
Peanut allergy cured in majority of children in immunotherapy trial - DanBC
https://www.theguardian.com/australia-news/2017/aug/17/peanut-allergy-cured-in-majority-of-children-in-immunotherapy-trial?CMP=twt_gu
======
hanklazard
Physician-scientist here. My graduate work was in an immunology lab. Just
wanted to clear up some confusion I've seen in multiple posts.

While both peanut allergy and celiac disease involve pathogenic immune
responses, they represent very different types of problems and this study's
results do not suggest any relevance to celiac.

The peanut allergies that they are referring to in this study are one of the
most striking examples of what's known as a Type I hypersensitivity (IgE-
mediated/anaphylaxis). In this type of reaction, high levels of IgE, a class
of antibody, generated toward a specific antigen become loaded onto mast cells
and on re-exposure, cause mast cell degranulation and subsequent smooth muscle
contraction. For this reason, anaphylactic responses frequently involve
closing of the airway, nausea/vomiting, and other dysregulations of smooth
muscle activation and require a strong adrenurgic agonist like epinephrine to
counteract this activation.

Celiac pathogenesis is not a Type I hypersensitivity. To my knowledge, the
exact mechanism of pathogenesis is not known, but it is likely a combination
of Type III (antibody-mediated) and Type IV (T-cell mediated)
hypersenitivities.

Anyway, I'm not trying to ruin anyone's hope here, but this study has no
relevance for celiac. What this has shown is that there is the potential for
food allergies to be systematically eliminated with long-term increasing
exposure to the problematic antigen, in this case, peanut antigen. This has
been done for some time with other, less aggressive types of IgE-mediated
conditions like dog and cat dander allergies. So in that way, it's not all
that surprising of a result, but I'm certainly glad to see that this was able
to be done safely. This is really great news for the millions of people out
there with anaphylactic food allergies.

All that being said, I do hope that celiac can be managed more effectively
with immune-modulatory (or other) treatments in the future and my sympathies
go out to those who have been affected by this horrible disease.

~~~
testestx
> This has been done for some time with other, less aggressive types of IgE-
> mediated conditions like dog and cat dander allergies

Can you link to this please? Is this "allergen immunotherapy"[0]?

[0]
[https://en.m.wikipedia.org/wiki/Allergy_to_cats#Allergy_shot...](https://en.m.wikipedia.org/wiki/Allergy_to_cats#Allergy_shots)

~~~
hanklazard
Yes, that's correct. Mayo Clinic has some good basic information here:
[http://www.mayoclinic.org/tests-procedures/allergy-
shots/bas...](http://www.mayoclinic.org/tests-procedures/allergy-
shots/basics/definition/prc-20014493)

Hope that's helpful.

------
S_A_P
My daughter has Celiac disease. It was diagnosed at age 4 when her growth
chart showed she did not gain a single pound and grew ¼" from age 3-4. We did
a biopsy of her small intestine and it was completely smooth. (Should be
almost like velvet) Herblood levels also showed high sensitivity to gluten. We
have her on a strict gluten free diet and she has since followed the growth
chart perfectly. However she is sensitive enough that she can not eat gluten
free food that has been prepared on the same grill/pan/cook or prep surface as
food containing gluten. She suffers from nausea and diarrhea when cross
contamination occurs. What this means is that I have to cook every meal she
eats and bring it with us if we go to restaurants. We live in probably the
best time ever for gluten free foods, but this is still a significant hardship
for her. She is 7 now and I worry about as she gets older and wants to hang
with friends/date/college. Unless things change she cannot just go grab food
at a restaurant. Some restaurants have a gluten free protocol (PF changs comes
to mind) but this is not common. From what I've read gut bacteria could be a
contributor to gluten intolerance. I really hope studies like the peanut
allergy encourage other dietary studies and immunotherapy becomes more common.
Her having celiac disease is not the end of the world but her quality of life
would change drastically if she didn't have to worry about that.

~~~
nibstwo
I have Celiac. Unfortunately immunotherapy is not currently done in a way that
would make much of a difference for us. Celiac is typically an autoimmune
response to Gliadin protein as a result of human leukocyte activation genes
HLA-DQ2.2/2.5 or HLA-DQ8. In either case, it is happening at the cellular
level for every cell that comes into contact with the protein. The intestines
are hard hit mostly because they spend the longest time with exposure. I found
for the first year or so I simply could not eat anything made by a restaurant
or friend because of cross contamination. My resilience went up over time
though, it takes a few years for inflammatory activation to come back down to
a subclinical level even if the gut repairs in 3-6 months. Gut bacteria change
in response to all the immune activity, but damping the immune response would
not necessarily fix the issue of the protein destroying the cells it comes
into contact with. The immune response is therefore not entirely autoimmune in
nature but necessary to protect the cells. The vili are being destroyed
directly, essentially. You could develop a drug that would dampen the immune
response (I think a few others posted links) but you could not realistically
get to a point where you can eat gluten. The antigen will always destroy your
cells, autoimmune response or not. Sensitivity depends on how many (one or
two) of the HLA genes you have that react with gluten. I have one out of two
so my reactions are less severe (only 2-3 days with symptoms). If you have
both Celiac HLA genes, it will always and consistently harm you.

