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Experts wary of at-home food allergy products
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The online shopping market for medical products has expanded during the past few years to include products that manufacturers claim can help families introduce peanuts and other common food allergens to children.
However, allergists told Healio Family Medicine that primary care physicians need to stress to their patients that a PCP is a much more reliable source for food allergen information.
Companies’ pitches
Some companies offer kits consisting of powdered blends with common food allergens and varying cost. Some advise a stepped approach, slowly increasing the amount, or mixing it with other foods. Other companies offer products they describe as “allergen-inclusive baby food.”
Many of the companies behind these products boast of board members with MDs and PhDs, and many also attribute the development of their respective products to medical experts with research or clinical fellowships in areas such as allergies, pediatrics and/or nutrition. Although none have scientifically rigorous research related to their own products, many provide links to general information, research and recommendations from the AAP, NIH and American Academy of Allergy, Asthma and Immunology to support the importance of introducing allergens into young children’s diets. At least one site encourages parents to Google information for themselves.
A small sampling of the available kits that introduce children to allergies using the stepped approach include: Hello, Peanut! which is priced at $25 for an Introduction Kit that contains seven introductory packets and one maintenance packet. “The first day’s packet contains 100 mg of peanut,” the product’s website states. “Each consecutive day gradually increases the amount of peanut your infant consumes. A maintenance packet which contains 2000 mg, has the most amount of peanut” and is “recommended for use up to three times weekly, until your infant can eat peanut in spread or whole form. The Maintenance packet should be used for the first time one week after your infant finishes the Day Seven introduction packet.”
Another product, SpoonfulOne, combines allergens into daily packets that are sold in monthly subscription boxes. The company’s website touts it as “an insurance policy for the immune system.” Boxes are $80 per month, or $70 per month if a subscription is purchased, and it is recommended that product — a powder with wheat, tree nuts, sesame, shellfish, milk, fish, soy, peanut and egg, — be used for at least one year. “Stir one packet into yogurt, mashed veggies, or your baby’s favorite meal,” Spoonful one’s website says. “We recommend breakfast.”
Some of the allergen-inclusive baby foods include Inspired Start, which states on its website that it is “the only baby food designed to introduce 8 common allergens.”
The website charges $23 for two pouches of either a peanut, egg, tree nut and soy powder or a wheat, sesame, shrimp and cod powder or one packet of each powder.
Another such product, Little Nut, is a “carefully crafted blend of peanuts, coconut, and banana or strawberry that can be enjoyed straight from the squeeze pack or with fruits, veggies or cereals,” according to its website. and costs $19.99 for 16 packs.
Lil Mixins another allergen-inclusive product is described as “100% peanut powder” and is available for $16.50 on Amazon, and according to the product’s website, is “easily” mixed in with food or milk and a jar lasts between 3 and 4 months.
Experts weigh in
Several allergists told Healio Family Medicine they do not believe these products’ claims.
“These kits are not a necessity by any means and are very costly compared with readily available forms of peanut such as peanut butter that can determine if children are allergic to peanuts,” David Stukus, MD, director of quality improvement of the division of allergy and immunology at Nationwide Children’s Hospital, said in an interview. “The kits will not replace any advice or discussion from a primary care provider.”
“These products are trying to medicalize a process that’s been a natural process for many years,” David Fleischer, MD, an associate professor of pediatrics at Children’s Hospital Colorado and the University of Colorado School of Medicine, added in a separate interview. “These companies are trying to capitalize on the fear parents have about introducing peanut.”
One expert in allergies said the only potential benefit to the products is that it would guarantee portion control in introducing common allergens to children, but even that may not always be needed.
“The kits may help preplan and divide doses but are not necessary if a parent feels confident with doctors’ instructions or if the parent follows guidelines put out by the American Academy of Allergy, Asthma & Immunology or the American College of Allergy and Asthma & Immunology,” Tonya Winders, Allergy & Asthma Network president and CEO, told Healio Family Medicine.
How to discuss kits, food allergies with patients
“These kits have not been studied in any way, and there is no evidence to support their use,” Stukus said. “There is no reason to recommend parents spend large amounts of money on these products.”
“These products are not necessary,” Fleischer added. “I don’t think it’s necessary for families to spend the higher cost to buy these products when there are cheap and easy ways to give peanut in natural way.”
