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Peanut allergy cured in majority of children in immunotherapy trial (theguardian.com)
479 points by DanBC on Aug 17, 2017 | hide | past | web | favorite | 169 comments



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.


> 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...


Yes, that's correct. Mayo Clinic has some good basic information here: http://www.mayoclinic.org/tests-procedures/allergy-shots/bas...

Hope that's helpful.


Since you know a lot about this, can you tell me about diary allergies that cause skin reactions? My partner doesn't have a traditional dairy allergy where here bowels go haywire. She does sometimes feel worse though. The most frustrating symptom for her however is that it always gives her acne. I could find very little to know scholarly articles for this type of allergic reaction.


Would love to know about dairy allergies as well, skin reactions as well as sinus congestion/post-nasal drip


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.


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.


< The antigen will always destroy your cells, autoimmune response or not.

In regards to autoimmunity, antigens themselves don't destroy cells--antigens only provoke a pathogenic immune response when presented to the immune system.

< 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.

You're not wrong with regards to the celiac, gliadin, and the association with the HLA alleles that you've mentioned. However, I'll point out that those particular HLA genes make up MHC class II proteins. These are the proteins present on what are known as professional antigen presenting cells, a small group of specialized immune cells throughout the body. MHCII proteins present foreign antigen to TH4 cells (helper T cells) which can then activate a larger immune response.

Epithelial cells of the intestinal villi have not classically been thought to be professional antigen presenting cells, and thus should have very small levels of expression. I found one older study (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC508181/) that suggests these intestinal villi cells can express class II but nothing since. All of this suggests that the pathogenesis of celiac disease is not as simple as intestinal villi cells expressing high levels of the HLA proteins encoded by the genes you mentioned and provoking a direct immune response--rather, like seemingly every autoimmune disease, the story is much more complicated and likely involves the activation of CD4+ T cells, generation of pathogenic autoantibodies, and a larger network of pro-inflammatory players.


> The immune response is therefore not entirely autoimmune in nature but necessary to protect the cells. The vili are being destroyed directly, essentially.

Isn't the damage to villi a byproduct of the (auto)immune reaction? I haven't studied it in depth, but what I've read seems to indicate that the damage is caused by inflammatory reactions (as part of the immune response) rather than directly from the prolamins.

> 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.

The gluten is not reacting with genes, but the genes help determine how your immune system responds to the antigen, so it's still entirely an immune response, at least as I understand it.


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.


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.


"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.


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 :)


Thanks for sharing. Those symptoms sound quite horrific. My daughter had some similar symptoms as well. She had 4 cavities when she was 3. I think she was too young at the time to articulate how she felt but I know she also had some cognitive difficulties(and is only now just getting caught up to grade level despite being a VERY EARLY talker and having a large vocabulary for a toddler)


Sorry to hear that - but I understand that Celiac disease it not an immune response in the same manner - so likely any treatment will be different to this - though as ever - probiotics and gut bacteria are worth a try. My wife has celiac disease too, and I really wouldn't worry too much - it is pretty damn easy to eat out now (in the UK, Europe and America at least) - and compared to 10 years ago, she can shop really simply and have high confidence when eating out. We've traveled widely, and it's not been an issue either - as long as you take notes in the language of the country you are going to: http://www.celiactravel.com/cards/

Plus - as horrible as a reaction is nothing compared to an allergic/anaphylactic response from ingesting a known allergen.


You are right, this really is a great time(even though that sounds weird to put it that way) to have a food allergy. I think about even 10-20 years ago how hard it would be to eat gluten free at most places. Thank you for the link- travel is always something we "worry" about. Most of the time we bring an extra suitcase of non perishables that my daughter can eat in case we cant accommodate her diet. Another reason why I love this site, in the 6 or so responses from my post, Ive gotten lots of helpful info. Thanks to all of you!


Sorry to hear about your daughter's healthy issues. For a while I've been dealing with food intolerance issues myself though things are much better now. One working theory I have is to have a high protein diet to build up the the lining of the gut. Maybe incorporate more high quality protein into your daughters diet and see if any improvement. I have no scientific evidence for this, just anecdotal experience... I don't think even doctors have all the answers based on those I dealt with.


