Food Allergy and Your Kiddo

How Food Allergy Parents Can Process the News on Early Introduction and Food Allergy Prevention

• Alice Hoyt, MD, and Pam Lestage, MBA • Episode 86

Share episode

What topic would you like discussed? Text us!

In this episode of "Food Allergy and Your Kiddo," Dr. Alice Hoyt welcomes back Tamara Hubbard (@foodallergycounselor) to discuss the impact of recent studies on peanut allergy prevention and how parents of children with food allergies may be feeling about this news.

The conversation highlights the importance of community support, evolving guidelines, and the emotional journey of parenting children with food allergies. 

Let us know how YOU are feeling by sharing your thoughts in the comments! Subscribe to YouTube: @hoytfoodallergy
Instagram: @hoytfoodallergy
Facebook: Hoyt Institute of Food Allergy

Looking for one-on-one time with a food allergist to finally get your food allergy questions answered? Sign up for Food Allergy Office Hours for Parents.

Are you a pediatric clinician and you want to stay up-to-date on food allergy information that's relevant to your practice? Join the Food Allergy Pediatric Hub.

Are you in need of an allergist in your area?
AAAAI Allergist Finder
ACAAI Allergist Finder
OIT Allergist Finder

Would like to become a patient? Reach out to the Institute!

Does your kiddo's school need help with medical emergency response planning? Check out the non-profit Code Ana.

This podcast is the official podcast of the Hoyt Institute of Food Allergy. Information on, within, and associated with this site and Food Allergy and Your Kiddo is for educational purposes only and is not medical advice.

Speaker 1:

Hello and welcome to Food Allergy and Your Kiddo. I'm your host, Dr. Alice Hoyt. Delighted to have my friend and colleague, Tamara Hubbard, back on the podcast. Hey Tamara, how are you? I'm good. How are you? I'm great. Thanks so much for joining me back today. Um, and so soon after our last discussion, where I was delighted to share your book, May Contain Anxiety.

Speaker:

How's it going? So far, so good. We just had a wonderful event to celebrate its birth into the world and um getting young. It is like birthing a baby. Writing a book is kind of like growing and birthing a baby. So that's how I've been referencing it. But it's going well. And um more than that, I'm hearing it's helping people, families, and that was the intention behind it. So that makes me happy.

Speaker 1:

That's so awesome. Yeah, if if you're listening, you haven't checked out that episode or interviewed Tamara on her book, May Contain Anxiety, Managing the Overwhelm of Parenting Children with Food Allergies. You should totally check it out. Um, if you don't know Tamra, she's a licensed clinical professional counselor and family therapist, all about evidence-based therapeutic support. She really is, um, she's really amazing. Tamra and I work together on what's now the Academy of Food Allergy Counseling. You want to talk a little bit about that before we dive into what we're talking about, which is some recent food allergy news and how it's impacting food allergy families?

Speaker:

Yeah, because I think it could relate and be useful for some people. And it's really just the topic we're talking about. So the Academy of Food Allergy Counseling is an organization, nonprofit organization that I created initially called the Food Allergy Counseling Professional Network. And one of its resources is the well-known Food Allergy Counseling Directory that helps families and clinicians connect with allergy-informed, licensed mental health professionals in their state or in their area of the world. And then, so that's what's facing the community and the practitioners. But what's facing the therapist and what's useful for the therapists at the Academy of Food Allergy Counseling is a network of those of us working in the food allergy and allergic disease counseling niche. And then we're also now providing education for therapists to help bring more of them into the fold. So it's all about supporting the community with food allergies and allergic conditions, supporting their emotional and mental health and wellness needs. So yeah, very proud of the organization and everything that's come from it.

