WEBVTT

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With food allergies more than tripling

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in two decades, birthday parties
are no longer a simple pleasure.

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Many children live in fear of food.
Shall I try one?

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Ah, it doesn\'t turn out so well.

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Scientists are looking for answers to
the allergy epidemic in unusual places

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like the barns of Amish farm families.
We have 45% among the non-farmers

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with children, 8% among the Amish. I
mean, this is absolutely amazing.

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And some researchers

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are experimenting with bizarre treatments.
I have to say that I am not comfortable

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with being infected with worms.
Or perhaps we can fix

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the allergy epidemic by feeding
children tiny bits of the foods

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that threaten them. Maybe soon
we\'ll be able to send kids

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to birthday parties without
worrying about what\'s in the cake.

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[music]

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Six-year-old William Comay is blissfully
unaware of his parents\' growing anxiety.

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Tomorrow they\'ll watch as he\'s deliberately fed
gradually increasing doses of what for him

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is a deadly substance, peanut.

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It makes me very nervous. We\'ve spent the
last four and a half years ensuring that

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he doesn\'t come into contact with peanuts.
So now we\'re giving our consent

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to expose him to peanuts. So for both of us

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it\'s very anxiety-provoking. (inaudible).

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No. William will be trying to get
into a study at McMaster University

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that hopes to desensitize him to peanuts.
First, the researchers will have to find out

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at what dose William begins to react.

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A little bit nervous about the actual amount
of peanut that will take to stimulate this.

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See my friend in trouble. If
William reacts in a big way

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to the tiny bits of peanut, it will
be too risky to let him in the study.

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If he reacts mildly, he\'ll be admitted.
Our biggest hope will be that

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he\'s desensitized enough that he could
accidentally ingest a peanut and not have

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sort of catastrophic reaction. Mm-hmm.
An anaphylactic reaction

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could shut down his airways
and dilate his blood vessels,

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triggering a dangerous
drop in blood pressure.

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The principle behind desensitizing is simple.
Begin with tiny amounts of the offending food

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mixed in a flour. Then gradually
increase the amount over time

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in the hope of training the
immune system to accept the food.

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Like in increasing number of children
in today\'s Western urban world,

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William carries a portable needle loaded with
epinephrine. It can be injected in his thigh

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if he begins having a bad reaction.
Take your lunch, William,

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and your EpiPen. Awesome.
Okay. We\'re all set.

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When he was at camp this summer, I counted seven other
children in his group that were wearing EpiPens.

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It\'s a much more prevalent than it was when
we were growing up. That\'s for sure. Yeah.

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In the U.S. peanut and nut allergies

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tripled between 1997 and 2008.

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One-third of our kids are now allergic to
something, be it food, animals, or plants.

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(inaudible) show of hands who here

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has a food allergy? I\'m allergic to

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Brazil nuts. I have allergies to
peanuts, all kinds except for Pine nut.

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And I also have… I think I
have allergies to shellfish.

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[music]

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Allergies run in families. There\'s definitely
a genetic component to the problem.

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But why the increase over 20 years?

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Allergies are part of the
family of autoimmune illnesses

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in which the immune system attacks
the body for no good reason.

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Our immune systems evolved to protect
us against everything from bacteria

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to giant tapeworms. But these days

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our immune systems seem
to be growing confused.

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Children often develop allergic reactions
to the most common foods in a culture.

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For instance, rice allergies
are common in Japan,

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but hardly ever seen in North America.
And milk allergies are rare in Japan,

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but common here, along
with allergies to nuts,

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fish, shellfish, and eggs.

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Okay. First thing you need to take
off the safety cap like that.

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Elizabeth Wagoner is allergic to milk.
She practices with her EpiPen

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pretending an orange is her thigh. Then you
do with that and hold it for 10 seconds.

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She was a baby and I was
introducing solid foods to her.

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I noticed that sometimes she would, you know, get more fussy
and other times she would get, you know, rash on her face.

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When my dad pour the milk and some cereal,

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I ate a… a little and then
it started going puffy.

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It was scary. When we suspected that

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she had a uh… food allergy,
I took her to Dr. Carr.

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Edmonton\'s Dr. Stuart Carr was one of the first
proponents of milk desensitization in Canada.

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She was a young lady who uh… very
obviously had a true honest-to-goodness

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a cow\'s milk allergy. She
would react umm… impressively

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uh… with even very low exposures to
the… to the milk products. Yeah.

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Carr tried desensitizing Elizabeth to milk
when she was four. But they had to give up

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because her reactions were too strong. Now
you\'re eating baked goods too, right?

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Muffins and stuff like that? Yeah. Top allergy
experts in the united states warned against

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immunotherapy outside of hospitals
because of the anaphylaxis risk.

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Carr is among a handful of allergists
trying to desensitize patients

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outside of a hospital believing the
benefits can outweigh the risks.

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This for well selected appropriate patients

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is a potentially very helpful
option for them. Come on in buddy.

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Today is the day for William
Comay\'s peanut trial.

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[music]

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(inaudible). (inaudible).

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William is relaxed during the short drive
from his home in Oakville, Ontario

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to McMaster Children\'s Hospital.

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Clearly, his parents have done a good
job of hiding their own anxiety.

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Half an hour later, the big moment arrives.

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William\'s given his first dose mixed into
some pudding is one milligram of peanut.

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That\'s one three hundredth
of a whole peanut.

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Then for an hour, the nurses watch
carefully for any reaction.

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Now William is clearly nervous.