~~~
S_A_P
Thanks for this- it sounds like I need to do some more research to completely
understand whats going on, but this is very helpful. If you dont mind my
asking, are your symptoms mostly GI related? Ive heard others can have
symptoms that manifest in things like sinuses getting plugged up or skin
rashes. Also sounds like a drug similar to Humara may be something that could
provide at least some relief to the immune response.

~~~
nibstwo
No. Mine were mostly cognitive. I mean, when I was a kid I had no tooth enamel
(had to have surgery to install fake teeth) and puked up everything I ate that
had wheat in it, but somehow no one diagnosed it until later. I just assumed
it was normal but my symptoms were migraines, anxiety, stomach bloating, joint
pain, hair loss, stunted growth, constant fatigue, sleep apnea, nutrient
deficiencies, malabsorption. It took about a year to feel better. It used to
be cross contamination would mean 3 days of pain, gluten 7 days. Now cross
contamination is a worthy trade off for occasional meal out, and gluten is 2-3
days in small amounts. I shudder to consider eating a full bun or something
but I haven't tried in years. I know within 10 minutes because the skin inside
my mouth peels off. So I kind of have systems for managing it. I have a normal
job and would say it has not really hindered me outside of eating a very
strict diet. Having support from my partner also helps a great deal. It's good
you caught it early.

~~~
jerf
"I shudder to consider eating a full bun or something but I haven't tried in
years."

I have it nowhere near as bad as you (which is why it went undiagnosed until I
was 30... although it's still pretty bad). But for about 5 years after I found
out I would have recurring dreams where I would be eating a hamburger and
realize after swallowing "Oh, crap, that's a normal bun!" I suppose in some
sense that might qualify as a nightmare the first couple of times, because it
would fully wake me up.

~~~
jjjensen90
I also have Celiac disease, somewhat less severe than nibstwo, and I also have
recurring dreams where I eat something (usually pizza) and midway through
realize it is made with wheat dough. This was further compounded when once I
ate a package of vegetarian chicken wings (made of wheat gluten) which was
mislabeled at the grocery store (gluten free tag on the price label) and next
to veggie burgers by the same brand with the same packaging where ARE gluten
free and I had eaten before without a problem... I was sick for about a week,
couldn't work or think straight. I won't make that mistake twice!

Another funny angle--I also have Type 1 diabetes (diagnosed when I was 9) and
for a long time after diagnosis I had dreams about drinking a 64oz soda only
to realize it wasn't diet, and panicking since I would probably be in DKA soon
after!

Maybe there is some immune system disease/nightmare link that has gone
undiscovered :)

------
gehwartzen
The AAP also recently changed its guidelines for introducing peanuts to babies
based on a study [1] showing a pretty dramatic decline in the development of
the allergy with early exposure vs total avoidance.

[1][http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#abstract](http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#abstract)

~~~
giarc
We've created this fear in parents that they must keep peanuts away from their
child. My colleague wouldn't bring peanuts into the house with her first child
and by age 3 her son still hadn't eaten peanut butter or any other peanut
products. She wanted to introduce peanut butter to him and went as far as
bringing him to the Children's Hospital emergency department and gave him a
tiny amount of peanut butter while sitting in emergency waiting room. The idea
being that she'd be able to get help quick if he went into anaphylactic shock.
I thought, and tried to explain to her, that a 3 year old in daycare probably
has been exposed to peanuts already, and therefore was very unlikely to have a
severe reaction. But you can't always use that logic on worried parents.