Are you familiar with ImmusanT Nexvax2? In a trial to treat celiac.

http://www.immusant.com/patient-resources/clinical-trials.ph...


Thanks for this! sounds very encouraging.


I've had several roommates with Ceiliac, and it can be a challenge, but it's not insurmountable. The biggest problem at first was, quite frankly, laziness on the part of other roommates in not cleaning up after themselves and leaving out a knife or cutting board that had been used to cut bread. It took a couple of talks and clear warning that no, this is not a joke, you will kill her if you continue to do this. We alleviated some of it by just chipping in to buy her a separate, labeled cutting board just for her.

Hardship at restaurants is a common thing, when people are inflexible. I felt bad for her sometimes because her boyfriend would insist on going somewhere he wanted to go, even if she wasn't able to eat anything there beyond a salad. There will probably be more of an emphasis on cooking at home, but, even then, friends and roommates can be part of it if they're just willing to make a few simple tweaks. We even managed to make fried chicken that she could eat just by tracking down a gluten-free breading option.

To boot, she's got about ten years or so before she's out on her own and this becomes her sole responsibility. My experiences are about five years old at this point, and we've already come a long way since then. In 2011, the most widespread "gluten free" option was Chipotle. Now, I see a gluten free menu at pretty much every sit-down restaurant I've gone to.


>From what I've read gut bacteria could be a contributor to gluten intolerance.

It wouldn't surprise me, the human microbiome (which includes bacteria) out numbers cells in the human body something like 100:1. They call it the second brain and just reading about some of the studies should be eye opening to many. For example, some mental health issues can be treated through the stomach and alternatively certain gasterointestinal issues can be treated via the brain.

I recall one of the more interesting studies about twins in (equatorial) Africa where obviously both nature/nurture are identical but 1 twin will be malnurished while the other is not, the only measurable difference coming from the bacteria in the gut, which impacts the ability for the body to absorb nutrients.

Truely sorry about you daughter and it seems you are keenly aware of the social impact of food. However, as someone who has self imposed restrictions it may be a blessing in disguise, because there is a very good chance greater than 10% of her peers will develop non alcoholic fatty liver disease during childhood, some childhood type 2 diabetes, and yet a significantly larger number will develop all kinds of health issues (including mental health problems) not even as of yet connected with food/nutrition. Admittedly, I'll sneak in a cheat meal and can eat at restaurants but most the time, just like most the food in grocery stores, I easily avoid because I view the same as poison. And while it may sound extreme, just look around at the people in the grocery or especially restaurants and honestly come to your own conclusion about the percentage of people who just look unhealthy.


> It wouldn't surprise me, the human microbiome (which includes bacteria) out numbers cells in the human body something like 100:1.

Fake news! [1]

[1] https://www.nature.com/news/scientists-bust-myth-that-our-bo...


Ok Donald, the ratio may be off, but your own linked article does in fact conclude microbiobial in the human body outnumbers cells (just slightly) and the study you linked isn't very clear in that it discusses just bacteria which is only part of the microbiome.

Further, the ratio has little to do with the actual function which is the major takeaway. Nice fake account btw!

Edit: from your article, “It is good that we all now have a better estimate to quote,” says Peer Bork, a bioinformatician at the European Molecular Biology Laboratory in Heidelberg, Germany, “But I don’t think it will actually have any biological significance.”


What an odd way of thanking someone for correcting a misconception?


Agreed- and in the grand scheme of things celiac is a completely manageable and minor inconvenience. A lot of how I feel about it is more me projecting my sympathy/pity on her because she is always going to have to think about where/what she eats and how it can impact socializing. Even though she is young she generally has a great attitude about it, and I can even say it has benefitted me as I have become a much better cook by figuring out how to make delicious gluten free cuisine. Obviously rice based dishes are pretty easy, but when you are making fresh breads or things like fried chicken, just substituting a gluten free flour doesn't always come out very well.


One of my friends in high school had celiac & peanut allergies. The kids / schools were super accommodating, I know everyone is going to have different experiences but I wish you both a good life. I think for him it ended up being more of an issue while young, gaining the discipline to really know & explain to people his condition and how it was important they just know and think about it. On a certain level it creates an interesting dynamic into figuring out if people are really listening & absorbing knowledge, in a weird way it’s probably given him a very unique life experience.