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Hi, William. How are you doing?
Dr. Susan Waserman

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runs this desensitization study.
These children have been raised

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to avoid peanut at all costs.
And sometimes we\'ve made them

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so incredibly vigilant and anxious that even when
we try and give it to them as part of a protocol

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that may be helpful, they\'re not buying.
They\'re very fearful.

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And you know, some of them do think
that they may die as a result of this.

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There\'s no reaction to his first dose. So
now they\'ll double it to two milligrams.

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These desensitization programs

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don\'t claim to completely cure
children of their food allergies.

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They simply reduce the risk of a major
reaction. Finding a more permanent fix

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means learning why there\'s been
such an increase in food allergies.

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[music]

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You won\'t find many allergies here

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on the old-style dairy
farms of southern Germany.

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This farming family is part of a
series of groundbreaking allergy

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and asthma studies by
Munich\'s Erika Von Mutius.

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When I started my work at the end of the 80s, people and
myself believed that air pollution was the driving cause

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of asthma and allergies. When
the Berlin Wall came down,

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Von Mutius was able to test populations

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in both East and West Germany.
She expected more allergies

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in the heavily polluted East. What
we saw was quite the opposite.

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Allergies and asthma were lower in the polluted
areas. She assumed there must be a flaw

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in the study itself. The very first
thought was that we had made a mistake.

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Then Von Mutius heard about something
called the hygiene hypothesis.

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In the early 1970s,

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Dr. John Gerrard, a Canadian pediatrician
discovered that in rural Matie communities,

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the number of allergic kids was much lower
than in the general urban population.

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He speculated that this had something to do

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with the abundance of germs in
their rural lives in contrast to

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the success of public health campaigns
to eradicate germs elsewhere.

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Did you keep your skin clean? There\'s less chance
that a disease will be able to get started.

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In a paper published in 1976,

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Dr. Gerrard suggested that
allergies are the price paid

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by some members of the white community for their
relative freedom from diseases due to viruses,

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bacteria and parasitic worms.

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Not much attention was paid to this
groundbreaking hypothesis for another 12 years

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until a large British study was
published showing a similar effect.

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That\'s when the name was coined:
the hygiene hypothesis.

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That hypothesis led Von
Mutius to suspect that

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something in rural life may be
protecting farm kids from allergies.

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I remember like yesterday, we said this is so intriguing. So we got
to start to do something. And there was the first big farm studies,

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which confirmed the very strong protective
effect of children growing up on farms.

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[music]

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Amazingly, the farm children were half as likely to
have allergies as their neighbors living in villages.

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The researchers decided to
call this the farming effect.

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But what was causing it?
Maria and Thomas Cooter

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raised dairy cattle on their
farm just west of Munich.

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The children play around the barn. The
family drinks unpasteurized milk.

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Animals live cheek to jowl with the family.

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But the farm kids are no less clean than their
more allergic neighbors in the village.

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The hygiene hypothesis
is sort of a bad name

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because it proposes that
it\'s your personal hygiene.

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So it\'s animals, and it\'s plant
material, and it\'s this milk.

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These are the three factors that are important, and not
the dirt in your backyard, and your personal hygiene.

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The more dust and bacteria Von
Mutius and her team tested,

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the more they realized what a
spectacularly diverse microbial soup

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the farm families were living in.
I want to know

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what is in those dusts, and what is it in the milk that
gives the protection because if we we\'re to understand

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this natural model, then hopefully,

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we could translate this into some
application. That\'s… that\'s… that\'s dream.

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Then Von Mutius heard about

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another farming community that
surprisingly had even fewer allergies.

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[music]

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This is Amish country in northern Indiana.

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The Amish here are of Swiss German descent,

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like the farm families
Von Mutius is studying.

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One big difference, the Amish live a
lifestyle that hasn\'t changed much

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in almost 200 years. I think
what\'s unique about Amish farms is

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the close connection between the
children, the animals, the barn.

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Allergist Mark Holbreich discovered
something else remarkable

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about the Indiana Amish. I started
to offer free allergy clinics

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for the Amish. And I began to know them.
And what we realized was that

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people would come thinking they might
have allergies, but in fact didn\'t.

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The Amish had half the allergies of
even the German dairy farming families.

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So Holbreich contacted Von Mutius.
She became particularly interested

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and said, \"We need to do
a study in the Amish.\"

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And she motivated me to do one. The study
of the Amish is absolutely intriguing.

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They represent the lifestyle that has disappeared in
Europe, but was prevalent maybe a 100, 150 years ago.

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On the Mast Dairy farm

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near Middlebury, Indiana, patriarch
Herman Mast brings in the horses

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while sons Andrew and Joel wean a cow.

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It\'s against their religion to be filmed,
but they allowed us into their lives

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as long as they didn\'t have to be interviewed
or look at the camera. They know how important

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Holbreich\'s research is.

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[music]

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This Saturday morning, Amish
families from the surrounding area

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gather at the Mast farm to donate blood
for a Holbreich\'s allergy study.

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Immunologist Carole Ober has come
in from the University of Chicago.

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The blood samples will tell her a lot about the
workings of the children\'s immune systems.

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The bloods that we\'re
drawing, we\'re exposing to

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various pathogens, bacteria. And we\'re going to
actually measure the response of those cells

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to these different microbes.

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In the barn, Irwin\'s grandchildren play amidst the
animals and muck while mom and dad do the milking.

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(inaudible).

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Holbreich suspects unpasteurized milk
may be a piece of the allergy puzzle.

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Our goal is to see if we
can identify a factor

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that may be in milk that\'s
unpasteurized, unhomogenized,

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that may be the protective factor.

