative so people don't need to take it therapy for the rest of their life.

Josh, really appreciate thank you so much for your insights and your research is really exciting stuff. Thank you so much.

Thanks so much for having me.