This idea of introducing the food in an ED waiting room is probably something
spread on mommy forums such as BabyCenter. One mom shares it, then there is
social pressure to do the same thing. A parent probably thinks "Does it make
me a bad mom if I don't do it." Very unfortunate.

~~~
ccleve
Instead of feeding our baby peanut butter, I smeared a small amount on his arm
first. The skin got red and bubbled up. We took him in, got him tested, and
found that he had the allergy.

Thank God I didn't feed it to him.

~~~
blakeholl
My son has a peanut allergy which manifested in the same way. We were then
told to have a component test done on his blood to determine which proteins he
was actually allergic. It was explained that some are more commonly related to
anaphylaxis while others tend to just cause rashes, etc. He ended up testing
positive to one that is considered "bad", and he has been in OIT for awhile.
So far so good - but I recently heard of a child doing the same with milk OIT
and the child passed away. Very scary stuff.

------
rhexs
Does anyone know the history of why allergists assumed this just wouldn't work
for decades? I'm assuming they initially tried this at the dawn of the
allergist specialization but gave up due to bad practices / deaths?

I only ask because it seemed to have been general knowledge that this was
impossible / couldn't be done up until recently. As a outsider looking it, it
seems quite obvious, but that's just due to naivete.

~~~
ljf
I'm relatively 'new' to allergies, but from some of the conversations with
doctors there was a fear that repeated reactions (even minor) could be priming
the body for worse reactions. This obviously goes against the results we are
seeing now, but don't forget this is a very new area of study - people were
only first diagnosed with food allergies in the 60s.

The original trial (I believe) came from a study that saw a certain Jewish
community that eats a lot of powdered peanut, had a higher incidence of
children losing their nut allergies. So the environment helped to prime these
children.

My kid has allergies, and over the last 2 years we've seen the advice change
rapidly - from initial suggestions to keep him away from anything that might
cause him hives (soft play centres etc) to now where they encourage that
(though obviously we still keep him away from eating allergens.

He had a laundry list of allergies that he responded to on his skin prick test
last year, but his results yesterday were so much better - with the
possibility that he only has 4 core responses left (peanuts, sesame, milk,
egg) - with time still to lose those over time (he's only 3). We've been
giving him loads of probiotics, namely Water Kefir - but no idea if he would
have grown out of them anyway.

Happy to have a stab at any questions people might have - but I'm no expert,
just a (reasonably) well read dad - my wife know far more than me about this.

~~~
throwaway5752
I don't think it's powdered peanuts. My understanding is that in Israel, a
snack food called Bambas (peanut butter flavored corn puffs) is widely given
to children and allergists noticed a huge difference in childhood peanut
allergies. It's changed peanut exposure recommendations for infants
completely.

~~~
ljf
Could well be - I read that article some time ago, so likely misremembed the
detail. Cheers

------
jwineinger
I'm a parent of a 4-year old with a peanut allergy. We've been told that
anywhere from 18-25% of kids with it "outgrow" the allergy by age 5. I've been
looking into private practice oral immunotherapy (OIT) recently, which this
protocol seems to be a variant of (adding the bacteria). My understanding is
that you start with a low dose and then gradually increase over months until
you're eating whole peanuts (4-12 of them) in the morning and evening as a
maintenance dose. From what I've found, this can work for many types of food
allergies and for all ages and all sensitivities.

~~~
JohnTHaller
This is basically what most allergy treatments are. Start with 1/1000th of a
peanut and gradually increase. It's a simple concept that's been used for
nearly a century for other allergens. I did it for cat allergies over a decade
ago. Developed them in college after growing up with cats. I have cats now.

~~~
wyldfire
I don't want to own cats but I would like to cope better with visiting cat-
owners' homes. You seem to describe some sort of DIY immunotherapy for cat
dander? Can you go into details?