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There\'s something unique about cows. The
whole picture of having a large family

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living a lifestyle very
close to the animals

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from early on in life, all that coming
together, that seems to be the factor.

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[music]

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After this one, we\'re going to try butterscotch
and you tell me if you like butterscotch more.

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William is two hours into his
peanut desensitization challenge.

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I don\'t wanna take too much at a time. Okay. He
doesn\'t react to the second dose, 2 milligrams.

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The biggest problem is that he doesn\'t
like the taste of the concoctions.

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They tried mixing the peanut powder
with ice cream, yogurt, and pudding.

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I bet you can do this whole spoonful.
No way.

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But after the third

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up dose of the morning… Are you feeling
sleepy? Are you feeling a little bit sleepy?

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Looks like William is
about to have a reaction.

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[music]

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Two hours into the trial to see
if he\'s a suitable candidate

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for the peanut desensitization
study, William Comay is showing

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signs of a reaction at 3
milligrams of peanut.

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Take breath.

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Hey. Hi. It\'s Dr. Waserman. So how are
you doing? Well, he had a tiny scare

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because kind of had a choking cough leading up
to it. He had a weird feeling on his tongue

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and a tummy ache, a bit of slurred
speech, fatigue, flushed cheeks.

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In addition to that, he also started to get sort of a little
bit spaced out. He was sort of looking around the room

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like wondering sort of where he was.
So those were symptoms

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that made me feel very nervous.
Is it hard to breathe?

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Once they start to react they become very quiet.
And the kids who were initially speaking to us

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and being very sociable become a little bit
more clingy and quiet. And then they develop

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some of the more typical signs.
Take breath.

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He really did not want the EpiPen administer. He started to
get very upset about the possibility that was gonna happen.

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We ended up not giving it to him.
There\'s no needle. One more medicine,

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but these medicines are all good so that it makes you
feel a little bit better. Okay, okay, okay, okay. Okay?

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Okay, okay. They give Williams some
epinephrine through his intravenous.

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All your medicines are in your body now. Okay?
So they will be making you feel better. Okay?

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Okay. Now, much to his parents\' relief,

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he\'s in the study. You\'re done eating
for today. You did a great job.

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You\'re gonna get to spend some
time with us, honey. All right?

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[music]

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Avi Segal has already
achieved Williams\' goal.

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He\'s one of the first people in
Canada to be desensitized to peanuts.

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To keep up his desensitization,

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he eats five peanuts a day.

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Every day I watch him come home from school, and deshell,
and eat straight up five peanuts. It\'s remarkable.

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Do you like them? No, I don\'t like peanuts.

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How much is this gonna hurt? Not gonna hurt
at all. These peanut desensitization trials

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are run by Dr. Gordon Sussman
out of his Toronto office.

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He started the trials three years ago because
he felt that science was at the point

00:19:45.000 --> 00:19:49.999
where the risk was minimal. We have a like an emergency
department. So you can\'t… it\'s a research study.

00:19:50.000 --> 00:19:54.999
It is a bit risky. But you have to know
what you\'re doing. Avi is part of a study

00:19:55.000 --> 00:19:59.999
to see if a drug called Ketotifen can
dampen reactions to the peanut doses.

00:20:00.000 --> 00:20:04.999
Ketotifen is like an antihistamine.
It\'s a very safe drug.

00:20:05.000 --> 00:20:09.999
It has other effects. So it stabilizes the cells
that are released during allergic reaction.

00:20:10.000 --> 00:20:14.999
The goal is to have the safety increased.

00:20:15.000 --> 00:20:19.999
For the time being, as
long as Avi keeps taking

00:20:20.000 --> 00:20:24.999
his dose of five peanuts a day, he should
be out of danger from anaphylaxis.

00:20:25.000 --> 00:20:29.999
But the question remains why are kids like

00:20:30.000 --> 00:20:34.999
Avi, and William, and Elizabeth
getting allergies in the first place?

00:20:35.000 --> 00:20:39.999
[music]

00:20:40.000 --> 00:20:44.999
Two-year-old Alex Newland lives in
Delta, BC with his parents and brother.

00:20:45.000 --> 00:20:49.999
He\'s in a study of 3500 Canadian
children and their mothers.

00:20:50.000 --> 00:20:54.999
A study that\'s trying to understand the underlying
causes behind the dramatic increase in allergies.

00:20:55.000 --> 00:20:59.999
Pregnant women were selected randomly.

00:21:00.000 --> 00:21:04.999
Some had babies who went on
to develop food allergies.

00:21:05.000 --> 00:21:09.999
He was about a year old, and we went in and they did the
scratch tests on his back. They let him run and play.

00:21:10.000 --> 00:21:14.999
And from across the room I… I couldn\'t
believe it. You can see these three welts

00:21:15.000 --> 00:21:19.999
coming up scared the bejeebers
out of me at that time.

00:21:20.000 --> 00:21:24.999
The scratch tests revealed that
he\'s allergic to peanuts, and milk,

00:21:25.000 --> 00:21:29.999
and egg whites.

00:21:30.000 --> 00:21:34.999
(inaudible) Young comes to the homes of
the volunteers to take dust samples.

00:21:35.000 --> 00:21:39.999
Samples of pretty much everything

00:21:40.000 --> 00:21:44.999
in Alex\'s environment are tested.

00:21:45.000 --> 00:21:49.999
Dr. Stuart Turvey heads up the study on the west
coast. We\'ll be testing for these allergens here.

