The Peanut Allergy Journey Part 2

In part 2 of our peanut allergy journey, Lindsay and Lauren do a deep dive into peanut allergy treatment and early introduction of peanut foods to infants, as well as the study that changed what we know about peanut allergy prevention. Join us as we speak with NPB CEO Bob Parker, NPB consultant and registered dietitian Sherry Coleman Collins, and NPB agency partner marketing expert Mark Dvorak.

For more information on early introduction and federal guidelines, see the Dietary Guidelines for Americans.

Transcript

Lindsay Stevens: 0:11

Hi, and welcome to The Peanut Podcast where we explore hot topics and future trends and back in the peanut industry including agriculture, sustainability, nutrition, allergies, culture, consumers and more. I'm Lindsay Stevens.

Lauren Highfill Williams: 0:25

And I'm Lauren Highfill Williams. Today we are tackling part two of our series on the peanut allergy journey. To date National Peanut Board has allocated more than $35 million to food allergy research, outreach and education. And it's a topic that's really near and dear to the hearts of just about everyone in our industry. So, we thought it should get a place of honor as one of our first podcast episodes.

Lindsay Stevens: 0:49

So, in our previous episode, we explored how peanut allergy work has become part of really the DNA of the National Peanut Board and the progress that's been made in correcting misinformation about peanut allergies and improving the actual diagnosis of the serious condition. Today, we're gonna be diving deeper into the early introduction of peanuts to help prevent peanut allergies and what's on the horizon for peanut allergy treatment.

Lauren Highfill Williams: 1:12

So, let's get started. I feel a little bit like Miss Frizzle from the magic school bus, but let's go. Okay, so you might already be familiar with the LEAP study, which stands for Learning Early About Peanut Allergy. So, this study was published in 2015, and found that introducing peanut foods to infants as early as four to six months, reduced the risk of developing a peanut allergy by up to 86%. But there was another important lightbulb moment study by the same researcher Dr. Gideon Lack of King's College in London, and this study led to LEAP. So, in the early 2000s, Dr. Lack was considering this discrepancy he'd noticed between peanut allergy rates in Israel and the United Kingdom. So, Dr. Lack learned that Israeli children were often fed a peanut based teething snack within their first year of life, which was totally contrary to guidance from the U.S. and the UK at the time. So, Dr. Lack conducted a comparative study of 1000s of genetically similar children in the UK and Israel to determine the cause of that difference in peanut allergy prevalence. Sherry Coleman Collins is a registered dietician, nutritionist, and food allergy expert who's been working with NPB for the past decade. Sherry can explain the study and its connection to LEAP in a little bit more depth.

Sherry Coleman Collins: 2:36

So, the LEAP study, LEAP stands for Learning Early About Peanut Allergy. And this study was designed based on a sort of observational study that had been done previously by the same group that identified a difference among children in Israel as compared to those in the UK. And what they found was in the UK, those children had a tenfold higher rate of peanut allergies than they did in Israel. And the researchers noted that in Israel, children eat peanut foods as a weaning food very early, almost ubiquitously, almost the entire population eats this peanut food very early. And they thought that perhaps this was why there was such a lower rate of peanut allergies in Israel. So, the LEAP study came out of that and was designed to look at children who were at high risk for developing a peanut allergy based on the fact that they had either severe eczema or already existing egg allergy or both. And they randomly assigned the children, the babies at this point, who are between four and 11 months to either start eating peanut foods when they started the study, or to not eat peanut foods, all the way to age five. And at age five, they did an oral food challenge then to determine which children had developed peanut allergy and which had not. And they found up to an 86% reduction in the risk for developing a peanut allergy and the children who had started eating peanut foods early. So, this was huge finding and was even better than anyone could have anticipated and showed that this early introduction of peanut foods actually prevented peanut allergies.

Lauren Highfill Williams: 4:17

I was working for the National Peanut Board at the time. And I remember when the LEAP study was published, and there was this resoundingly cheer across the peanut industry. But LEAP was just one study, which might make you ask what was so groundbreaking about it, or why were future changes made based on this study? In short, everything about it was huge.