You’re also right to hope for better treatment paths for her future. Compared to even when we grew up the cultural knowledge of celiac is so much better. And since it’s something that’s been discovered to be not nearly as rare as once thought, the research dollars have caught up. These are all signs that point to a bright future :-)


I really wish you and your family well. It can't be easy to accommodate her food habits; although I imagine after a while it becomes an (albeit difficult) habit.

And I agree with her quality of life being affected. Hopefully, other restaurants will catch on, similar to how we label food that may contain peanuts.


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


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.


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.


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.


Curious if you hand wash or use a dishwasher for the baby bottles? There's a hygiene hypothesis to explain why allergies are more prevalent in 1st world countries.


> I thought, and tried to explain to her, that a 3 year old in daycare probably has been exposed to peanuts already

Prior to the recent AAP recommendation (and possibly still after it) many daycares had nut-free policies as a selling point.

> This idea of introducing the food in an ED waiting room is probably something spread on mommy forums such as BabyCenter.

Introducing an allergen with ready access to medical care may be an overreaction, but is hardly problematic.

It's the delay in introduction which is problematic, and which research suggest drove the big upswing in incidence of peanut and some other allergies.


I agree. And the study actually points out that "There was no significant between-group difference in the incidence of serious adverse events."

It's important to remember how vital early introduction to both beneficial and harmful environmental agents are to human development. Its easy to have the mindset that I will wait until my child is 3+ years old before I introduce anything potentially harmful with the idea being that they will be bigger and stronger. The immune system is actually quite strong and adaptable early in development which is precisely why vaccines work better at an early age

That being said the parent (esp mother) also plays a large roll in the first introduction of helpful bacteria that break down various foods. The bacteria that are transferred during a vaginal birth give the baby a leg up in establishing its early gut flora. Additionally there is a direct transfer of antibodies through the placenta and breast milk which help protect the baby. I would imagine a mother eating peanuts during both those times would help pass some of these antibodies to her offspring.

https://en.wikipedia.org/wiki/Passive_immunity


We gave our kids peanut butter as soon as they were eating solid food. We live right next to the emergency room so we figured, let's just get it over with. Sounds like it's the right approach to introduce it as early as possible, anyway.


My wife is a dietitian and we gave our first daughter peanut butter (natural, no sugar added) starting at 6 months. The only other concern with PB is choking hazard, so we just spread it really thin on toast or crackers. At 6-9 months, they usually just suck on food or handle it. Rarely do they get a ton down anyways.


Huh. My wife and I deliberately did the opposite of the "avoid exposure to allergens (especially nuts)" guidelines for kids because it seemed like obviously ass-backwards, stupid advice, considering that rates of kids with serious food allergies seemed to have gone up like 10x under those guidelines vs. when we were kids and everyone just fed their kids peanut butter (and everything else) ASAP and serious food allergies were a thing that a couple kids per school had, rather than a couple per classroom now. Looks like we guessed right on this one.


> [we] did the opposite of the [...] guidelines [...] because it seemed like obviously ass-backwards, stupid advice

> Looks like we guessed right on this one.

You conclude that the advice is wrong because of your sample size of however many kids you have?

You didn't explicitly say "our kids" but merely "kids"; God help you if you feed nuts to other peoples' kids based off your conclusion.


Did you read the linked page? Or google for how recommendations re: feeding kids peanuts have changed since 2015? We concluded the advice was wrong because very few of our peers in school had food allergies, but now a crazy percentage of the kids who've grown up under the no-peanuts-for-kids-or-even-for-pregnant-women advice are allergic to peanuts. And it turns out we got that one right.


What I'm saying is: do what you want with your own kids.

Feel free to discuss your ideas/concerns with other parents and censure them like anti-vaxxers if you want. BUT if you either 1) don't ask them first and give their kids peanuts or 2) disregard their concerns and give their kids peanuts, and a kid dies because of it, you are culpable and responsible for that kid's death.


Where'd I say I was giving strangers' kids peanut butter, like some kind of creepy peanut butter bandit?