Fleischer, a member of both the AAAAI and ACAAI, suggested several ways that PCPs can encourage parents to introduce their children to peanuts to determine their allergy status.
“Heat up some peanut butter, mix it with a food such as a fruit, vegetable, or cereal, let it cool down and then you can give peanut butter in a safe form to an infant. There are certain powders out there that contain peanut that you can mix with cereal, fruits, or vegetables. Peanut puff products that can be dissolved in water are still another option,” Fleischer said.
Winders described another way PCPs can recommend parents perform food allergy tests.
“Feed the child creamy peanut butter in small quantities that has been thinned out with breast milk or water, depending on the child and age, and as long as he or she has good neck control. After introducing the food, look for common signs of allergic reaction such as rashes, hives, or eczema and/or coughing, wheezing, vomiting, diarrhea within 2 hours of eating.”
Stukus, who also belongs to the AAAAI and ACAAI, provided an overview of which children should not be introduced to peanuts.
“Infants who have already had a suspected reaction to peanut should not be fed peanut again until they are evaluated by a board-certified allergist or their pediatrician. Infants with severe eczema or preexisting egg allergy are advised by the guidelines to have a peanut allergy test before introduction, but this is almost always to provide information about how to introduce,” he said.
“Even infants who have a mild or moderately elevated peanut allergy test results often tolerate it just fine, and in fact, they're the ones who absolutely should be eating peanut regularly to prevent allergy from developing, but the first feeding for these infants should be done in the physician's office to be safe,” Stukus added.
Company offers simplicity, convenience
Of the five companies mentioned in this article, only Lil Mixins responded to Healio Family Medicine’s request for an interview prior to this story’s posting.
Founder Meenal Lele, who has a bachelor’s degrees in engineering and economics, provided more insight into the personal story that led to her product’s development
“I found it to be a huge pain to prepare peanuts, eggs, tree nuts, etc. for my second son as our doctor recommended, to help him avoid food allergies that his brother has. Many friends echoed this sentiment when their babies were young. Given how effective early introduction has been shown to be in a number of studies, it was frustrating to have an effective strategy put out of parents reach. We don't claim Lil Mixins will prevent allergies, only that we are making it simple to bring allergens back into infants' diets,” she said.
“The product aims to take the guess work out of following current pediatric guidelines to introduce peanuts with an affordable alternative to daily preparation of food. Parents are still confused by exactly how to prepare peanut butter into forms safe for a 4-month old's developmental stage so we do it for them. We save parents a few minutes each day so that they will actually follow through with regular exposure while maintaining the quality and purity of homemade food,” Lele continued.
She encouraged the use of Lil Mixins in tandem with the advice a clinician provides.
“Lil Mixins’ simply supports parents in working with their pediatricians. If the doctor recommends x grams per day y times per week, our product makes it easy. 1 teaspoon is 1 gram of protein. The powder will mix easily into whatever foods baby likes. No prep, no mess, no fuss. We just save parents the time and money of figuring out how to get peanuts into their baby’s food and how much to give.
Lele also said she “totally agreed” with the comments made by Winders, Fleischer and Stukus for this story.
“Allergens are just foods. It's just that some foods in their normal formulation are hard for young infants to eat because they don't have teeth,” she said. – by Janel Miller
References:
AllergyNorthShore.com. Asthma & Allergy Affiliates, Inc. https://allergynorthshore.com/eyal-oren-md-faaaai/ Accessed July 9, 2018.
Amazon.com. Lil Mixins Peanut Powder Jar. https://www.amazon.com/Lil-Mixins-Peanut-Powder/dp/B079RMFR5H?SubscriptionId=AKIAIOCEBIGP6NUBL47A&tag=&linkCode=xm2&camp=2025&creative=165953&creativeASIN=B079RMFR5H. Accessed July 9, 2018.
Broadinstitute.org. Food allergy science initiative. https://www.broadinstitute.org/scientific-areas/food-allergy-science-initiative. Accessed July 9, 2018.
Childrenshospital.org. Boston Children’s Hospital. http://www.childrenshospital.org/directory/physicians/m/tara-mccarthy. Accessed July 9, 2018.
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Disclosures: Both Fleischer and Stukus were members of the National Institute of Allergy and Infectious Diseases coordinating committee and expert panel for the “Update to the Food Allergy Guidelines, Prevention of Peanut Allergy.” Neither Mele nor Winders report any relevant financial disclosures.