Sherry Coleman Collins: 4:40

I think the first thing was it was a very rigorous study. It was large, there were over 600 babies involved. So, that's a lot. That's a lot of kids. It's not like it was a very small study and many food allergy related studies are small, but this one was big. They had a great retention rate. So, the people who started the study overwhelmingly stayed in the study and the results, the outcome was significant, huge, right? And it really changed the way that many pediatricians and allergists looked at prevention, recognizing that previously, the recommendation was to withhold these allergens in these high-risk infants thinking that if we waited to feed the food, peanuts, in this case, but other allergens perhaps as well, if we waited until the immune system was more developed, then maybe there'd be a lower risk. But this actually challenged that and changed that thinking completely. almost overnight.

Lauren Highfill Williams: 5:34

The National Peanut Board was able to help provide some of that initial support in this study. So, starting in 2002, NPB began to support the work of Dr. Lack and his team to better understand the impact of early feeding and other factors on the development of peanut allergies. Bob Parker is the President and CEO of the National Peanut Board. This is 41st peanut crop.

Bob Parker: 5:58

Early research was provided by the National Peanut Board to King's College in London, England, that they credit with them being able to take the small research study they did, and garner that into a huge research study called LEAP.

Lauren Highfill Williams: 6:18

The LEAP study was a game changer and many in the industry have wonderful memories of the day that it was published in the New England Journal of Medicine. Mark Dvorak, has been working with the board for more than 15 years, through our PR and marketing agency Golin. Just over the past couple of years, Mark's focus has been on food allergy, specifically driving the recommendation of early introduction of peanuts, that came from the LEAP study, and making it the standard practice that all pediatricians, healthcare professionals and parents follow with their infants.

Mark Dvorak: 6:52

I remember the day that the LEAP study came out like it was yesterday. It was February of 2015. In Houston, Texas, at the the gathering of the AAAAI, and we didn't know what exactly it was going to say. But we knew it was going to be good news, or at least though that was the impression that certainly had that had been shared with us. And it because it was such a big deal, not only did it get the allergy and pediatric community excited, but we saw lots and lots of coverage in the mainstream media about the study. It was 180 degrees different from what pediatricians for the most part had been telling parents for most of the past generation.

Bob Parker: 7:41

That was, that was one of the best days to see that. It's been disappointing that we still have slow uptake in the medical community in the U.S. and a lot of parents don't know about early introduction or haven't bought into it yet. A lot of medical professionals have not. So, we've got a lot of work to do.

Lindsay Stevens: 8:06

While the American Academy of Pediatrics backed away from their previous guidance on avoidance in 2008, stating that the introduction of peanuts shouldn't be delayed as a means to prevent peanut allergies. It wasn't until after the LEAP study was published, the health organizations got together to provide some updated guidelines.

Sherry Coleman Collins: 8:22

Because of the results of the LEAP study, around the world, allergy organizations and pediatric organizations came together and they initially developed a consensus statement. So basically, it was all of these big groups came together and said, We believe that we should be feeding babies peanut foods in order to reduce the risk of developing a peanut allergy around the world. But every country has sort of a little bit of a different way that they're implementing those guidelines or taking that information and applying it to their population. Here in the U.S., we have the National Institute of Allergy and Infectious Disease, the NIAID, and they actually developed addendum guidelines to some previously published guidelines on managing food allergies. The new addendum really used the LEAP study as the guide and established recommendations for introducing peanut foods based on the child's risk because of their either eczema or egg allergy just like the LEAP study.

Lindsay Stevens: 9:21

Then, more good news followed with the USDA using the LEAP study to adjust their guidelines as well. This change actually happened within my first month of working at the National Peanut Board, which was super exciting. I just gotten on board and all of a sudden we had these great new guidelines to support what we were doing.

Bob Parker: 9:38

And then at the very end of 2020, the very last week of 2020. The new dietary guidelines were published by USDA, that included guidance on early introduction of peanut for the first time ever, and so we're going to see hopefully a broad adoption of early introduction for peanuts.