For a bit of extra anecdotal evidence - in Israel a common easily-digested semi-junk food is Bamba, peanut puffs. Rates of peanut allergy are very low there.

What you have instead is milk allergies, and briefly doctors recommended delaying introducing milk to infants. (This advice has also changed.)


That's actually, according to something I read a while back (sorry, don't remember the source), not just an extra anecdote, it's the observed fact which motivated the study that led to the AAP changing it's recommendation.


with that said, sesame is also a huge product in Israel (techina, chummus....) and rates of allergies to it are higher than average. With that said, sesame is not something little kids are going to be eating as much of or creating dust in the air.


Israeli here - not sure how common it is, but sweet tahini (with honey usually) is a toddler favorite, and young kids also eat hummus a lot. Not sure it's as popular as Bamba, but pretty commonplace.


right, but its not exposed in the same way. I agree that chummus is a staple (with pita), just that bamba produces dust / stickiness on fingers in a way sesame based dishes don't. i.e. even if not eating it, one probably have low level of exposure to it.


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.


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.


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.


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


This is especially confusing to me given the fact that immunotherapy (allergy shots) for hay fever has been used effectively since at least the 1930s[1]. I've heard that it may be due to the severity of a possible reaction to peanuts compared to that of (most cases of) hay fever, but I'm guessing that's probably not the full story.

[1] https://en.wikipedia.org/wiki/Allergen_immunotherapy


That's where my uncertainty comes from. I did the allergy immunotherapy for a few years, asked the Doc if they did anything like that for food allergies, and got the no, it doesn't work answer.


The reason is actually answered in the paper ;) There have been many studies looking at introducing peanut allergens in small increasing doses over time. this does somewhat work but the effects ware off pretty quickly after stopping. The 'secret sauce' in this study is the use of the specific bacteria which somehow teaches the body to retain the non-immune response.



When I was in school, allergens were taught as follows (This also explains why people presumed it would fail):

1) Your body "sees" this, meaning it has antibodies that react to it

2) Cells whose antibodies are activated replicate, as they are recognizing something that is, to the body, presumably foreign and bad

3) Because you now have more cells after the originals replicated, the effects of the allergy worsen as you are now more reactive than before

I'd be interested to see some tests on this. I have a few hypothesizes that we could test:

1) If the children are still reactive to immunological tests (Meaning they still have the antibodies!), are those antibodies being blocked by another compound, another cross-reactive antibody? Another idea is that the actual immune response to antibody activation (Recognizing peanuts) might be handled differently within the cells that produce the actual response to the allergen (Swelling and stuff).

2) If the antibodies no longer exist, I would start looking in the areas where immune cells develop to see if cells producing reactive antibodies to the allergen are being killed off during development (This process is also why you don't kill yourself with antibodies recognizing yourself). If that isn't the case we need to track individual immune cells over the course of treatment.


IgG is usually implicated in fighting off pathogens like viruses and bacteria. It doesn't typically cause an allergic response. IgE is usually implicated in fighting off pathogens like parasitic worms or mosquito bites. It's the antibody that regularly get confused and binds to peanut proteins and pollen. There is speculation on why the IgE mediated immune response gets confused. One hypothesis is IgE evolved much more recently and "needs more work".

The immune response to IgE binding is intense. Allergic reaction is an IgE response to a harmless antigen. However, IgE can be downregulated by repeated exposure to the antigen in question. If the body uses IgE too much (eg. from repeated exposure), it starts to replace IgE antibodies with the more subtle IgG antibodies.

The immune system is very fascinating really. IgE might be the key to effective cancer immunotherapy. Imagine if we could program your immune system to fight a cancer as intensely as it fights a pollen grain or peanut in an allergic individual. There is a lot of research in this area these days.


I was unaware that IgE producing B cells transform to IgG after repeated exposure. My previous understanding was that IgE production was a terminal state and responded similarly to increased antigen on IgG presenting Bcells. The hygiene hypothesis makes a good bit more sense now, given that transformation.

Thanks for clarifying that.


Medical momentum is a crazy thing. You should see how long it took hand washing to catch on.

http://www.npr.org/sections/health-shots/2015/01/12/37566392...