Speaker 1:

It's amazing. It really is amazing. And that's, you know, why I guess last, I don't know, the last few years when you've been really building it, and then you know, we had been talking and and how to continue growing this really just amazing, amazing network for therapists, for families, you know, bringing it into the Teal Schoolhouse family, which supports the Codana organization that I lead. It's it's just been such a wonderful, it's I mean, I love working with you. You know that, Tamara. Yeah. Um, but I do it's it's such a wonderful resource. And so if you haven't checked out the Academy of Food Allergy Counseling, definitely check it out. If you have a kiddo with food allergy, chances are, you do if you're listening to this podcast or you love a child who has a food allergy, check it out. There are definitely times where all of us can benefit from having some some guidance when we're going going through something, and especially having a kiddo with a food allergy. Um, you know, just parenting in general, it's like, okay, I'm I'm doing great in this season of life, and then that season's over, and then you're figuring out the next thing, right, Tamra?

Speaker:

Yep, absolutely. The only constant in life is change, and so that that applies here too. Yep.

Speaker 1:

That is so true. That's so true. And, you know, change, there is a little bit of change um going on. And that's that's why I wanted to have you back today because we were talking offline about stuff. Um, Tamara and I, or full disclosure, Tamara and I are friends, and we talk a lot about um life and food allergy life. And recently there was a study published in Pediatrics, which is the journal of the American Academy of Pediatrics. And what the study demonstrated was that early, the early introduction of peanut recommendations that were made in 2015 through a consensus statement, and then in 2017 through the National Institutes of Health, specifically the National Institute of Allergy and Infectious Disease, the N I A I D, they updated their guidelines in 2017 to encourage introduction of peanut around four to six months of age. So much earlier than the previous guidance. The previous guidance, um, and I'll I'll back up a little bit, as you've heard me talk about on the podcast before, the uptick in peanut allergy was first noted in the 1990s. We don't know why, but we don't know why it was happening then, right? But it was noticed more children were having anaphylactic reactions to peanuts than prior, than previous to that time. And so expert opinion was well, let's have kids avoid these foods until their immune system is more ready for it. Translation. Let's delay the introduction of commonly allergenic foods. By 2008, it was pretty clear that was the wrong thing because not only peanut but other food allergies um were increasing in incidence. And so in 2008, the AAP walked back that 2000 guidance um kind of quietly, really.

Speaker:

Honestly, I did not know about that. And I was having children around that time. So that tells you it was pretty quiet.

Speaker 1:

Pretty quiet. Yeah, because there still wasn't data. There weren't the studies that we have now, which we'll get to in a minute, that very clearly demonstrated what we should do. I mean, it was pretty clear that delaying it wasn't helping. So let's get rid of that. But it was kind of quiet. And around that same time, Gideon Lack, amazing allergist researcher, had been noticing that in Israel they had other food allergies. Little kiddos had other food allergies, but they didn't have a lot of peanut allergy. And he's like, hmm, what's up with that? And realized, recognized that one of the first foods babies get in Israel is this little puff called bumba. It's a little peanut puff, kind of like a Cheeto but peanut, and like a little babies. You can just imagine little babies kind of like sucking and gnawing, kind of gnawing on it. Exposure to peanut much earlier than two, three years of age, right? Like they're babies. And so he led then the leap study, learning early about peanut that enrolled children at risk or babies at risk of developing peanut allergy, meaning he had already identified that kids with severe eczema or babies with severe eczema and with egg allergies, they were those two things or risk factors for peanut allergy, enrolled those kids, had half of the group start eating peanut between four to eleven months of age at enrollment, and had the other group avoid it until they, until there was a challenge when both groups were five years of age. The kids who were eating peanut were significantly less likely to have a peanut allergy than the kids who had been avoiding it, demonstrating that early introduction of peanut does decrease the risk of peanut allergy. The follow-up to that study had the kids who were avoiding it, or the kids who were eating peanut until they were, you know, at five years of age had them stop avoiding it or had them avoid it. Wow. I need to get it together. Where's my coffee? Um five years of age. Um, the kiddos who had been eating peanut, they said, okay, well, let's uh let's have you avoid it for a year, rechallenge them at six years of age, so gave them peanut again at six years of age, they were still less likely to have a peanut allergy. You might be wondering, well, why'd they have those kids who are eating it avoiding, uh, start avoiding it for a year? They wanted to see if this was like a temporary fix, if they were just putting a band-aid on something. And then when they kind of removed the band-aid, when they said, okay, avoid no more peanut for you, no more peanut band-aid, than if it un unmasked an allergy, but it it really didn't. And so it really demonstrated that this is a sustained effect when you get the food into the diet sooner rather than later, when their babies, four to eleven months of age, the sooner the better. Um, that it really has a sustained effect of not having the allergy. So you're like, okay, Dr. Hoyt, that was in 2015. What's the deal now? Well, it's 2025. And we know that it does take about 10 years for research to kind of trickle out. But what this paper in pediatrics demonstrated is that this effect of decreased amount of peanut allergies and other food allergies is occurring since those recommendations were made in because of that leap study. The leap study is what prompted that 2015 consensus statement from the allergy societies to say, hey, okay, kids should eat peanut early. And then 2017, the NIH. And so what this study was demonstrating in pediatrics is that since those recommendations were published, the incidence of peanut allergy and other food allergies has significantly decreased, which is amazing. Like I, as an allergist, like, yes, this is this is what we knew, like this is what the data clearly showed, this is what we're seeing clinically, this is what you know we're championing and we're championing, championing for pediatricians to really do this because it is hard. As a pediatrician who has practiced something for so many years, it's hard to make a change, especially when you're concerned that a baby might have a reaction, right? But this this is what the data says. And so for you who list who are listening, and you have a child with peanut allergy and you may have not been told this, or you may have been told this, and your kiddo was just a kiddo where this didn't work because it's not a hundred percent.

Speaker:

No.

Speaker 1:

Um, you know, the feelings of this. And so that's why I wanted to have Tamara on to talk about the feelings that some food allergy families are having.

Speaker:

Yeah. Well, my family is a family who has a peanut allergy and was under the previous guidelines, which now I've just learned actually, after having been in this field for this long, I did not know that there was sort of this pause around 2008 saying, hang on a minute, we know this isn't right, but we don't quite know yet what to do. So that was uh interesting news. But we were in that around that time frame. And so, yeah, when new information like this comes out, uh for any of us, whether it was that or maybe we were on that cusp within those years of that guidance changing and and getting pushed out to the community, we can have a whole lot of feelings about this, right? And when we have more than one feeling that might even be seemingly contradictory to one another, that's called ambivalence. And it's completely normal and understandable to be ambivalent about this news. On one hand, many of us are excited for the new development in data, the new development in guidelines, things that are hopefully going to decrease food food allergies and allergic conditions. On the other hand, some of us may be feeling frustration that this wasn't the case when our child was younger and getting diagnosed. Um, some of us might feel sad about that. Some of us might be angry about it. Uh, and that might give way to even more feelings. Guilt, resentment, right? All of these feelings can get stirred up when news like this comes out. We feel both happy and excited for the development and frustrated, sad, angry, guilty, which is not necessary, by the way. We'll get into that in a moment. Hopefully, guilt is not necessary as an allergy parent, but we do tend to feel it when this kind of information comes up.

Speaker 1:

Yeah, yeah. I mean, mom guilt in general, right? But add something like this onto it, and it's it's tough, you know?