~~~
JohnTHaller
Not DIY. I went to an allergist, found out what I was allergic to, then they
inject you with gradually increasing amounts of what you're allergic to weekly
in their office. There are risks, as you could have a bad reaction. If you do,
you down 1/2 a bottle of Benadryl and go to the ER if necessary. I had one bad
reaction in the 2 years I did shots and a double dose of Benadryl fixed it.

~~~
BenjiWiebe
Nowadays some immunotherapy clinics require you to have an EpiPen along or
they refuse to give you your shot. Source: currently getting immunotherapy
shots

~~~
JohnTHaller
This was over a decade ago and in NYC, so it was basically impossible for me
to be alone or far from a hospital within 30 minutes of getting a shot. When I
started to feel the reaction coming on, I had plenty of time to grab my bottle
of Benadryl out of my bag and take a couple swigs while I was walking down the
sidewalk. I'd wager it looked interesting to other NYers.

------
herewegohawks
Very severe peanut allergy here - honestly go away with this crap of comparing
your gluten allergy. I have to carry an epipen and worry about risking my life
when I so much as eat food that was on the same table as baked goods that
MIGHT have traces of peanut butter.

~~~
gozur88
Yeah, this article is great news. I have a relative with a severe reaction
similar to yours - I swear it's off to the hospital if he looks at something
that was processed in the same state as food with peanuts. It's heartbreaking,
and his parents break out into a cold sweat whenever he's far from emergency
medical care, like on a long flight.

------
sageikosa
When in her teens, my daughter developed a peanut allergy during her time in
drum corps such that it was confirmed with skin patch tests and she had to
carry an epi-pen. After about a year it just went away and she's back to
"normal".

~~~
6d6b73
Did she changed her diet in that time? Personally I noticed that the diet is
what really drives the allergies. What's more, my son developed dog allergies,
and we were about to give up our dog, but before that we decided to change the
diet of .. the dog. Believe it or not, after 6 months my son is no longer
allergic to our four-legged family member, but also to most other dogs.

~~~
Spacemolte
That sounds really interesting, that's one of those things i would never even
have thought about. Can you elaborate on what dog food you used before and
after?

~~~
6d6b73
I also would not suspect that this could help, but we noticed that he did not
react to my sister' dog, that has a very strict diet (below) but was reacting
to other dogs. So it made sense to try switching the diet before giving up on
the dog.

Before my dog was getting a mix of dry and "wet" food, from various companies,
and occasional scraps from the table. Currently we only feed him dry food from
Orijen, and plan on introducing some other "wet" food soon. He's also getting
a good quality bones with a lot of bone marrow, and about once a week some
boneless sardines in olive oil.

~~~
nucleardog
A bit of anecdata - but all of our animals (few dogs, couple cats) have shed
significantly less and had a much healthier looking coat once we switched them
to better foods.

The reduction in shedding going from kibble that's primarily rice and corn to
something that's actually nutritionally appropriate ingredients for a dog/cat
was astounding (but should have been unsurprising).

My understanding is that pet allergies are generally allergies to the shed
hair and skin, so a healthier diet may have reduced that significantly.

(For anyone curious, a basic analysis of a "cheap" food:
[http://www.dogfoodadvisor.com/dog-food-reviews/alpo-dog-
food...](http://www.dogfoodadvisor.com/dog-food-reviews/alpo-dog-food-dry/)
And a basic analysis of a "good" food: [http://www.dogfoodadvisor.com/dog-
food-reviews/acana-singles...](http://www.dogfoodadvisor.com/dog-food-
reviews/acana-singles-dog-food/))

------
0xbear
True story: in Russia (and I can only assume other Eastern European countries)
peanut allergy is so rare that I've never even heard of it until I emigrated.
Pollen allergy is about the same, ragweed pollen allergy can be really bad
too. But not peanut allergy.

~~~
makmanalp
I've wondered too. Very similarly in Turkey - growing up I'd never even heard
of anyone with serious allergies to anything really, except perhaps seasonal
allergies, which mostly meant a runny nose. Certainly I'd never seen an epi-
pen in my life, and no allergies people took serious medication or did
immunotherapy for. Do we have a proper explanation for this?

edit: one study citing a need for more data:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879010/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879010/)

another old article (2011) on the Hygiene Hypothesis:
[https://www.nature.com/nature/journal/v479/n7374_supp/full/4...](https://www.nature.com/nature/journal/v479/n7374_supp/full/479S2a.html?foxtrotcallback=true)

~~~
rconti
I had never heard of it, either, growing up in the US in the 80s and 90s.
Certainly it is far more prevalent now than it was back then.

------
6d6b73
I wonder if they had a control group taking only the bacteria, and another one
taking only peanut proteins. If not, why did they decide on this combination?

------
matt_wulfeck
What's amazing to me is that they used to recommend you don't give children
any peanuts until a specific age, but then they learned that easily exposure
actually dramatically decreases the chance of developing an allergy.

I feel like I have to throw away almost all advice they give us about kids
these days. These types of things do a lot to undermine the advice of doctors.