Sherry Coleman Collins: 10:04

The Dietary Guidelines for Americans, of course, is a document that is published jointly by the USDA and HHS. They come together each five years, and they publish this document that essentially tells Americans how they should be eating. And in the past, it has not included recommendations for infants. But this time around, they decided to go ahead and include recommendations for babies zero to two years old. And in these new guidelines, they make recommendations for sort of dietary patterns. But in the infant guidelines, they specifically included recommendations for introducing potentially allergenic foods and highlighted peanuts as one that is sort of a must feed for infants, all infants, and that's unique and different from both the LEAP study and from the NIAID guidelines, which focus heavily on those high risk infants. But what we know from the subsequent studies that have happened after the LEAP study is that there seems to be a benefit for all babies, when they start eating peanut foods early. We know that it's not just the high risk infants that go on to develop peanut allergies, peanut allergies can develop in children that we had no idea had any risk factors. And so, when we feed peanut foods to all babies, we can reduce the risk of developing a peanut allergy among all babies.

Lindsay Stevens: 11:33

So, with the consensus statement from leading allergy and pediatric associations, new federal guidelines and the inclusion in the federal dietary advice for feeding infants, all supporting introducing peanut foods early to help prevent a peanut allergy, you think that every new parent, pediatrician and health care provider would be following this guidance. But that's really not the case. Mark explains the challenges and opportunities of reaching parents and healthcare providers.

Mark Dvorak: 11:59

In marketing, there's the traditional push pull model about when you're trying to get a consumer to take a step or make a purchase. Are you driving them to go talk to their doctor, for example, about the the new drug or the new product or the or the intervention? Or are you encouraging the doctor to reach out to their patients? And what works best, particularly in this case is both. And so we had already been working and continue to work with reaching healthcare professionals. But we said let's see how we can move the needle if we do more and get deeper with with new parents and parents-to-be and encourage them to seek out the counsel of their health care provider. And the reason that's such an important step is because the research we did showed us that doctor recommendation far above anything else was the number one motivator that would get a parent over the hump from just knowing about early introduction to actually implementing it with their child. And so, as we were getting ready to decide what we were going to do, we went to New York, we took Dr. JJ Levenstein, the chair of our food allergy Advisory Council, and Sherry Coleman Collins, and sat down with editors at places like Parents magazine and an all the new online parenting and baby sites and said, Alright, let's you covered this once most of them had. Back when NIAID guidelines came out. Let's talk about what a an additional package or set of stories could look like. And resoundingly they said to us, there's no new news here. And we said, as we joked about earlier, there are new parents born every day Why, what do you mean there's no news? And their their answer to us very clearly was give us something new and different. Now, we didn't conduct the LEAP study. We are you know, we are not researchers. But it became really clear that the best thing we could do was show parents, other people like them, people they respected or trusted or could be proxies for for those people in their lives, going through the same kinds of thought processes and steps that they would be going through. And that led us to our first campaign in 2017 with Justin Baldoni who many folks know from Jane The Virgin and, and other Hollywood shows and events. And he had a newborn new son Max, who was getting to be about four months of age. And Justin and his wife embraced this project wonderfully. They took us in a series of three videos through what they were experiencing. They were deciding about early introduction and then carrying it through with with their son. And it's, it's probably not probably it is the campaign I'm most proud of in my career, for a lot of reasons. It was it was phenomenally successful, most of all, because we did research before and we do research after. And those folks who were exposed to the campaign, I forget the specific numbers, but significantly more likely, and ready to actually introduce peanut foods early. And that said, Wow, we just need to keep the drumbeat going.

Lindsay Stevens: 15:38

So, going back to what Mark said about having to both push consumers to actually introduce peanut foods to their babies and pull healthcare providers to advocating for early introduction with their patients, pediatricians were the obvious group to focus on. But it soon came to light that we needed to ensure that other health care professionals who see babies like family, doctors, nurses, and even WIC counselors, were also carrying the torch for early intro too.