Speaker:

It's hard. And the one main thing that I like to remind people, and I'm sure you do the same thing, is that as parents, we're doing the best we can with the information we're given at the time in which we're dealing with the challenge. And so if your child was diagnosed years ago like mine was, that's the information we were given at that time, and we did what we could with it, right? We are not doctors, we are not most of us. I can't speak for all of us, we're doctors, we are not researchers. And so how would we know that 10 years later the guidelines and the guidance would change? We wouldn't. Um, it's this is not unique to allergies and the allergic disease community. This happens in all sorts of health condition uh diagnoses and fields. We see the evolution of research and data and guidelines. Um, even what we see today may change in 10 years from now. And so this will keep happening. New data will come out, feelings will get stirred up. Um, for some families, you know, they've been able to sort of separate themselves enough from that diagnosis period and move on. And then this kind of information comes up and it brings all of that right back to the surface, right? Um, so it's about how to handle that is not to avoid it because it's going to happen. The feelings are gonna be there. We then have to just acknowledge that, accept that they're there, let them be there, process, and move forward.

Speaker 1:

And you talk in your book about different parenting traps.

Speaker:

Yeah.

Speaker 1:

Um, how do you feel like this kind of can, I mean, you have so many so many good strategies in your book for dealing with situations, but is there a parenting trap that you feel like parents can fall into with something like this?

Speaker:

Yeah, I would say um definitely the certainty trap. And so the certainty trap is when we, you know, we want to be doubt-free, we want to have zero risk, which is not possible in life usually. Um, and we tend it tends to drive behavior like excessive research, spending time online, not getting sleep or looking things up. And so, again, new news and changes like this can stir up feelings of, especially for the families who maybe had their child diagnosed right as this guidance was changing, or the couple of years after, and maybe their pediatrician didn't push that information out, so they didn't know. They might feel like they missed the boat on this guidance. And so they don't want to do that again. And so it's a way to avoid more pain or more food allergy diagnoses or more things to happen that are, you know, life-changing. And so they might see themselves kind of an uptick in behaviors where they're trying to find certainty and make sure they don't miss anything again, even though likely they didn't miss it. It just was a situation at the time.

Speaker 1:

Right. Right. You you had an Instagram post the other day um along these lines, and you were getting a lot in the comments.

Speaker:

Can you talk a little bit about that? Yeah, there was a lot of. Can you watch your handle? Um, at Food Allergy Counselor. So that's one of them. I have a couple, but that's the main one for this purpose. Um, yeah, so there was a lot of really dynamic conversation on both the Instagram post and the Facebook post. It was the same post, but um in two different places. Families talking just about all of this, right? All the feelings that come up. Um, I think they were thrilled that somebody just sort of put it out there because I think we can feel guilty sometimes going, gosh, I I yes, I'm happy for the community and the kids who have avoided peanut allergies and other allergic uh diagnoses, but I'm also sad and upset and feeling, you know, unhappy about the fact that we didn't. And so as long as we can just name it and put it out there and say that it's okay to feel this way and it's expected to feel this way. I think it normalized it for people. And so then they felt comfortable enough to share their feelings and their stories. And so we had people sharing all of these things that we've been talking about, and others commenting back, going, I I hear you, I see you. So what it did was just basically say, let's be honest. This can feel hard. It can feel great, but it can feel hard too. And I appreciated that people were vulnerable enough to say those things. Um, and we're not judging it. It is what it is, it's hard and great at the same time.

Speaker 1:

And did you get anything in the comments about, well, I did that and it didn't work, or I was afraid to do that?

Speaker:

Yeah, so both. I saw conversations on both of those points. And that is the hard, an even harder point still, is if you followed the guidelines, you did what the new guidelines said to do, and your child was still diagnosed with a with a food allergy. I think one parent said, um, you know, it's not, what did she say? It's not a magic, um, a magic wand. I'm not using the right phrase that she said, but it's just a magic ticket. That's what she said. She said, This isn't the guidelines, they are not a magic ticket.

Speaker 1:

Right.

Speaker:

And I think that that's important to highlight that even when we do things according to the guidance, the new guidance, it may still not work. Um for reasons we still don't know, and we're trying to figure that out even still. That's exactly right. But that hope is really, really strong for families with food allergies. Any kind of hope we can hang our hat onto and connect ourselves to is very strong. And so when we hope we're gonna have good outcomes by following the guidance, and that doesn't happen, that's gut wrenching. That's a gut punch, like you'll never, you know, expect to feel. It's it's it's hard. And so that can bring this back up and and and bring up all sorts of emotions too, where unfortunately you didn't get the magic ticket.