00:21:50.000 --> 00:21:54.999
There\'s soy bean, egg white, whole calories. We looked at the
infectious environment. So what infections children have

00:21:55.000 --> 00:21:59.999
early in life? We looked at the psychosocial
environments, so socioeconomic status,

00:22:00.000 --> 00:22:04.999
uh… early life stress. We looked
at their nutrition environment.

00:22:05.000 --> 00:22:09.999
What mothers were eating during pregnancy?
And what the children were eating?

00:22:10.000 --> 00:22:14.999
Young also takes a fecal
sample from a dirty diaper.

00:22:15.000 --> 00:22:19.999
I\'m very excited about the idea
that we might be able to look

00:22:20.000 --> 00:22:24.999
at the stool and look at the bacteria within…
in… in the stool samples of those children

00:22:25.000 --> 00:22:29.999
and maybe actually identify uh… species
of bacteria that are beneficial

00:22:30.000 --> 00:22:34.999
and… and species that are harmful.
And… and that knowledge

00:22:35.000 --> 00:22:39.999
could then potentially allow us to intervene and… and maybe reach
the holy grail, which is the prevention of these diseases.

00:22:40.000 --> 00:22:44.999
[music]

00:22:45.000 --> 00:22:49.999
Microbiologist Brett Finlay is a partner
in the study and is closing in on

00:22:50.000 --> 00:22:54.999
those key species of bacteria. I\'ve always
had close association with microbes.

00:22:55.000 --> 00:22:59.999
Then about a hundred years ago, we started
realizing that some microbes are bad.

00:23:00.000 --> 00:23:04.999
We\'ve been on this major societal campaign to get rid
of bugs. We cleaned up their new pasteurized milk.

00:23:05.000 --> 00:23:09.999
We, you know, sanitized food when as a
result we\'re exposed to way less microbes.

00:23:10.000 --> 00:23:14.999
Yes, it got rid of infectious diseases. But
now we\'re seeing all these other diseases:

00:23:15.000 --> 00:23:19.999
inflammatory bowel disease, multiple
sclerosis, type 1 diabetes, asthma.

00:23:20.000 --> 00:23:24.999
These are all just going through the roof in our
society. The millions of bacteria that live in our gut

00:23:25.000 --> 00:23:29.999
are collectively called our microbiome.
There seems to be

00:23:30.000 --> 00:23:34.999
a symbiotic relationship between the
microbiome and our immune system.

00:23:35.000 --> 00:23:39.999
We know that antibiotics can
destabilize that relationship.

00:23:40.000 --> 00:23:44.999
One day, my wife was a pediatrician. She came home
and said, you know, Brett, kids that get asthma

00:23:45.000 --> 00:23:49.999
that have antibiotics in first-year life have much higher
rates of asthma than… than kids that don\'t get antibiotics.

00:23:50.000 --> 00:23:54.999
And most of the time asthma is
a kind of allergic reaction.

00:23:55.000 --> 00:23:59.999
Finlay was curious and launched a study

00:24:00.000 --> 00:24:04.999
in which mice were fed antibiotics.
The lungs were removed and analyzed.

00:24:05.000 --> 00:24:09.999
They have the asthma. What
you\'ll see is the lung gets

00:24:10.000 --> 00:24:14.999
very constricted, very tight. You also
look for inflammatory cells coming in.

00:24:15.000 --> 00:24:19.999
That\'s another cardinal sign of
inflammation and an allergic type actions.

00:24:20.000 --> 00:24:24.999
We\'ve got tons and tons of inflammation here. Finlay
was surprised by the strength of the results.

00:24:25.000 --> 00:24:29.999
There was a big, big effect. Umm…
Some antibiotics had profound effects

00:24:30.000 --> 00:24:34.999
on increasing levels of asthma in these
animals. What this means is that

00:24:35.000 --> 00:24:39.999
antibiotics may be killing off certain
strains of bacteria that help create

00:24:40.000 --> 00:24:44.999
a balanced immune system. We\'re
able to basically come up with

00:24:45.000 --> 00:24:49.999
a short list of seven bugs that seem to be associated with
increased or decreased levels of asthma in this model.

00:24:50.000 --> 00:24:54.999
Other mouse studies worldwide
have shown similar results.

00:24:55.000 --> 00:24:59.999
The hypothesis that creatures in our gut

00:25:00.000 --> 00:25:04.999
may help us avoid allergies
and asthma is called

00:25:05.000 --> 00:25:09.999
the \"old friends\" Hypothesis.
These are other old friends.

00:25:10.000 --> 00:25:14.999
They are parasitic worms.

00:25:15.000 --> 00:25:19.999
Happily, most of us no longer carry worms.

00:25:20.000 --> 00:25:24.999
But in the name of science,
some dedicated researchers

00:25:25.000 --> 00:25:29.999
instead of deworming are reworming.
I was given 50 worms

00:25:30.000 --> 00:25:34.999
and… and they certainly itched. While
studying the people of a remote island

00:25:35.000 --> 00:25:39.999
of New Guinea, the University of
Nottingham\'s David Pritchard discovered that

00:25:40.000 --> 00:25:44.999
Islanders with hook worms inside
them had fewer allergies.

00:25:45.000 --> 00:25:49.999
Since then other studies have
found that the presence of worms

00:25:50.000 --> 00:25:54.999
seems to protect against allergies.
People itself infected with the parasite

00:25:55.000 --> 00:25:59.999
and reported loss of hay fever during the
hay fever season, people in Ethiopia

00:26:00.000 --> 00:26:04.999
with Holcombe infection had a lower
response rates to dust mites.