~~~
YCode
Not just these days... Not long ago breast milk was considered
distasteful/inferior to formula and newborns were forced on their stomachs so
they didn't choke to death on their own tongues/vomit.

The latter by the way led to a dramatic increase in incidents of Sudden Infant
Death Syndrome causing us to roll out the "back to sleep" movement.

Many still disapprove of sleeping next to your baby despite it being as safe -
safer in some instances - than sleeping in a crib and providing a protective
effect against SIDS via the parents breathing/heartbeat as rhythm keeping and
carbon dioxide that triggers regular breathing.

You basically have to take all parenting advice (even from a doctor) with a
grain of salt and at the end of the day do what you as the child's guardian
feel is best, especially because no one style or technique will work for all
children.

~~~
nradov
Yes there have been some bad errors by the medical and public health
communities. But on the other hand, now we have parents who don't vaccinate
because they "feel" it's better for their child. Most peoples' feelings aren't
to be trusted.

~~~
YCode
To be fair, the vast majority of people feel they should vaccinate their
children.

And I use "feel" explicitly because often on more subtle issues there wont be
a clear answer, even from your doctor.

------
nsxwolf
This seems so obvious, and I've been hearing about this approach for years and
years. Yet it still feels like 20 years from now, this will still not be a
treatment, and kids classrooms will still be "nut free", and more and more
kids will be carrying around epi-pens which will still cost a fortune.

------
gregwebs
Journal article is here:
[http://thelancet.com/journals/lanchi/article/PIIS2352-4642(1...](http://thelancet.com/journals/lanchi/article/PIIS2352-4642\(17\)30041-X/fulltext)

------
manmal
Can we derive that Lactobacillus rhamnosus could reduce all kinds of allergies
when taken, even without adding proteins that you are allergic to?

~~~
ljf
We really don't know - but I really think there is a link between gut bacteria
and allergies, based on some of the reading I've done, though it's all very
early days for research in this area. Our boy has allergies and we've been
giving him Water Kefir daily for the last year (we would give Milk Kefir, but
he's currently allergic to dairy too :( His allergies developed after a dose
of antibiotics - which likely would have wiped his gut bacteria out, so
anything which can help him there is worth trying. The amount he's had now
though, it's be shocked if he wasn't better than average in that metric

I personally think that we will look back at the symbiotic relationships that
bacteria provide, and be amazed by the way we currently live - with hand
sanitisers, and even antibiotic dish soap - plus antibiotics in our meat and
water... Sure we will look back on this time in the same way we look at Romans
and lead water pipes.

~~~
6d6b73
Suggestion based on my N=1. If your son has any seasonal allergies, try giving
him tiny amounts (1/4 of a teaspoon) of raw local honey every single day.

~~~
ljf
Cheers for that - need to track some local honey down now ;)

------
vanattab
Yumm... I can't wait for the shellfish version! I would love to try shrimp
again and find out what all the fuss is about with lobster.

~~~
rangibaby
Don't expect too much lobster (like caviar) is basically a Veblen good unless
you live somewhere you can get it very cheap

~~~
ghaff
You'd have to convince me that lobster is a Veblen good. Yes, it's often
priced as a luxury good once you get away from the New England coast--and
sometimes even there--but that's not the same thing as saying higher prices
increase demand. I expect the restaurant selling $25 lobster rolls would sell
more if they were a more reasonable $12 but they might not make as much money.

I do like lobster when the price is reasonable. What is true is that it's very
delicate so it's really wasted in things like lobster mac and cheese.

~~~
Retric
We used to use Lobster as prison food / dog food because nobody liked it. It's
mostly a tasteless meat which has become more popular as westerners have
shifted to blander foods.