Mark Dvorak: 16:05

I think back a couple of years, particularly right after the guidelines came out in 2017. And we were not the only group or organization pushing early introduction. But I would argue, I think, pretty safely that we put the most time and resources into it and had the loudest voice. And we started with pediatricians, because they are obviously the ground zero. They're the folks who see the most infants. They are also through their academy, the Academy, American Academy of Pediatrics, are the voice of what what is right, how do you how do you raise healthy infants. And so, getting them on board and and making sure that we were in sync with them was so very important. And we've just completed an online course not only for pediatricians but for all healthcare professionals, that walks walks them through the basics, and most importantly, how to handle objections. When a parent says, Well, what about or how do you handle this? We we deal with those directly, because that's what a lot of the pediatricians have been telling us that that's where the comfort level was not quite there. But, you know, pediatricians are key, as we said, but 50% of the children in this country are eligible for WIC women, infants and children. That's a lot of babies who may never see a pediatrician. You know, their, their mothers are getting care through the WIC system, a public health doctor, and they were important to us. We also know that family practitioners, Family Medicine doctors, particularly in rural areas, see a lot of folks and often for a lifetime. So, we them, dieticians, nurse practitioners, physician assistants, there are a lot of health care providers who come in contact with or influence parents when it comes to their children, particularly around infant feeding. And if we don't reach all of those groups and bring them on board, we're gonna find gaps. And I'm I'm also very proud just like of that campaign with Justin Baldoni that we have been ahead of a lot of other groups and and thinking in terms of reaching those folks. Everybody's pediatrician, pediatrician pediatrician, which is absolutely right. But as that momentum has been building that's allowed the National Peanut Board to start looking at these other groups. And again, I'll credit the Board that said to us a couple of years ago, as we launched this expanded campaign, you know, let's make sure we engage and reach underserved and at risk populations, particularly rural, particularly folks low income, or, or minority communities who get short shrift often in health care in this country, and make sure that they don't fall further behind. And so, that's really what we've been focused on most recently.

Lauren Highfill Williams: 19:19

People outside the peanut industry or those who don't have a peanut allergy may not actually realize that having a food allergy is a serious health condition. It can have not only physical consequences, but can also impact quality of life and cause a financial burden for families and the healthcare system at large, especially when you consider the costs of emergency medication and medical care. That's why taking the steps early for preventing peanut allergy for everyone is so important.

Sherry Coleman Collins: 19:48

Food allergies as we know now can be prevented and we may not be able to prevent every single case of peanut allergies in every child moving forward through early intervention through early feeding, but we can prevent a lot of them, maybe we can prevent most of them. And I think that to me is the most exciting thing is to see the numbers of children in the in the United States. The numbers of children with peanut allergies consistently go down over the next generations.

Lauren Highfill Williams: 20:16

Prevention is not the only part of the peanut allergy story. Recent breakthroughs and treatment are also changing the lives of allergy families. In early 2020, a new peanut allergy treatment was discovered with Palforzia. While it's not a cure, it's a start.

Sherry Coleman Collins: 20:33

Unfortunately, you know, at this point, we do not have a cure for peanut allergies. We can't cure food allergies, at this point with what we know now some children who develop peanut allergies and other food allergies will outgrow them. And that's fantastic. And that might happen naturally. But what we know is that oral immunotherapy and other types of immunotherapy can help increase the threshold at which a child might have a reaction. So, we know that now Palforzia is the newest treatment actually the only treatment for peanut allergies that's available on the market that can increase the threshold here, just as I've described, so making it less likely that if a person accidentally eats peanut foods, they're going to have a severe reaction, it doesn't mean that reactions won't happen. It doesn't mean that the food allergy is gone. But it reduces the risk. And it can have some really positive benefits like increasing quality of life, reducing anxiety, making it more comfortable for people to live their lives, without worrying as much about anaphylaxis. A couple of exciting areas where I think there's a lot of promise are in the area of biologics. So, these are medications that you may have heard about being used to treat autoimmune diseases, for example, similar drugs or even in some cases, the same drugs seem to have some very good potential for treating or even preventing all reactions due to food allergy. So, an individual who has a food allergy may be able to take some of these medications, and they actually prevent reactions from happening. So, the food allergy again, it's not a cure, the food allergy doesn't completely go away. But the individual with the food allergy doesn't have a reaction when they eat the food, because this drug actually blocks the reaction from happening. So, these are under a category called biologics. That's one. Another one is in the development of vaccines, which you know, vaccines are very much in conversation these days. But these vaccines actually, similar to the biologics stop reactions from happening, they may not cure a food allergy, the person might still have the food allergy, or in some cases, there's, there's, you know, the thinking that perhaps it could be a cure, I think we're a long way from knowing that, you know, years away research has, you know, there's a lot of research that still has to be done for both of these, both of these options, they're also pretty expensive. That's another thing that's a bit of a challenge. The biologics in particular, these drugs are available, but they're expensive. They're also injectable drugs, which is another sort of barrier for some people. But they're they're exciting. It's it's promising. I think that the fact that the pharmaceutical industry sees this as an opportunity means that that there's going to be opportunities for people with food allergies in the future.