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.


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.


Historically the idea is much earlier, it comes from the legends around Mithridates, King of Pontus, circa 100 BC:

https://en.wikipedia.org/wiki/Mithridates_VI_of_Pontus#Mithr...

https://en.wikipedia.org/wiki/Mithridate

http://www.thefreedictionary.com/mithridatism


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?


Here is what my wife did (not the commentor though). She had dogs growing up, went away to school and developed an allergy. We bought a dog and she would take allergy pills each day but eventually starting cutting the dose as time went on. Now the allergy is gone.

For you, I would say visit your friends with cats often, at first taking an allergy pill before hand. Continue with frequent visits and cutting the dosage down. After you cut out the pill completely, make sure to continue to visit.


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.


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


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.


You may also want to pair it with the actual bacteria (probiotic) used in this study: Lactobacillus rhamnosus. Its available as a supplement.


It is a great time for this study - really hopeful for my child too :)


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.


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.


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".


Several years ago, I developed a bad allergic reaction to mango. Hyper sensitive skin that will rash and welt with the slightest irritation, such as sitting in a car and wearing a seat belt. This will last for over a month. I carry an EpiPen in case my throat swells shut. I know allergies can come and go, so I may no longer be allergic, but I dare not find out.


Mango skin has a similar allergen as that in poison ivy, poison oak and poison sumac. My sister cannot touch the skin w/o getting a rash. However, if it's already peeled she can eat it w/o issue. I understand this is not uncommon:

https://en.wikipedia.org/wiki/Mango#Potential_for_contact_de...


Of this I was aware, and thanks for bringing it up for general knowledge! For me, oddly, I can walk through poison oak no problem, as long as I don't have an open cut. Near a cut, the area will get all "poison-oaky" and rash and itch still.


Interesting. I'm extremely sensitive to urushiol but mango skin doesn't affect me.


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.


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?


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.


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... And a basic analysis of a "good" food: http://www.dogfoodadvisor.com/dog-food-reviews/acana-singles...)


She first noticed that she was feeling sick and started eliminating foods until we guessed it was the peanut butter sandwiches she was eating for lunch on tour. She did see an allergists who confirmed (with pretty obvious evidence) the reaction to peanuts.

She stopped eating peanuts for about a year, then gradually found she was capable of eating them again (her favorite candy was Reese's peanut butter cups, so a heartbreaking year that was). My belief is she is more cautious on the volume and frequency of her consumption now, but is otherwise unrestricted.

My guess was always that she must've had some low-grade infection (viral or otherwise) and the response was also broadly interacting with the proteins in peanuts.

The immune system isn't a designed system, it's a series of responses (and the ability to generate new response) that we broadly call a system because the net effect is as if there were some dynamic thing protecting us. Sometimes it just does its thing without regard to the segmentation faults it creates.


I do wonder about how many kids that think they have peanut allergies (or otherwise) have actually lost or outgrown them.

My anecdote: our daughter was diagnosed with a peanut allergy at ~7 months of age. She developed hives after eating some peanut butter and we confirmed the allergy at our allergist's office with a skin test. We were told to give it another shot in ~5 years, but to avoid all nuts and carry an epi-pen in the meantime.

But just about a year later after an insurance change, our new pediatrician encouraged us to do another test with our new allergist. A blood test came back negative, and the ultimate test - eating increasing amounts of peanut butter in the allergist's office over a couple of hours - was fine.


Seems that the allergy subsystem is very psychology dependent.


I don't see how you got that from the anecdote


It's not from the anecdote, I had many many allergies and they appear much more if I'm in a stressful or unfamiliar context.


Stress is not just a mental state. There are real, physiological changes, such as rising cortisol levels. To say that it is just a "psychology dependent" situation is to say it is all in your head.


I didn't mean to imply mental problems, but emotion can trigger imbalances in how your system produce and regulate this molecules.


that's not psychology, that's neuroscience, and while generally observed, the phenomenon you describe isnt understood.


Stress isn't psychological? Think about what you are saying!


Strictly speaking, from a conventional mainstream scientific view, stress is physiological. Psychology is a subset of physiology (unless you believe minds are aphysical). The "stress" that you feel in your head when you're stressed is only part of a larger, bodywide physical response.