[http://www.npr.org/sections/thesalt/2015/03/26/394339284/how...](http://www.npr.org/sections/thesalt/2015/03/26/394339284/how-
snobbery-helped-take-the-spice-out-of-european-cooking)

~~~
sageikosa
It holds butter real well, without it soaking in too much.

~~~
eric_h
This. Lobster is an excellent vehicle for butter.

------
tmaly
My daughter is allergic to eggs, salmon, and fish in that similar family.
Having vegan options in this modern day has been a real help.

I started my food side project
[https://bestfoodnearme.com](https://bestfoodnearme.com) with the idea in mind
that I can catalog dishes at restaurants based on allergies, gluten free etc.
Allergic reactions are a very scary thing especially with small children.

------
waterhouse
Could this be made to work on allergies in general? The article suggests it
could at least be used for food allergies in general.

~~~
dharma1
Immunotherapy can work for allergies in general, but for non-food allergies is
quite inconvenient (several shots per month for years)

~~~
ljf
My wife was really allergic to cats, but a year living with our kitten and
being bitten and (playfully) scratched - and she was pretty much cured - which
she puts down to DIY immunotherapy

~~~
cowpewter
Add another anecdote on to that - I had the same experience. Got a kitten, got
a lot of playful scratches when she was still too young to understand gentle
play. The scratches would welt up. Now my cat allergies are significantly
reduced.

------
zeapo
A previous article (2015) talked about the same study
[http://www.abc.net.au/news/2015-01-28/probiotics-offer-
hope-...](http://www.abc.net.au/news/2015-01-28/probiotics-offer-hope-for-
children-with-peanut-allergies/6051278)

------
cst
48 children were enrolled in the trial. Half of them were given the treatment
and half the placebo, leaving 24 children in each group. Statistical
significance testing is reported in the article and seems fairly robust, but
this is too small a sample size to be fully confident in the results.

~~~
nucleardog
Of 24 children treated, apparently 20 of them were successfully treated.

The control group only saw one person's allergy diminish during the initial
treatment period.

I'll freely admit I don't have a background in statistics or clinical trial
design, but it seems to me with that significant of an effect you can be
fairly confident in the results even at that trial size.

If we were talking 8% to 4% in 24-person groups, sure, one extra person having
a positive result could be random chance. We're talking 82% to 4%. It seems
pretty unlikely that 19 people all randomly has a positive result unrelated to
the treatment.

How big do you think these trial groups need to be to confirm the effect of
the treatment, if this isn't good enough?

~~~
cst
I agree that 82% to 4% seems pretty robust. However, larger data sets are more
robust to potential flaws in experimental implementation.

------
melling
Will this work in adults too?

------
justinc-md
If you're in the bay area and considering OIT, a friend of mine is opening a
private practice offering only OIT [0], starting next Wednesday in Redwood
City. She is currently a full-time clinician at the Sean N. Parker Center for
Allergy and Asthma Research at Stanford University.

Her clinic is relatively unique, in that it will be offering multi-allergen
rapid desensitization. Using this procedure, a person can be desensitized to
multiple allergens simultaneously, in as little as three months. She can treat
milk, egg, wheat, soy, peanut, tree nut, fish, and shellfish allergies.

[0]: [http://wmboit.com](http://wmboit.com)

------
LordKano
I have a young cousin who had a pretty severe nut allergy. After receiving
chemo for cancer treatment, she was cured of both the cancer and the nut
allergy.

------
matt_heimer
Someone watched the Princess Bride - I spent the last few years building up an
immunity to peanut powder.

------
alfon
Link to the original 2013 study
[http://www.jacionline.org/article/S0091-6749(14)01737-0/pdf](http://www.jacionline.org/article/S0091-6749\(14\)01737-0/pdf)

------
Tade0
Interesting how this bacteria is a common ingredient in yogurt.

~~~
nikolay
Maybe this explains why the allergy was rare when yogurt used to be consumed
daily in Bulgaria although I am not able to find reliable statistics and I'm
basing this on anecdotal data.

~~~
VeejayRampay
Ah, so yogurt REALLY is a Bulgarian thing! In France, we've always had a slew
of "Bulgarian taste" yogurts, which are usually slightly acidic in taste (and
which I enjoy a lot) and I've always wondered if it was just a marketing thing
or grounded in reality.