Lauren Highfill Williams: 23:22

So, with all that's been accomplished with peanut allergies in the past 20 years, what can we expect from the future?

Bob Parker: 23:28

We have 4 million babies a year born in the United States. And based on a prevalence rate of 2% to two and a half percent, we have 80 to 100,000 cases of peanut allergy emerge each year from this group. If we can reduce that, by over 80%. We're, we're having a profound impact on the health and happiness and peace of mind, millions of Americans over time.

Mark Dvorak: 24:03

If you go to the AAP website, they have a list of 10 innovations in child health that AAP made possible. And my goal is to get early introduction on that list. And I think part of the challenges is that these other things on the list aap identified and made it the cause and this is more of like we're bringing it to them. That's kind of where the ownership thing comes in where it's, you know, how do we, you know, Robert Woodruff, the longtime CEO of Coca Cola, and and I've learned since other people have said this, it's amazing what you can get done when it doesn't matter or you don't care who gets the credit. The peanut farmers deserve a heck of a lot of credit for this and even more when it really becomes the standard. But the industry doesn't care about the credit as much as it cares about keeping kids and family safe. So, you know if we can get to that point where there's where folks really get on board with this and really embrace it. That's, that's what it's gonna take.

Lauren Highfill Williams: 25:14

So, Lindsey, what stood out to you from the conversations you had for this episode? What did you really take away from all this?

Lindsay Stevens: 25:22

Yeah, so, I think that what really stood out to me the most was the time that it took for new guidelines and medical recommendations to even come to light. I think Andy Bell really said it best in our last episode, that progress can come slow at it, it really does take time. And I feel like the peanut allergy journey is a true testament to that. How about you, Lauren?

Lauren Highfill Williams: 25:43

Well, I think usually as marketers communicators, we're really focused on those measurable changes, data, ROI, like, okay, we've made these huge investments and getting parents to introduce peanut early, how has that translated to reducing the actual prevalence? And I think that's still an important question. And we'll take some time to see an impact, like you said, but something that was part of every single conversation I had was how important changing hearts and minds and conversations is. making inroads, building bridges with the food allergy community, having national healthcare groups take up the charge of early intro organically, those are achievements that are hard to quantify, you know. But for me, and I think for everyone that we heard from today, they would argue that they're just as important in the long term for making that meaningful impact on peanut allergy that we're really looking for.

Lindsay Stevens: 26:38

Yeah, absolutely.

Lauren Highfill Williams: 26:40

Yeah. So, now it's time for our peanut fact or joke. Lindsay, are you ready for this absolutely nutty joke?

Lindsay Stevens: 26:47

Let's hear it.

Lauren Highfill Williams: 26:50

Okay, why did the peanut lose the rap battle?

Lindsay Stevens: 26:54

Oh, gosh, how come?

Lauren Highfill Williams: 26:56

He was roasted!

Lindsay Stevens: 26:58

Oh, wow. That was that was really something. Love the play on words.

Lauren Highfill Williams: 27:04

Yes, it it was a joke. I told that to my five year old and it didn't didn't resonate, no.

Lindsay Stevens: 27:12

You know, you you can't you can't hit every

Lauren Highfill Williams: 27:15

We'll try some others. Alright, so as mark. always, don't forget to subscribe to our podcast. If you have any ideas or comments, questions about our episode, shoot us an email at Lh Williams at National Peanut Board dot org. Also make sure to join us once a month here for a new episode of the peanut podcast. Thank you for joining us.