60k kids have avoided peanut allergies due to 2015 advice, study finds

Maybe part of it is a consequence of the risks of honey, which can actually spawn camp infants with botulism. But it seems that fear spread to everything.

I hadn't heard of this. Very intriguing that only camp infants would be affected.

Not just parents sheltering kids. Take a look at this (in)famous tweet https://x.com/d_spiegel/status/1271696043739172864 from *June 2020* ...

"[eg] women aged 30–34, around 1 in 70,000 died from Covid over peak 9 weeks of epidemic. Over 80% pre-existing medical conditions, so if healthy less than 1 in 350,000, 1/4 of normal accidental risk"

It will be interesting to see what happens with allergies for those who were born in the 2020-2023 timeframe.

The thing I'm a bit curious about is how the research on peanut allergies leading to the sort of uhhh... cynic's common sense take ("expose em early and they'll be fine") is something that we only got to in 2015. Various allergies are a decently big thing in many parts of the world, and it feels almost anticlimactic that the dumb guy take here just applied, and we didn't get to that.

Maybe someone has some more details about any basis for the original guidelines

I always think about how animals eat - basically their food is never clean and always mixed with dirt. Evolution dealt with this problem since forever.

Putting China to one side, broadly speaking weren't the most stringent and prolonged restrictions mostly in wealthier, highly-developed countries?

In 2000, the American Academy of Pediatrics recommended not allowing your kids peanuts until they were 3 years old. It was just parents following doctor's (bad) advice.

The hygiene hypothesis is not impossible, but evidence for and against it is questionable. But anyway, for peanuts it's not the hygiene.

It's a much more complex mechanism that retrains your immune system from using the non-specific rapid-response allergic reaction to the T-cell-mediated response.

The same method can be used to desensitize yourself to poison oak or ivy. You need to add small amounts of them into your food, and eventually you stop having any reaction to urushiol contact with the skin.

Are there missteps? Certainly. Figuring out what is effective, what has bad secondary effects (fragility, allergies etc) and what is simply wrong is an ongoing effort and that's great, but less dying is a pretty nice baseline and progress on that front is inarguable.

Maybe we live in bubbles.

I am from Asia. I have only seen people need to be taken to emergency hospital in American tv shows for any allergies. Here I've never seen it in my whole life and didn't even know allergy can be this dangerous. We don't have peanut allergy too. First time even I saw it in TV, I was very confused.

Allergies do exists here, but "not to the extent" like what I've seen in American TV shows or heard online.

Only thing I remember is people need to take medicine for to allergy from venomous caterpillar hairs, they mistakenly touched those. And stung by honey bees, wasp etc.

I don't particularly believe this, but it fits Occam's razor, so it seems to deserve some examination.

Pretty irrational, but definitely celebrated.. eventually

"Older adults are at highest risk of getting very sick from COVID-19"[0]

[0] https://www.cdc.gov/covid/risk-factors/index.html

How? You can use that to decide between two (or more) explanations, but you only presented one.

Science failed here.

One could argue that science being celebrated too much leads to this type of present-day outcome. Science can tell you how to do something, but not why, or even what we should do to begin with.

I'm pretty sure it is.

https://en.wikipedia.org/wiki/Immunological_memory

https://en.wikipedia.org/wiki/Supercompensation

For baby number 2, soap and water is enough. There's no time for Sterile Field nonsense. This kid isn't allergic to anything.

There was a local mom who had 4 thriving kids. When their baby dropped the pacifier in the dirt, it just got brushed off and handed back to the baby. I don't think those kids had any allergies.

No allergies.

I don't agree that this is "all" that it has done.

There are many cases where reducing exposure as much as possible is the correct thing to do. Lead is the best-known example.

As the other reply pointed out, the second-order effect, the nuance that comes later is that sometimes this isn't the right thing to do.

But it would be basically incorrect to reduce it to blanket, binary, "all good" vs "all bad" black-or-white conclusions, just because the there is a smaller course correction when it's found out to be not entirely good. Concluding that "all it's done is cause problems" is a knee-jerk reaction.

If the best available means to perform an experiment carries some risk, it could still be entirely rational to do it rather than forfeit the knowledge gained from the experiment.

Must've been the garden hose water.

Nobody is suggesting you go and add some heavy metals to your corn flakes (except you).

Infants in SE Asia are probably getting near daily exposure to peanuts.