~~~
nikolay
Yogurt's homeland is Bulgaria, and if it doesn't have Streptococcus
Thermophilus and Lactobacillus Bulgaricus, it's not yogurt, but just a form of
fermented milk. It has to be tangy and, in fact, in Bulgarian, its name is
literally "sour milk". After joining the EU, our traditional manufacturers
started to westernize yogurt, and now we have all kinds of fruit-sweetened
forms, and the country's taste is shifting via the young, which is
unfortunate. Now you can find all kinds of low-fat alternatives, and in the
past, there was just one single variety, sold in a glass jar, and it was pure
medicine: [http://e-vestnik.bg/imgs/home_page/Kiselo_Mlyak-
sots.jpg](http://e-vestnik.bg/imgs/home_page/Kiselo_Mlyak-sots.jpg)

It used to be a healthful breakfast given its balanced nutritional profile per
one cup: 150 calories, 8 g of fat (5 g of which saturated), 5 g of carbs, and
13 g of protein while supplying 1/3rd of your daily calcium need.

~~~
option_greek
Isn't Yogurt a common thingy in various countries. At least, in India it is
known to have been used for a long time (specifically the clarified butter
derived from the yugurt[1]).

[1][https://en.wikipedia.org/wiki/Ghee](https://en.wikipedia.org/wiki/Ghee)

~~~
nikolay
Ghee is clarified butter and has nothing to do with yogurt. Now, when the
native to Bulgaria bacteria has been spread around the globe, yogurt is
available worldwide, but not until recently.

~~~
jogjayr
Beg to differ. Here's how my mother makes ghee at home:

1\. Heat milk and milk cream (mostly milk cream), let cool, add yogurt culture

2\. After yogurt is set, add water and churn

3\. Extract the butter that you get from churning, drink the leftover
buttermilk :-)

4\. Heat the butter till it's ghee

~~~
nikolay
Thanks for this! I'll try to reproduce it!

But what I meant is that ghee is not made with yogurt and not solely from
fermented milk - and ghee doesn't have to be cultured either (most brands
available in US stores are not). Again, my point was, that for fermented milk
to be called "yogurt," it needs to have a particular Lactobacillus profile,
which is not traditionally available in India. Nowadays, maybe you use the
imported starter cultures just like Japan, USA, and EU does.

~~~
jogjayr
> Thanks for this! I'll try to reproduce it!

Please do :-)! The butter by itself is quite tasty; more tangy than store-
bought butter and delicious when whipped with powdered sugar then spread on
bread.

> it needs to have a particular Lactobacillus profile, which is not
> traditionally available in India

Sorry, do you have a source for this? I was unable to find anything. I don't
think it would've been too difficult for yogurt cultures to diffuse gradually
from Bulgaria to India in ancient times. There were plenty of traders and
conquering armies going back and forth. Yogurt has been in India for thousands
of years.

With regard to yogurt cultures used in India, I only found the following: "In
India, a combination of "Lactobacillus bulgaricus" and "Streptococcus
thermophilus" is used for commercial production." [1]

[1]
[http://www.indiacurry.com/faqmilk/mfaqdahichemistery.htm](http://www.indiacurry.com/faqmilk/mfaqdahichemistery.htm)

~~~
nikolay
I've had ghee before, and I like it - especially the one I buy at the farmers
market from grass-fed Jersey cows.

Every country has some regulation on what should be marketed as "butter,"
"cheese," "yogurt" so that consumers are not deceived. For example, in
Bulgaria, recently there's been "butter" on the market with 70% hydrogenated
palm oil! If there's no precise definition of what "yogurt" is, kefir, butter
milk, and lassi can be sold as yogurt then - they are fermented dairy products
as well

Here's the definition of FDA although it's possibly the vaguest:
[https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFR...](https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=131.200)

In Bulgaria, for example, there's strict standard, which even limits the types
of containers that can be used to sell yogurt (as some may alter the taste or
leach chemicals).

I know that there's EU regulation on yogurt as well, but I'm not able to find
it, unfortunately.

------
jordache
Is nut allergy a rising issue for other parts of the world?

------
grb423
When I was a kid I never heard of peanut allergies. What happened? Did
children's guts change? Did peanuts?

~~~
ljf
My personal point of view:
[https://news.ycombinator.com/item?id=15036246](https://news.ycombinator.com/item?id=15036246)