Only if you don't realize how psychology involves and implies biology.


Probably hormonal or sympathetic nervous system responses helping that along.


Presumably yes.


I developed an extreme sensitivity to caffeine after overdosing on another stimulant. Before, I could drink 5-6 espressos without a problem, after the incident, ~25mgs of caffeine gets pretty uncomfortable.


I had to stop eating almost everything in a grieving period, bodies are .. weird.


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.


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/

another old article (2011) on the Hygiene Hypothesis: https://www.nature.com/nature/journal/v479/n7374_supp/full/4...


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.


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?


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.


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.


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.


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.


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.



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


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.


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.


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


Hmm one interesting thing I found is that Lactobacillus rhamnosus is "The Lactobacillus rhamnosus and L. reuteri species are most commonly found in the healthy female genito-urinary tract" [1]

I would think that it is transferred to the child at birth. Some factors that could lead to a higher incident of peanut allergies if this bacteria is vital to preventing it:

- Child was delivered via cesarean w/o a vaginal swab transfer. The rate of c-sectons has certainly increased quite a bit in the last few decades.

- The Mother did not have a health population to begin with.

- The use of antibiotics that could wipe these strains out. Either in the mother prior to delivery or in the child after being born.

- lack of introduction through other sources (some yoghurts and cheeses)

[1]https://en.wikipedia.org/wiki/Lactobacillus_rhamnosus


What I understand is that no, because the probiotic is just a digestive support and used in the study as being a 'supportive' agent. The real actionable item is adding the allergen intentionally and increasing the dose over time.


That's not entirely true. The study itself lists several previous works that only introduced the peanut allergen in varying amount over time. The results of those studies show that yes the body increasingly builds antibodies while the allergen is introduced but those effects diminish rapidly after the treatment is stopped.

The importance of this work is that with the simultaneous introduction of this bacteria the effect is maintained for years. The bacteria plays a important role in allowing the body to retain the immunity.

"Moreover, because there was no convincing evidence that allergen OITalone was effective in promoting sustained unresponsiveness at the time our randomized controlled trial (RCT) was designed and initiated, we elected to undertake a clinical trial evaluating whether coadministration of Lactobacillus rhamnosus CGMCC 1.3724 (NCC4007) and peanut OIT can induce sustained unresponsiveness to peanut among children with peanut allergy (Australian New Zealand Clinical Trials Registry ACTRN 12608000594325, 25/11/2008). This probiotic was selected based on its demonstrated tolerance-promoting effects, including induction of regulatory T and TH1 cytokine responses."


It still would have been nice if they'd done a control group, an allergen-only group, and an allergen-and-probiotic group – all from the exact same initial randomization and using the exact same administration/follow-through practices. That would have best quantified what, if any, added benefit the probiotic creates.


True. Additionally it would be good to have a baseline measurement of the probiotic population in each subject prior to starting.


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.


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


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.


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...


Well, it was extremely plentiful and cheap--which led to a sort of stigma being attached to it. Lobster is also very delicate; if it's not prepared super-fresh, it's not very good.

Food fashions aren't always rational though. It seems to have become popular largely when people from New York and DC started vacationing up in New England in the 1800s.


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


This. Lobster is an excellent vehicle for butter.


Higher prices increase demand are called giffen goods iirc.

Veblen goods are goods that people buy to signal their higher status.

(No opinion on whether lobsters outside of New England are Veblen goods. Am vegetarian)


They both have inverted demand curves. Veblen goods because of status or because price becomes a signal. Giffen because of substitution effects.

It's not clear that Giffen Goods actually exist.


Lobster is tasty, and kind of an unusual experience if it's your first time. Depending on how much you value experiences, it may be worth it even if it's expensive -- I wouldn't know, it's cheap in this area.

Caviar is still tasty, but not fundamentally different from, say, peanut butter. It's something you spread on bread. I don't think I'd bother with it.

If you do get some, try putting sliced, hard-boiled egg in a sandwich, caviar on top of the eggs. That's a great combination.


Veblen goods aren't supposed to go up in price as supplies increase. See the graph in https://www.bloomberg.com/view/articles/2017-05-18/maine-is-...