Speaker 1:

Right. Yeah, and I I see that in my practice where, you know, most families when they do early introduction, I I exclusively see families of kids with food allergies, right? And so um, when they're pregnant with another child, we'll focus on doing early introduction. In most cases, it works. Now, there are some cases though where you try to do early introduction and it's it can be cumbersome. Um, but you try to do it and it doesn't work. And so I want to, you know, reassure the families out there that just and and when if you're listening, like if you're listening to this and you've listened to me talk before, you know that I am a faithful woman. I believe that God has a plan and that we do not always understand the plan. And that for whatever reason, this is the path that we have, right? This is this is the path that we are on, and we we do the best we can with that path, um, even when we don't understand it, even when we hate it, right? Those are our children that we're talking about.

Speaker:

But we don't have to like any of this, by the way. Accepting it doesn't mean we have to like it. But we don't want to live in, we don't want to live in rumination and frustration all the time either. Right.

Speaker 1:

That's exactly right. And and letting families know that even if you had had this information and you had done this, it's not a hundred percent right. It's not a magic ticket like what your commenter said. And because even when you do it, there are still some kids that are developing the allergy. So I also want to encourage families who might be thinking, oh, well, now there's a decrease. So now there's gonna be less studies about it and less funding. I don't see it going that way because as a scientist, what I see is okay, it works in a lot of people, but why isn't it working in this group? What's different in this group? We still have a group to learn.

Speaker:

We still have things to learn. I'm glad you brought that up because I posted it on another social media platform and one person said something along those lines if there's a decrease in food allergy diagnoses for babies, does that mean we'll have less accommodations and less focus on it? And I said, gosh, I hadn't thought about that, but I really hope not. And to your point, you made a good one. It's not a magic ticket, again, so there's still a lot to learn, and that doesn't mean that they don't exist. There's still a ton of people living with them, and so we still do need the accommodations, the education and the understanding.

Speaker 1:

Right. And if we go back in time to the 1990s, that's when we noticed the uptick and we don't know what that was about.

Speaker:

Right.

Speaker 1:

And then the problem got worse when we delayed introduction. So are we going to go back to like were those babies who were developing peanut allergy in the 90s? Were those babies that weren't being exposed to it until later? Right? Like, why did those babies start developing it in the first place? One of the one of the most common questions I get asked is, well, why are all these food allergies happening? And we don't know the answer. I say, you know, Job had a lot of stuff, but he didn't have food allergies. So it really was not a thing. Allergy itself is a relatively new condition, really not really not really reported until the 1870s. Dr. Thomas Plattsmills has a beautiful article. Um, it's about 10 years old now, actually, on called the allergy epidemics. He was asked to write an article on the allergy epidemic, and he said, No, this is not an epidemic. These are epidemics. We're talking about seasonal allergies, talking about childhood asthma, which is often an allergic condition, talking about food allergies, also talking about alpha gal allergy, which is just a horse of a totally different color, right? Has nothing to do with intro early introduction, not introduction, has to do with being bitten by a tick. And then you develop an allergy to a sugar that causes delayed anaphylaxis when you eat red meat. It is mind-boggling and not consistent with other types of anaphylactic food allergies. Overall, just highlighting how much we don't know. And while this is amazing news, it is reinforcing what what we already knew, thanks to Dr. Lack, thanks to other researchers who were doing this work over a decade ago. It's not all of the answers. And if anything, I'm hopeful that with there being more and more studies on food allergy, that we are gonna clearly continue to it's it's like you answer one question, but then you have three more questions.

Speaker:

Yep.