00:26:05.000 --> 00:26:09.999
Prichard has now launched a trial to
learn if hookworms can help patients

00:26:10.000 --> 00:26:14.999
with the autoimmune disease, multiple
sclerosis. To find a safe level

00:26:15.000 --> 00:26:19.999
for the MS sufferers, the researchers knew they
would have to take on some worms themselves.

00:26:20.000 --> 00:26:24.999
They suck blood from the small intestines.
If you have too many,

00:26:25.000 --> 00:26:29.999
you suffer from iron deficiency, anemia.
We were given either

00:26:30.000 --> 00:26:34.999
10, 25, 50, or 100 worms on
sticking plasters onto the skin.

00:26:35.000 --> 00:26:39.999
The hookworm larvae penetrate
the skin, travel to the lungs,

00:26:40.000 --> 00:26:44.999
then up the larynx, and
down into the intestines.

00:26:45.000 --> 00:26:49.999
At… at some stage during that first few weeks, uh…
you wake up thinking are they currently in my mouth

00:26:50.000 --> 00:26:54.999
or are they in transit? So yeah, I… I
have to say that I am not comfortable

00:26:55.000 --> 00:26:59.999
with being infected with worms. Pritchard\'s
team finally concluded as safe

00:27:00.000 --> 00:27:04.999
but effective dose would be
between 10 and 25 worms.

00:27:05.000 --> 00:27:09.999
The parasite has to moderate the immune response
to survive. So if you can get the balance right

00:27:10.000 --> 00:27:14.999
and produce uh… produce an effect
by a tolerable level of parasites,

00:27:15.000 --> 00:27:19.999
then you could see therapeutic benefit in
patients. But Pritchard is full of caution

00:27:20.000 --> 00:27:24.999
about using worms to cure allergies.
People react to worms.

00:27:25.000 --> 00:27:29.999
They… they\'re not benign. You produce an inflammatory
response. So the last thing you want to see is

00:27:30.000 --> 00:27:34.999
to superimpose an inflammatory response
on an existing inflammatory response.

00:27:35.000 --> 00:27:39.999
We\'ve got multiple pieces to this chick so
that imply that worms might be beneficial.

00:27:40.000 --> 00:27:44.999
But I sometimes feel as if the pieces of
the jigsaw been hammered together to fit.

00:27:45.000 --> 00:27:49.999
Let\'s hope that reworming campaigns aren\'t
the solution to the allergy epidemic.

00:27:50.000 --> 00:27:54.999
Desensitization is certainly
a more attractive option.

00:27:55.000 --> 00:27:59.999
That\'s where 9-year-old Elizabeth
Wagoner is pinning her hopes.

00:28:00.000 --> 00:28:04.999
After an upsetting first attempt,
Elizabeth is bravely giving milk

00:28:05.000 --> 00:28:09.999
another try.

00:28:10.000 --> 00:28:15.000
[music]

00:28:25.000 --> 00:28:29.999
About a year and a half ago, that\'s decided on
her own that she would like to try it again.

00:28:30.000 --> 00:28:34.999
Elizabeth knows the risk. She remembers
the upset stomach and swollen lips

00:28:35.000 --> 00:28:39.999
she had trying milk the first time. I think
any kid who agrees to do this is very brave

00:28:40.000 --> 00:28:44.999
because it isn\'t fun for them at that time. All
right. Let\'s see how your blowing test looks today.

00:28:45.000 --> 00:28:49.999
Regular checks for asthma are part of
her ongoing desensitizing program.

00:28:50.000 --> 00:28:54.999
Asthma could make the
treatments more dangerous.

00:28:55.000 --> 00:28:59.999
All right. So same thing you\'ve done lots before.
Really deep breath first, tubing all the way.

00:29:00.000 --> 00:29:04.999
Ba… ba… ba… ba… ba… ba… ba… ba… ba… ba… ba… ba… ba… ba…
ba… ba… ba… ba… ba… ba… ba… ba… ba… ba… ba… ba… ba.

00:29:05.000 --> 00:29:09.999
Stop. Awesome. So, Elizabeth,
you\'re ready for your milk.

00:29:10.000 --> 00:29:14.999
Yeah. Elizabeth drinks 46 milliliters
of milk each day as a treatment.

00:29:15.000 --> 00:29:19.999
For now, that\'s as much as she
can take without reacting.

00:29:20.000 --> 00:29:24.999
Dr. Carr would ultimately like
to get her to 200 milliliters.

00:29:25.000 --> 00:29:29.999
[sil.]

00:29:30.000 --> 00:29:34.999
What? Considering how
sensitive she was before,

00:29:35.000 --> 00:29:39.999
umm… it\'s… it\'s quite a relief
that she\'s gone this far.

00:29:40.000 --> 00:29:44.999
But there\'s no guarantee even this is a
permanent fix. In recent US milk trials,

00:29:45.000 --> 00:29:49.999
75% of the graduates found that
symptoms of their milk allergy

00:29:50.000 --> 00:29:54.999
returned after they stopped
taking their daily doses.

00:29:55.000 --> 00:29:59.999
Elizabeth\'s immune system persists and
believing that milk proteins entering her body

00:30:00.000 --> 00:30:04.999
are a threat. But many people
show up in Dr. Carr\'s office

00:30:05.000 --> 00:30:09.999
believing they are allergic
to a food when in fact

00:30:10.000 --> 00:30:14.999
they have a food intolerance. There\'s
a lot of confusion between the two.

00:30:15.000 --> 00:30:19.999
Allergies affect the cardiovascular
and respiratory systems,

00:30:20.000 --> 00:30:24.999
the gastrointestinal system, and the skin.
Sometimes all at the same time.