My wife has a allergic reaction to shrimp. Interestingly she can eat most wild caught shrimp without issue but has a pretty distinct reaction to the farm raised type (oral swelling, itching, hives). I don't know enough about the difference between the two to know why this is. Maybe farmed are a different species, or it's the diet they are exposed to, or they are treated with something.


Lobster is okay.

Crab is where the flavors at!


I'm not sure what the fuss is about lobster, but I would hate to give up crab and oysters. I love standing around a fire in the winter shucking and eating oysters.


Lobster is like crab but better and with a much better time spent cracking shells to time spent eating food ratio. If you've eaten lobster crab just feels like a waste of time and effort (but it's less messy so it lends itself better to being eaten in a restaurant).


I've eaten tons (possibly literally ;) ) of both, and the body meat of blue crab is much better than any lobster I've ever had. I'm not saying lobster is bad, but it's possibly overrated.

At the end of the day, I would take oysters over both because I prefer salty to sweet. A fresh local oyster from the water that morning either raw or lightly steamed is delicious.


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 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.


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


I just searched for the bacteria mentioned in the article and it seems that you can simply BUY that online and even many other types of bacteria. Here's a link for the curious https://www.swansonvitamins.com/swanson-probiotics-lactobaci... I am in no way affiliated and recommend looking the company and products up.

Anyway I've a severe allergy against figs and hope I can one day eat them again.

I have never heard of these kind of bacteria and thought that probiotics is a scam in that it replaces your gut bacteria with ones that are genetically modified so that you "feel" bad without re-consuming them. I think it sounds crazy, while being in the technically possible realm with no law against that.


I had very serious pollen allergy which was greatly alleviated by immunotherapy. Nearly 5 years of regular shots though (initially weekly after that eventually biweekly, then finally booster shots at less regular intervals). Since some pollen and food allergies seem to cross-react it also impacted the severity of my food allergies.


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


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


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.


Posted above as well: https://www.oit101.org/


A previous article (2015) talked about the same study http://www.abc.net.au/news/2015-01-28/probiotics-offer-hope-...


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.


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?


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


And did the 24 children in the placebo group die?


Will this work in adults too?


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


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.


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



Interesting how this bacteria is a common ingredient in yogurt.


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.


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.


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

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.


People look at me weird sometimes when I tell them we usually drink our yogurt.

In Serbia we have different types of yogurt some more thick (the westernized with flavor), yet some runny/less thick. But sour milk (kiselo mleko for us) is always of same texture and we eat it with a spoon. So, my question is - do Bulgarians drink their yogurt or do they eat it with a spoon?


We eat yogurt ("кисело мляко") only with a spoon - it's not liquid. We drink ayran ("айрян"), which is yogurt diluted with water yogurt with added salt. There's also kefir ("кефир"), which is liquid, but it is not Bulgarian at all.


Gotcha. Ayran is something I will definitely try if I visit! Yes, I'm familiar with Kefir and it's sort of the same as our version of yogurt, but Kefir has a bit stronger/more "recognizable" taste!


I've found that pretty much all Turkish places (be it a kebap shop or a restaurant, snack shop, etc.) usually sells Ayran, it's what I usually get with kebap / iskender / adana, it helps with some of the spicy sauces.


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


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.


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


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.


> 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


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...

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.



>In France, we've always had a slew of "Bulgarian taste" yogurts, which are usually slightly acidic in taste

In the US, I think this is being marketed as "Greek yogurt." (I don't like yogurt so no first hand experience, but in the last few years I've noticed many brands being advertised as "Greek", and as being more tangy and possibly more healthy/"natural")


“Greek yogurt” is the same thing as “yogurt cheese”—it's yogurt strained to remove/reduce whey. Well, except that US rules allow thickeners to be used instead of straining, so many US versions are thickened, rather than strained.

I don't think either process affects acidity.


Not sure about that, we have both, Greek and Bulgarian, they're noticeably different in texture and taste, though it might be different on the American market, I don't know.


Is it? I've never seen it in yogurt. I've always seen other Lactobacillus species (Lactobacillus is the genus).


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


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





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