Dr. Kevin Most: Food Allergies and The 5 Second Rule

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I am sure we all have heard, seen or participated in the 5 second rule. It seems to always happen with the last cookie, the last piece of bread or something you really want. It is part of growing up.

Many actually believe that the 5 second rule is in fact a rule and has been tested and is accurate. Well hate to break the news but the 5 second rule does not hold up and researchers at Rutgers University spent 2 years showing that. I know many of you are now thinking, “seriously, someone spent 2 years testing that rule?, Don’t we have better things to research, better ways to spend our research dollars?” These are all good questions but not lets get back to the study results.

Researchers tested four surfaces and four different foods to test the theory. They also used 4 different contact times and two different types of bacteria. In all they did 2,560 tests analyzing for bacterial contamination. I know you are thinking, “things must be slow at Rutgers”. They wanted to make sure their results were scientific in nature and no longer lore. The data shows that food is contaminated quickly by bacteria often in less than a second. Some surfaces are better than others, for example, if you drop that bread on carpet it is much safer than if the same bread is dropped on tile. The study also showed that moist items allowed for bacteria to adhere very quickly, so watermelon dropped on the floor should be pitched right away.

The study did show that the longer an item is left on the floor the higher chance of greater contamination but the five second rule is not a simple as we all thought. Now we have to take into consideration the type of food, its moisture level, the type of flooring and the time. No one said there would be Math when we first heard the 5 second rule.

A study in this weeks JAMA is probably a little more important. We all know that food allergies are important and getting to the science on how to prevent food allergies is important as well. Researchers looked at close to 150 studies and trials that looked at the effects of exposing children under the age of one to foods that may cause allergies. They took the data from these studies and have data to present. One way to have more meaningful data is to look and see if it can be coupled with others studies and if similar enough the data can be combined to come to conclusions. In this case they started with 16,000 studies and after looking at how they were performed they found 146 that were very similar. Combining this data allowed them to present us with some interesting findings.

The team identified that introducing egg to the diet of infants between 4-6 months of age, reduced the risk of egg allergies by 40 %. Introducing peanut butter between the age of 4-11 months may lower the risk of peanut allergy by 70%. They looked to see if the age of a child first exposed to gluten had any impact on gluten intolerance and they found the age of first exposure has no influence on celiac disease. This study did not look for the underlying cause or link to the allergies. The researchers think it is an issue with the immune properties of the intestines, but as they were looking at other studies this could not be tested.

The reason for this study was to come up with feeding guidelines for parents. The top researcher feels that some parents may wish to introduce egg and smooth peanut butter into the diet of their children at the same time other solid foods are being introduced. This study shows that delaying the exposure of these foods to a child is likely to increase their risk of allergy to these foods in the future.

This study was just published so I am sure we will be hearing from many pediatricians and allergy physicians as it is reviewed. This will trigger other studies and may also help getting to the basis for the allergies and perhaps a tighter set of feeding guidelines. It may lead to lower rate and number of children with these potentially life threatening allergies. To put it in perspective Children food allergies cost the US almost $25 Billion dollars a year, 300,000 visits to Emergency Rooms for food allergy related symptoms. This may allow us insight as to why the number of children with food allergies rose 50% between 1997- 2011.

Now many parents are thinking , Great but my child has already shown that they are allergic to peanuts, is there anything we can do. A study that was just published last week, coming out of The University of North Carolina has shown that oral immunotherapy can reduce allergies to some foods. This study tested this on preschool age children that were newly diagnosed with peanut allergy. They had 40 children under the age of 36 months who had just been diagnosed with peanut allergy. They took those patients and gave them a very small amount of peanut protein each day and increased it gradually. They also had a control group who received standard treatment and avoidance of peanuts.

Patients received treatment for 29 months, then all of them refrained from any peanuts for a month. After that month patients were given 5 grams of peanut protein. 80% of those treated had no allergic response, the control group only had 4 % that had no response. These results were much better than a similar study done in older children who had a longer duration of peanut allergy.

This study shows evidence supporting the safety and effective treatment of oral immunotherapy. This is being looked at in other clinical trials but the results are promising.

Couple this with the earlier study on exposing all children to peanut butter at a young age may impact the life long consequences of peanut allergies that we are faced with now.

Many parents and grandparents may be thinking that this is fact played out in the past as we often did not restrict food from children as they advanced to solid foods. It also shows the time to start this potential effective treatment is directly linked to the success of the treatment.

I think we will see a lot more about this in the next few months to year and it will have a big impact on we advance diet in children and treat potential food allergies when noted.