00:30:25.000 --> 00:30:29.999
Food intolerances affect only
our gastrointestinal system

00:30:30.000 --> 00:30:34.999
and are never a life-threatening.
For instance, lactose intolerance

00:30:35.000 --> 00:30:39.999
isn\'t the same as milk allergy.
The best test for food allergy,

00:30:40.000 --> 00:30:44.999
can\'t emphasize this enough, is eating the
food. It\'s not a skin test or blood test.

00:30:45.000 --> 00:30:49.999
It\'s not a Vega machine. It\'s not applied
kinesiology. It\'s not iridology.

00:30:50.000 --> 00:30:54.999
It\'s not uh… an IgG blood test at the pharmacy.
It\'s what happens when you eat the food.

00:30:55.000 --> 00:30:59.999
And if a patient can eat the food
without identifiable symptoms,

00:31:00.000 --> 00:31:04.999
they\'re not allergic to it.

00:31:05.000 --> 00:31:09.999
Peanut goes in. Two weeks after
beginning his desensitization,

00:31:10.000 --> 00:31:14.999
William has arrived at the hospital for
an increase to 2 milligrams of peanut

00:31:15.000 --> 00:31:19.999
per day everyday. Here you
go that\'s one scoop. Okay?

00:31:20.000 --> 00:31:24.999
I\'m ready to time you. Go.
Exactly the same.

00:31:25.000 --> 00:31:29.999
At home he started on a 1 milligram dose 2 weeks
ago and he has that every day after school.

00:31:30.000 --> 00:31:34.999
The only reaction that we\'ve
seen umm… with the first

00:31:35.000 --> 00:31:39.999
probably three to four doses
was redness in his cheeks.

00:31:40.000 --> 00:31:44.999
Does anything feel different, William? No. Since you\'ve
had that peanut? No. Did you… We also have to give him

00:31:45.000 --> 00:31:49.999
three doses of medicine. So he has a liquid
antihistamine in the morning, and then two doses

00:31:50.000 --> 00:31:54.999
of something for a stomach. He\'s
not crazy about the medicines.

00:31:55.000 --> 00:31:59.999
It\'s a bit of a slow process in the morning. The
medicines are an important part of this study.

00:32:00.000 --> 00:32:04.999
Our study is also looking
to see whether taking

00:32:05.000 --> 00:32:09.999
uh… certain pre-medications like
antihistamines and antacids

00:32:10.000 --> 00:32:14.999
uh… help children tolerate the peanut throughout
the study. Sometimes children develop

00:32:15.000 --> 00:32:19.999
bad abdominal pain. They can\'t go through with the
desensitization. So that\'s one of our questions.

00:32:20.000 --> 00:32:24.999
Another big question for allergist

00:32:25.000 --> 00:32:29.999
at what age do they recommend children
be given allergenic foods like nuts?

00:32:30.000 --> 00:32:34.999
Until recently parents
were routinely advised

00:32:35.000 --> 00:32:39.999
not to feed their babies allergenic
foods until they were three years old.

00:32:40.000 --> 00:32:44.999
The theory was the child\'s immune
system had to develop more

00:32:45.000 --> 00:32:49.999
to deal with these foods. But that thinking

00:32:50.000 --> 00:32:54.999
has changed dramatically, partly
because of a surprising discovery

00:32:55.000 --> 00:32:59.999
made by a London immunologist. How… tell
me how old are you today, Samuel? Four.

00:33:00.000 --> 00:33:04.999
Dr. Gideon Lack learned that
allergists in Israel were seeing

00:33:05.000 --> 00:33:09.999
very few cases of peanut allergies. Yet
Israeli children are fed peanut products

00:33:10.000 --> 00:33:14.999
from a very young age. We
compared peanut allergy

00:33:15.000 --> 00:33:19.999
in Jewish children in the UK with uh…
Jewish children in Israel who therefore had

00:33:20.000 --> 00:33:24.999
a similar ancestral or genetic background.
And uh… we found that

00:33:25.000 --> 00:33:29.999
the rate of peanut allergy in the UK
children was 10 times higher than in Israel.

00:33:30.000 --> 00:33:34.999
Allergist no longer see any advantage
in withholding allergenic foods

00:33:35.000 --> 00:33:39.999
from young children. Now
they\'re waiting for results

00:33:40.000 --> 00:33:44.999
from a big study Dr. Lack
designed called LEAP,

00:33:45.000 --> 00:33:49.999
Learning Early About Peanut allergy.
640 children are enrolled.

00:33:50.000 --> 00:33:54.999
Half get peanut products as young as
six months. The other half hold off

00:33:55.000 --> 00:33:59.999
for three years. Partway through the study

00:34:00.000 --> 00:34:04.999
Lack found something puzzling. Children
who had never been exposed to peanuts

00:34:05.000 --> 00:34:09.999
had antibodies to the peanut protein as
though the body was protecting itself

00:34:10.000 --> 00:34:14.999
from something it had never experienced.
Let\'s say we have a successful outcome.

00:34:15.000 --> 00:34:19.999
Maybe all we\'re doing is suppressing their
peanut allergy by having them consume peanuts

00:34:20.000 --> 00:34:24.999
three times a week. So in
an extension of the study,

00:34:25.000 --> 00:34:29.999
subjects will stop eating peanuts for
one year and then be given them again.