Speaker 1:

Right? Like this isn't going away. We want it to go away. We want it to go away, but it's not going away. We need to figure out why. And researchers are working on that. There's you know, having a food allergy is not is not anything I wish on anybody, right? Like nobody wants a food allergy. But if you're gonna have one, now's the time to have it. Not five years ago, not 10 years ago, not 20 years ago. It's probably only EpiPen back then.

Speaker:

Right, there I think there only was, yeah. And you can see that divide, you can see that divide, not a divide in the community where they're against each other, but that sort of that line that change in the parents who, you know, parents of older kids versus younger kids now. Um, and so that is hope too. Again, I I want to reframe that as hope. There's hope that there's more focus on all of this, that there's hopefully more answers coming, more information and knowledge that will also bring up all those mix of feelings that we feel about the fact that we're even in this community. And so two things I would leave for those listening is uh lean into an and mindset. We can feel happy and sad, excited and frustrated at the same time about this news. Let it be there. Don't fight it, just allow it to be. Uh, rather than an or. I can feel happy or I can feel upset about that, right? No, we can feel multiple feelings at once. We can be ambivalent about this, and that is okay. And the second part of that is to not judge yourself for feeling that way. When we're feeling like something is hard and challenging as this might feel, right? All these feelings about all of this new news and development in the field, we want to meet ourselves with self-compassion because this journey is hard enough as it is, and we don't need to judge ourselves for the very real, honest, normal feelings and responses we're having to this news. So that might look like saying, hey, yeah, I know I'm feeling a little angry about that. Of course I am, that makes sense. You know what? It's okay. It's okay to feel all those feelings. You'll get through this, right? We need to tell ourselves that. So have all the feelings. It's okay, you're not the only one, and meet yourself with some self-compassion that it's normal to feel that way.

Speaker 1:

That's so good, Tamara. I'm so glad. Um, I'm so glad we're friends, right? Um, but I'm also so glad that we were talking about this, and I was like, Yeah, this just organically came up in our channel. It really did. I think you brought it up even like, oh, we should do this. I was like, we a million percent should do this.

Speaker:

Because people are thinking and feeling it. So let's put it out there, right? That's the reason why I made the posts I made this week, is because as an allergy parent, I feel it, right? As a therapist, I my clients, my patients feel it. As somebody who's educating the community, I see them feeling it. Let's just put it out there, let's normalize it, let's talk about it. It's okay. I love it.

Speaker 1:

Tamara, thank you so much for coming back on the show. And if you're listening, definitely get Tamara's book, May Contain Anxiety. It is it is so good, and it has so many great strategies, not just for food allergy, but just in general, just like your and you can feel this and this. I think that's great.

Speaker:

Thank you. Yeah, a lot of that stuff that I have in there can apply just in general. Even my editor who's not an allergy parent was reading one chapter going, that was really helpful for what was going on for me this week. So yeah, thanks for the thanks for the endorsement and the encouragement. I appreciate it.

Speaker 1:

You're welcome. Well, like I told you the other day, if everybody would read this, if all my patients would read this, I'm amazing patients, but if all of the allergy patients would read this, it would make it make everybody feel so much more at peace. And because like you you've said before, like nothing's ever 100% risk-free. But when you're able to to to plan, when you're able to manage how you're feeling, when you're feeling it, um, when you're able, I know you talk a lot about clearly anxiety in the book, and when you're able to use anxiety as a tool and not let it control you, it can be so helpful, not just in you and your kiddo's food allergy journey, but just your your lives in general. So thank you so much. I love this. I love your book.

Speaker:

You're welcome. And people can read or listen to it because it's uh it's an audiobook as well.

Speaker 1:

So well done, ma'am. Well done. Okay, we'll talk soon.

Speaker:

Sounds good. Thanks for having me on. Great chat.

Speaker 1:

Thanks so much for tuning in. Remember, I'm an allergist, but I'm not your allergist. So talk with your allergist about what you learned today. Like, subscribe, share this with your friends, and go to foodallergy in your kiddos.com where you can join our newsletter. God bless you, and God bless your family.