Ready, Set, Go Peanuts for the Baby!

Over the past decade, the prevalence of peanut allergies has exponentially increased.  For parents, children, families, physicians and teachers, there is significant frustration because the reason for this is still unknown.  There are many theories however, but nothing that is overwhelmingly responsible.  I will table this topic for another day. Back to the actual allergy to, rather than the cause - with this increase, peanuts are getting a lot of attention in the food allergy community and with that comes a lot of studies using them. One in particular, is known as the LEAP (Learning Early About Peanut) study. The study parameters, subjects and results were released in Q1 of 2015.

                                  

WHO: The subjects were infants (less than one year old) that were considered high-risk. High-risk equated to the infant having severe eczema (as described by the parent(s)), having a confirmed egg allergy or both.

WHAT: Some subjects will strictly avoid peanut protein until 60 months of age. The other group will receive peanut protein, regularly in their diet, multiple times per week until the age of 60 months.

ADDITIONAL INFO: Subjects were further stratified by sensitivity to peanut evidenced by a skin-prick test. Subjects experiencing a severe reaction to peanut at this point were dismissed from the study since they would likely be unable to consume the weekly requirement of peanut protein.

CONCLUSION: The results were remarkable. High-risk (eczema and/or egg allergic) infants showing mild sensitivity to peanuts or no sensitivity to peanuts via a skin-prick test that regularly ingested peanut protein until 60 months of age had a dramatically lower chance of developing an allergy to peanut when compared to the strict avoidance group.  There small window of opportunity to potentially change the infants sensitivity to peanut protein.

Ultimately what this study illustrated went against the American Academy of Pediatrics' (AAP) recommendation to delay peanuts.  The AAP has since revised their stance on the introduction of peanuts in high-risk infants.

In summary, at the earliest signs of eczema and/or egg allergy, an infant should be tested for a peanut allergy. If negative, introduce peanut products and have infant/child regularly consume following the LEAP protocol of at least two grams three times per week indefinitely.  If positive, complete the initial introduction of peanuts under medical supervision.

Pregnant? What Your OB is NOT Telling You

You're tired. You're hungry. You're nauseous. You're late.

You're pregnant! Congratulations! Babies are the world's greatest gift and they provide endless joy and challenges. What happens when those challenges are health related and could have been prevented or been less extensive?  Well, from experience, it sucks and you then work to restore the baby's health.

When pregnant with Jahan, I followed the advice of my OB, she was board certified and it was her fiduciary duty to guide me to optimal fetal health. She prescribed me prenatals that were rather pricey, $100 for a month supply, and didn't provide any other recommendations. I would visit her monthly until I was 36 weeks along and then I visited her weekly until my son was born.

There was no other guidance from my OB, so I opted to do my own research.  Some things I learned included:

• There is a vaginal advantage versus a c-section. A recent study from the Canadian Medical Association Journal discusses this further.
• There is a clear advantage in breastfeeding versus formula feeding. Here are 18 breastfeeding benefits and here is a more scientific article that credits breast milk with a lot of positives. The immune system boost to the baby when breastfeeding is undeniable.  A simple google search will yield endless articles, scientifically backed showing the benefits of breastfeeding.

So shoot for a vaginal delivery and breastfeed the baby - easy enough. 

Once Jahan arrived and started showing baby eczema, we learned a lot of other things that we could have done while pregnant to ensure the highest immune system possible. My OB never shared these tips. Perhaps she didn't know. Maybe a new protocol could be to see a pediatrician or immunologist at week 20 of pregnancy. There has got to be a way to ensure pregnant mothers receive all information that may impact their baby. Some things to consider while pregnant:

• Avoid antibiotics while pregnant and get Group B Strep tested closer to delivery instead of at 35-37 weeks
• While pregnant, supplement with prebiotics and probiotics
• Ensure you are getting adequate Vitamin D
• Limit sugar intake while pregnant
• If a c-section is required, inoculate the baby with mom's vaginal flora immediately following the c-section delivery 

When pregnant with my second child, Emrys, I applied all of the above and he has had no immune system issues. His microbiome is flourishing.  He has had none of the complications Jahan has had and we also expose him to germs and dirt! 

The Scratch that Itches and the Itch that Scratches

Jahan's eczema at seven months old

The correlation between eczema and food allergies although undeniable, is often not common knowledge to all.  Jahan's food allergy journey began shortly after birth with full body eczema covering his tiny body by five months old. Weeping, bleeding, itching, repeat. It's the scratch that itches and the itch that scratches.  We have had ups and downs, learning a lot along the way, but around the age of 14 months old, Jahan's baby skin was finally just that, soft and supple, like it's supposed to be.

This lasted for six short months and then a chest to knee flare began. Wet-wraps, diet revisions, elimination diets, creams and ultimately steroids. Ugh, that feels like the ultimate fail, having to resort to god awful steroids on my toddler's young and still thin skin.  All to end up back with an unwavering flare.  We opted to see our functional doctor, think east meets west, a holistic, natural MD.  The marriage of the two had produced some amazing results in the past, so I thought, lets get in to see Dr. Wong.

As we meet with Dr. Wong, Jahan is fearful, he must be thinking what will this doctor do to me. He has seen more doctors in his short two years of life than I have in my 32 years.

Right away Dr. Wong takes a look at the eczema and then scans Jahan's tongue and suggests eliminating cow diary. That's all milk, cheese, yogurt, mac n' cheese, string cheese, pirates booty, milk chocolate and the list goes on. We will switch to goat dairy, no problem since we live in an area where we have access to these foods and Amazon basically delivers same day now.  Dr. Wong also reminds us that Jahan's eczema is his body's way of showing the internal inflammation and suggests we complete a stool sample to see inside of his gut, where two-thirds of his immune system lives.  We agree.  Then Wong as Jahan calls him tells me that I have to prepare the samples at home, FedEx them overnight to the lab and wait.

Eczema flare at 22 months old before dairy elimination

So off we go.  Waiting for Jahan to have a bowel movement was our next step, which thankfully was only the next day (Saturday).  Jahan does his business and quickly I start in on this home scientific lab.  This was not fun.  Spooning fecal matter into various tubes, mixing and smoothing, repeat. They should really consider sending a mask home with this sample kit.  Not one of my finer mothering moments, but someone had to do it.

I package it up and off the stool goes to the lab for testing.

The results are in and right away from them I can see there are issues that need to be addressed. Inflammation. Leaky gut. Dysbiosis. Minimal bacterial diversity. And worst of all, two pathogens. Shit, how did this happen to my little guy? He was born vaginally, solely breastfed for 6 months, no antibiotics for the first year of life, probiotics from birth. He's only two!

Jahan's eczema and gut resolution regimen 

We circle back with Dr. Wong and he confirms everything from above.  Mehul and I are not interested in putting a "band-aid" on Jahan's symptoms, we want to solve the problems at the root. Wong knows this. He works to find "safe" supplements for Jahan's issues. This is quite the task given all of his food allergies, but ultimately we go home with our list of supplements and prescription to remove all dairy, even goat. So now Jahan is dairy free and ingesting 11 vitamins, supplements and herbs multiple times daily in hopes to improve the gut.

With this routine, the eczema has dissipated entirely with the exception of one stubborn patch.

And now we will continue the routine for eight weeks and then I get to spoon, smooth and smell the fecal matter of my adorable two-year old....again all while hoping we can stabilize Jahan's gut and entirely eradicate the scratch that itches and the itch that scratches.