Early Allergen Introduction Reverses Food Allergy Epidemic

Key Quotes

"The story of epipen is also a story of unintended consequences and unexpected discoveries one that goes from the azores some islands in the middle of the pacific ocean to sweden the home of the nobel prize to israel today epipens are in schools they're in malls they're on airplanes they may even be in your backpack or purse or glove compartment just in case and there's also the biggest unintended consequence of all it turns out that for many of the millions of people like alex who live with food allergies and the risk of anaphylaxis well their condition may in fact be the result of one of the biggest blunders of the past century of medicine and public health."

Thomas Gettys highlights that the history of the EpiPen is intertwined with unforeseen outcomes and surprising revelations. He suggests that the current prevalence of food allergies, a condition managed by the EpiPen, might stem from significant errors made in medical and public health practices over the last century.

"The precautionary principle still held sway and food allergy rates they continued to rise and and just remember the fear here it's very real in 2001 the journal of the american medical association estimated that between 500 and 1 000 people die every year in the us from anaphylaxis thankfully there was something that could help should a child or an adult to consume a food they're allergic to this was a simple device called the epipen it administered a small but effective dose of epinephrine with a simple stab the trick was to make sure there was an epipen at hand at that moment of need."

Thomas Gettys explains that the "precautionary principle," a strategy of avoiding potential risks, continued to influence medical advice, contributing to rising food allergy rates. He notes that despite the fear and the significant number of annual deaths from anaphylaxis, the EpiPen offered a critical emergency treatment by delivering epinephrine.

"The only problem was this recommendation wasn't based in science it was based on the precautionary principle with more children allergic to foods it seemed sensible to delay the introduction of those foods to children and it turns out that scientifically biologically this was exactly the wrong advice what the aap had done was to unintentionally create a feedback loop as more children avoided foods at an early age more children would be sensitized to those foods later and more children would be diagnosed with food allergies and that rise in food allergies created more concerns and more fears about the foods which led to more avoidance less exposure and yes more allergies."

Thomas Gettys points out that the American Academy of Pediatrics' "one two three rule," which advised delaying the introduction of certain foods to infants, was not scientifically grounded but rather based on the precautionary principle. He argues that this advice inadvertently created a cycle where avoidance led to increased sensitization and a subsequent rise in food allergy diagnoses.

"The leap study recruited 640 children between four and 11 months old and the plan was to carefully expose half of them to peanuts regularly and consistently until they turned five and then to compare the rates of allergies between the two groups of children talking to dr lack though i was curious how exactly did they convince 640 parents to enroll their babies in this study a lot of resources went into screening and talking to the families and explaining to the parents what the situation was people respond to data and common sense and realized that the guidelines were not working and that there was a significant chance that by doing nothing their baby would develop peanut allergy anyway here was the possibility of an intervention that would actually reduce peanut allergy."

Thomas Gettys describes the LEAP study, which involved exposing infants to peanuts to assess its impact on allergy development. He notes that parents were convinced to participate by the compelling data, common sense reasoning, and the realization that existing guidelines were ineffective, offering a potential intervention to reduce peanut allergies.

"The leap study found that at five the rate of allergies in children who had avoided peanuts was nearly 14 percent about what it was in the general population but in the group that had been consistently consuming peanuts since those first few months the rate of allergies was just 1.9 percent compared to 14 percent that's a huge difference exposing babies early as early as four months was clearly and profoundly beneficial this prevented food allergies."

Thomas Gettys presents the findings of the LEAP study, highlighting a significant difference in peanut allergy rates. He states that children who consistently consumed peanuts from an early age had a dramatically lower allergy rate (1.9%) compared to those who avoided them (nearly 14%), demonstrating the profound benefit of early exposure.

"The precautionary principle is still holding us back what's more the belief in hygiene and sterility it hasn't gone away many parents are probably still bathing their infants too much and so food allergies and other sensitivities they're still common and prevalent meaning there is still a very big market for the epipen and the epipen is still a huge money maker in 2023 the epipen and the generic they brought in nearly 2 billion in revenue yes that's double the amount from 2016 and the price of a two pack it's now about 700 that's 15 percent higher than when the mylan ceo was called in to testify in front of congress."

Thomas Gettys observes that the precautionary principle and a persistent belief in hygiene continue to hinder progress in combating food allergies. He notes that despite updated guidance, allergy rates remain high, sustaining a significant market for the EpiPen, which generated nearly $2 billion in revenue in 2023, with prices increasing since 2016.