The post that I am responding to does in fact deal in absolutes by asserting that "What doesn't kill you makes you stronger" is a natural law. Please don't troll by attributing that to me.

My more detailed take on this is here: https://news.ycombinator.com/item?id=45653240

It is in response to someone else who is dealing in absolutes. It seems pretty common, actually. Must be a lot of Sith around today.

For clarity, I will include both here:

The two explanations for increased adult fragility are:

forgotoldacc> Parents shelter their children too much and have created adults that have additional allergies as a result of lack of childhood exposure

rocqua> Increased sheltering of children has allowed more of the fragile ones to survive to adulthood, increasing the number of fragile adults we observe today.

A quick google search says Asians populations have more allergies to buckwheat, royal jelly, and edible bird nests from swiftlets. Shellfish is still one of the highest allergies anywhere.

There wasn't much information one way or the other on what avoidance did as far impacting development of allergies, and with the evidence available, delaying exposure seemed prudent.

"Mithridatism is not effective against all types of poison. Immunity is generally only possible with biologically complex types which the immune system can respond to. Depending on the toxin, the practice can lead to the lethal accumulation of a poison in the body. Results depend on how each poison is processed by the body."

"A minor exception is cyanide, which can be metabolized by the liver. The enzyme rhodanese converts the cyanide into the much less toxic thiocyanate.[12] This process allows humans to ingest small amounts of cyanide in food like apple seeds and survive small amounts of cyanide gas from fires and cigarettes. However, one cannot effectively condition the liver against cyanide, unlike alcohol. Relatively larger amounts of cyanide are still highly lethal because, while the body can produce more rhodanese, the process also requires large amounts of sulfur-containing substrates."

Our immune, metabolic, and other systems are built to be adaptable, and some things are easy to adapt to, but other things are difficult or impossible for them to adapt to.

But generally speaking, the USA is an outlier on the prevalence of Peanut Butter specifically, and to a lesser extent peanuts in general.

Telling anxious parents to have their kids avoid peanuts caused harm that wouldn’t have happened otherwise. I guess it’s valuable to better understand allergies, but learning at others’ expense isn’t worth it.

Is this true? What percentage of doctors are scientists?

The UK seems to be a bit of an exception. And it shows, the only two countries I've been asked if there are any allergies by waiters as a standard are the US and the UK.

The real problem is some of those claims and reports were true, but we were so inundated with the rhetoric that everything was going to kill us that many of us sort of lapsed into apathy about it. Stepping back, the food industry in the US clearly does not have consumer health at heart and we struggle to find healthy options that avoid heavy processing or synthetic fillers. Those parents who sheltered their babies back then may have been on to something when it came to stuff we consume and we should have been on the path to demand better from our food sources had more of us been more diligent with our grocery choices (myself included, at the time), but instead we ended up with bread that lasts unnaturally long and has an allowable amount of sawdust as an ingredient.

Also this "more fragile people" argument assumes the "fragility" is both inherent and of a lifelong kind. This ignores that most causes of infant mortility are external, and that for many of those being exposed to them results in a lifelong increased mortality risk. Excessive hygiene leading to more allergies is a direct example of this.

There’s been a similar shift with people letting their dogs roam free. When I was a kid I remember hearing stories about a dog getting run over by a car every year. I rarely hear these stories anymore because people usually keep their dogs supervised or in a fenced yard. I don’t have any hard data, but I suspect there’s something to these cultural shifts.

A lot of people who today would be considered to have a condition which is entirely treatable by doing (a), taking (b), not doing/avoiding (c), etc, would, a century ago, have just been kind of deemed broken. Coeliac disease is a particularly obvious example; it was known that there was _something_ wrong with coeliacs, but they were generally just filed under the 'sickly' label, lived badly and died young.

(And it generally just gets worse the further you go back; in many parts of the world vitamin deficiency diseases were just _normal_ til the 20th century, say).

Your math isn’t checking out here.

doing nothing is better than something if that something might hurt people without understanding how and why

I've brought up this example many times before, but Measles is a great example. Measles resets your immune system and breaks immunological memory for anywhere up to three years after having recovered from it. But now we have a bunch of people that assume any diseases can simply be dealt with in a natural way by your immune system thanks to the logic above, and well, the consequences of that are becoming clear.

https://www.jacionline.org/article/S0091-6749(08)01698-9/ful...