00:34:30.000 --> 00:34:34.999
If we find out that eating
peanuts very early on

00:34:35.000 --> 00:34:39.999
in the first few years of life causes a
decrease in the rate of peanut allergy,

00:34:40.000 --> 00:34:44.999
which is sustained after
removing peanuts from the diet,

00:34:45.000 --> 00:34:49.999
then we would have what I would
call true tolerance as an outcome.

00:34:50.000 --> 00:34:54.999
Well, allergists await the
results of Lack studies.

00:34:55.000 --> 00:34:59.999
Some are trying another possible fix. How
are you doing? Good. Thanks. How are you?

00:35:00.000 --> 00:35:04.999
Good. You wanna sit down? Jessica Strachan
is one of Dr. Sussman\'s peanut patch kids.

00:35:05.000 --> 00:35:09.999
Your patches bother you? Umm… No, not much.
I first discovered

00:35:10.000 --> 00:35:14.999
I had peanut allergy I think
it was when I was three,

00:35:15.000 --> 00:35:19.999
and umm… I was having Thai food.
She got hives all over her body

00:35:20.000 --> 00:35:24.999
and her lips swelled up from uh… one piece of
chicken and one noodle that I actually forced her

00:35:25.000 --> 00:35:29.999
to… to eat actually. I said, \"You got
to try it.\" So that\'s how we knew.

00:35:30.000 --> 00:35:34.999
Should we take a look at your patches?
Is it there? Jessica is part of

00:35:35.000 --> 00:35:39.999
an international experiment testing a promising
new peanut desensitization technique.

00:35:40.000 --> 00:35:44.999
Neither she nor her mother know whether
she\'s in the placebo or treatment group.

00:35:45.000 --> 00:35:49.999
It\'s not red. It\'s not irritated. Everything
looks good. You\'re having no trouble with it?

00:35:50.000 --> 00:35:54.999
No. The peanut patch is a fascinating
way to desensitize patients.

00:35:55.000 --> 00:35:59.999
It works through epicutaneous absorption,
that means absorption through the skin.

00:36:00.000 --> 00:36:04.999
Okay, Jess. We\'ll do your patch.
The patch sends peanut protein

00:36:05.000 --> 00:36:09.999
directly into the immune system instead of the
blood stream. You\'re ready, Jess? 1, 2, 3.

00:36:10.000 --> 00:36:14.999
The beauty of the peanut patch is
that it\'s safe. It\'s a unique way

00:36:15.000 --> 00:36:19.999
to desensitize patients. The hope is to
cure peanut allergy. And the goal is

00:36:20.000 --> 00:36:24.999
to do that hopefully with
3 years of treatment.

00:36:25.000 --> 00:36:29.999
While allergists cautiously try
different methods of desensitization,

00:36:30.000 --> 00:36:34.999
immunologists are thinking
outside the box about causes.

00:36:35.000 --> 00:36:39.999
For instance, is it possible that

00:36:40.000 --> 00:36:44.999
eczema is a cause of food allergies? Or maybe
we\'re just not getting enough sunlight.

00:36:45.000 --> 00:36:53.000
[music]

00:36:55.000 --> 00:36:59.999
Two-year-old Shawna Giles lives in Iqaluit
in the Canadian Arctic. The common foods

00:37:00.000 --> 00:37:04.999
she\'s allergic to aren\'t milk or peanuts.

00:37:05.000 --> 00:37:09.999
We had a family gathering. We had arctic
char, frozen caribou, and beluga whale.

00:37:10.000 --> 00:37:14.999
And I gave her a few bites and she started
reacting to it. It started off from her mouth,

00:37:15.000 --> 00:37:19.999
started spreading, started getting hives.
Her eyes were swelling.

00:37:20.000 --> 00:37:24.999
And so we had to go to the hospital.
And a couple of months later

00:37:25.000 --> 00:37:29.999
she got tested, and we were not sure
allergic to arctic char and uh… raw caribou.

00:37:30.000 --> 00:37:34.999
I feel really bad sometimes because
she\'s… she\'s not able to have

00:37:35.000 --> 00:37:39.999
any of that. You\'re okay.

00:37:40.000 --> 00:37:44.999
Yeah. So the hairs look fine. Dr. Anthony
Ham Pong runs an Ottawa allergy clinic,

00:37:45.000 --> 00:37:49.999
but travels to the north each year
where he finds food allergies

00:37:50.000 --> 00:37:54.999
are keeping him busier. A few years ago we
weren\'t seeing as many, but it looks like

00:37:55.000 --> 00:37:59.999
it is increasing. The western
lifestyle is gradually creeping

00:38:00.000 --> 00:38:04.999
into there with medical… better
medical care and better health.

00:38:05.000 --> 00:38:09.999
And therefore that seems to be causing a
creeping increase in allergies as well.

00:38:10.000 --> 00:38:14.999
Ham Pong has also noticed that
skin contact with some foods

00:38:15.000 --> 00:38:19.999
seems to trigger allergies. There
are reports of some children

00:38:20.000 --> 00:38:24.999
becoming allergic to whale meat possibly
because whale oil was rubbed on their skin

00:38:25.000 --> 00:38:29.999
when they were young. If you apply a food on the skin and
it\'s absorbed, you are more likely to become allergic

00:38:30.000 --> 00:38:34.999
than if you eat it. And
if a child has eczema,

00:38:35.000 --> 00:38:39.999
the food has easier access
through the broken skin.

00:38:40.000 --> 00:38:44.999
Doctors have long known that babies with eczema
are more prone to develop food allergies.

00:38:45.000 --> 00:38:49.999
Now some British researchers
think that maybe eczema

00:38:50.000 --> 00:38:54.999
is a cause of food allergies.
If the skin is uh… broken down

00:38:55.000 --> 00:38:59.999
and they\'ll so to speak microscopic holes
in the skin, then small amounts of egg,

00:39:00.000 --> 00:39:04.999
and peanut, and milk protein that are present in the
environment can potentially enter through the skin.

00:39:05.000 --> 00:39:09.999
Uh… The theory, and this is all theory,
is that the body\'s immune system

00:39:10.000 --> 00:39:14.999
sees this as an invading parasite,
and tries and rejects it.

00:39:15.000 --> 00:39:19.999
Or perhaps there\'s something
else affecting the skin

00:39:20.000 --> 00:39:24.999
that may hold the key to
the allergy epidemic.

00:39:25.000 --> 00:39:29.999
Maybe modern Western cultures are
just not getting enough sunshine.

00:39:30.000 --> 00:39:34.999
For a while now there\'s been
a building body of evidence

00:39:35.000 --> 00:39:39.999
that vitamin D has a positive effect
on the immune system and lack of it

00:39:40.000 --> 00:39:44.999
can mean the potential development of allergies.
The University of Exeter\'s Nick Osborne

00:39:45.000 --> 00:39:49.999
gets some of his vitamin D from the
cornice sunshine in West England.

00:39:50.000 --> 00:39:54.999
I ride my bike to work a couple of days a week.
So I\'d probably get enough sunshine doing that.

00:39:55.000 --> 00:39:59.999
I play cricket on the weekends.
I definitely get too much then.

00:40:00.000 --> 00:40:04.999
Osborne used the long-term Australian population
study to compare the rate of allergies

00:40:05.000 --> 00:40:09.999
between states that get more
Sun with states that get less.

00:40:10.000 --> 00:40:14.999
We found that the kids that were closer
to the equator had lower allergies

00:40:15.000 --> 00:40:19.999
and lower eczema than their
counterparts in the southern states.

00:40:20.000 --> 00:40:24.999
And it\'s almost like a two-fold uh… uh… increase.
So we\'re pretty confident in our results.

00:40:25.000 --> 00:40:29.999
Osborne wants to follow
up with new studies.

00:40:30.000 --> 00:40:34.999
We\'re gonna add some extra layers in around
cloud cover and how that might affect

00:40:35.000 --> 00:40:39.999
the relationship between sun
exposure and vitamin D.

00:40:40.000 --> 00:40:44.999
Osborne knows there\'s a lot of uncertainty
around this vitamin D theory.

00:40:45.000 --> 00:40:49.999
Right now there\'s more
confidence in desensitization.

00:40:50.000 --> 00:40:54.999
Eight months later,

00:40:55.000 --> 00:40:59.999
Jessica, the peanut patch girl, now knows
that happily she was in the treatment,

00:41:00.000 --> 00:41:04.999
not in the placebo group. Her
tolerance of peanuts was tested

00:41:05.000 --> 00:41:09.999
and she\'s improved. In the next phase,
she\'ll get a bigger dose to see

00:41:10.000 --> 00:41:14.999
if her peanut allergy can
be eliminated completely.

00:41:15.000 --> 00:41:19.999
A year of peanut desensitizing

00:41:20.000 --> 00:41:24.999
hasn\'t been easy on William\'s parents.

00:41:25.000 --> 00:41:29.999
It\'s been very difficult to get William to
take his medicine. There\'s been a few times

00:41:30.000 --> 00:41:34.999
where I thought we throw in the towel.
Umm… but I just keep thinking about

00:41:35.000 --> 00:41:39.999
the reason why we\'re doing the
desensitization. Here we go.

00:41:40.000 --> 00:41:44.999
And now William is eating whole peanuts.

00:41:45.000 --> 00:41:49.999
[sil.]

00:41:50.000 --> 00:41:54.999
Already for us, we are just
a little bit more relaxed.

00:41:55.000 --> 00:41:59.999
Going somewhere else for dinner, going out for
dinner, you know, if someone makes a birthday cake,

00:42:00.000 --> 00:42:04.999
I\'m just a little bit, you know, a little
bit more relaxed about the whole thing.

00:42:05.000 --> 00:42:09.999
Happy birthday. Hey, come on in.
Have fun (inaudible). Bye.

00:42:10.000 --> 00:42:14.999
The big question for Beth and Dan, for Dr.
Sussman, for Dr. Carr,

00:42:15.000 --> 00:42:19.999
for Dr. Lack, and for Dr.
Waserman, will the allergy return

00:42:20.000 --> 00:42:24.999
if the child stops taking the daily dose?

00:42:25.000 --> 00:42:29.999
What isn\'t yet certain is whether
this type of procedure is a cure?

00:42:30.000 --> 00:42:34.999
Can these children ever stop the protocol,
stop taking daily peanut, and yet lose

00:42:35.000 --> 00:42:39.999
the allergy over time? I\'m (inaudible) like
about four peanut (inaudible). I\'m not sure

00:42:40.000 --> 00:42:44.999
it\'s like sort of like a peanut cover
up like a peanut covered uh… cake.

00:42:45.000 --> 00:42:49.999
I can\'t have that. (inaudible) myself

00:42:50.000 --> 00:42:54.999
to treat it like a peanut allergy. I just feel
like there\'s so much less stress in our life

00:42:55.000 --> 00:42:59.999
and I just never really realized how much
uh… it impacted our… our life as a family.

00:43:00.000 --> 00:43:04.999
And incredibly, after all his complaining,

00:43:05.000 --> 00:43:10.000
William now likes peanuts.

00:44:10.000 --> 00:44:18.000
[sil.]