Also, the most common type of accidental death is car accidents. So is even that difference from kids not getting to play outside anymore, or is it radial tires and crumple zones?

This research shows physicians harmed kids recommending they avoid allergens like peanuts, is that something we should ignore because all the benefits of science are “worth it”?

Science is amazing not because it’s always right, but because it (should) strive to always do better next time

Essentially all of this was infant mortality, i.e. kids who died before the age of 1, and that in turn was more related to things like sanitation and vaccines and pre-natal screening.

“it’s worth it” is a horrible argument when people’s health is on the line.

https://en.wikipedia.org/wiki/Hormesis

However this doesn't need to continue very long until basic cleanliness and medicine can be used effectively without harm.

- Before the age of 1, top cause of death were defects (prematurity/immaturity, birth injuries) and congenital deformations.

- Age 1-4 it was accidents (e.g., drownings, burns, traffic) followed by influenza/pneumonia.

I think a lot of the delay is it took a while for people to realise there was a problem. The perhaps excessive hygiene thing didn't really get going till the 1960s and so you didn't really see the rise in allergies till a couple of decades after, then maybe scientists started figuring it like in the 90s and then it takes a while to get proven enough to recommend to parents?

For me, as a kid: very, very allergic to cats, kinda allergic to many food items and a little to horse hair (only noticable when shedding in the spring)

As a young adult: Only 2-3 food allergies remain, cats still strong, hayfever starts.

Then I took some shots against the hayfever for 2-3 years, and the cat thing has mostly improved and the hayfever is basically gone. So only 2-3 food items remain.

I still maintain its mostly in foods people don't generally give to toddlers. People may give a PB & J to a 5 year old, but they don't generally feed that to a 6 month toddler. Not because they are protecting them from peanuts but because generally people dont give sandwiches to toddlers.

For humans, that solution may have been 9-month gestation periods and two-decade fertility windows. A solution, to be sure, but not very desirable.

So if the "dumb guy" take is "just expose the kids, they'll adapt to it", in the absence of hard evidence to the contrary (and maybe even with it) the average doctor is going to _reflexively_ take the opposite position, because that shows that you (or the conventional wisdom) were wrong.

There are exceptions, and they are either the ones that just don't care at all, or they're the best docs you'll ever find.

It comes from a philosopher, talking about something that is completely not related to health-care, and ironically a strong criticism claiming that people that say things like that are stupid by one of the people most vilified in history by being misunderstood when claiming that things are stupid.

For example take the famous mask debate. It could easily be solved by having volunteers willing to stand in a room with people with covid at various distance, each using randomized masks/no mask. There would be plenty of volunteers for such a study but there's no way it would be approved.

The FDA doesn't count lives lost due to inaction and slow approval of new drugs and treatments. As Munger always said "show me the incentive and I'll show you the outcome." By any rational calculus, that one Thalidomide win by the FDA has caused incalculable death, pain and suffering by pushing out the timeline on not only recently discovered cures but all those built on top.

Imagine for example the number of lives saved if GLP-1 was purchasable over the counter in the 1990s when it was first discovered.

Hell, most of hayfever season in Tokyo is a bunch of people with allergies!

I think you should remember that American TV shows will use certain kinds of extreme scenarios to make a story. Lots of people who are allergic to things in a fairly benign way.

And also just more generally, I think Americans will be more likely to identify that _they have a shrimp allergy_ when every time they eat shrimp they feel bad. But I know plenty of adults who just go through life and be like "I guess I feel sick every time I eat this" and not be willing to use the word "allergy".

Like with humans, though, animals have immune systems which help. This is the trouble with food hygiene arguments: you can eat "dangerous" food and 99% of the time be fine. But it's still good for people to not roll the dice on this stuff, even with a 1% hit rate. We eat food 3 times a day, so that's potentially 9 very adverse events per year!

"Yeah I get food poisoning once every month or two" is a thing that some people live through, and I do not believe they enjoy it. I have not have food poisoning for a very long time, and appreciate it a lot.

source: https://www.visualcapitalist.com/cp/charted-peanut-butter-co...

yes, there were some surprises to me there. I suspect that it's a cooking ingredient in Satay sauce for the top countries. Not on e.g. sandwiches as in the USA.

But the UK is not the same in USA.

If you scroll down you'll see they do give context about the African countries. They're major peanut producers, and it's used in a lot of traditional cuisine.