How do Israelis give babies peanut products—and escape allergies?

In the US, some children with allergies are given small amounts of peanut powder.
In the US, some children with allergies are given small amounts of peanut powder.
Image: AP Photo/Gerry Broome
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Israelis so love the peanut snacks known as Bamba that the factory making the stuff has been classified an “essential wartime industry.”

Bamba looks a lot like Cheez Doodles but tastes like peanut butter. It boasts a 25% share of Israel’s snack market, making it the most widely sold snack in the country, according to Bamba manufacturer Osem. Not only is Bamba popular, but it is such an icon of Israeli childhood that the Olympic Committee of Israel proposed using the brand’s mascot, a diaper-clad cartoon figure known as the Bamba Baby, as the country’s mascot in the London Olympics (though that idea was ultimately shot down as too commercial).

Meanwhile, in the US and Europe, schools are banning peanuts and peanut products from classrooms, lunchrooms, and bake sales. Parents go to great lengths to keep peanuts far, far away from their babies, often waiting till age 2 to introduce the product. In fact, allergy anxiety is so strong that far more people think they have food allergies than have actually been diagnosed with them.

This is at odds with the Israeli approach—and lots of places around the world that feed children peanut products, such as the peanut soup of West Africa and the porridge of rice, peanut butter and sugar common to Central Africa.

There are reasons for the extreme reactions peanuts can engender, of course, like the tripling of nut allergies among children in the United States between 1997 and 2008, at least based on self-reported assessments (more definitive conclusions are harder to come by), and the fact that a particularly severe allergy can potentially be fatal if not treated immediately. But given that the national hysteria over nut allergies, which a Harvard professor of medical sociology has said looks a lot like mass psychogenic illness, shows little indication of subsiding, is there any reason to think there might be room on the supermarket shelf, or the Western psyche, for a peanut product fed to children from as young as five or six months of age?

In a word, yes.

A study published in last month’s issue of the Journal of Allergy and Clinical Immunology found that a majority of subjects with documented peanut allergies who were given small amounts of peanut powder every day over 44 weeks were desensitized to some degree compared with those who received a placebo, even though peanut allergies had previously been considered untreatable.

While many Western doctors had long recommended waiting between one and three years before feeding peanut products to babies, the National Institutes of Health and the American Academy of Pediatrics more recently determined that there is no reason to avoid feeding babies any possibly allergenic food like nut products or eggs beyond four to six months. This holds true even if the infants are at risk of developing an allergy because of their family history, as long as the babies don’t have a documented food allergy of their own. Britain adopted a similar position in 2009.

“There is no known benefit to avoiding potentially allergenic foods,” an expert panel sponsored by the NIH’s National Institute of Allergy and Infectious Diseases stated in guidelines released in 2010. The guidelines also say there is no recommendation for pregnant or breastfeeding women to stay away from potential food allergens due to fears that, say, the peanut butter candies they crave might increase their babies’ likelihood of developing an allergy.

The theory behind delaying the introduction of potential allergens is that being exposed early could mean becoming allergic early. But if the opposite is actually the case, then parents and doctors seeking to be on the safe side by limiting the intake of certain foods may actually be part of the problem.

Enter Bamba.

“There has never been anything [in Israel] prohibiting parents from giving peanut snacks from a particular age,” Dr. Yael Levy, the deputy director of the Kipper Institute of Immunology at Schneider Children’s Medical Center of Israel, told me. “The advantage of this snack is that you can even put it into the mouths of babies who don’t have teeth, because it really melts,” she added. “The practice is to give it the first year, from six or seven months old, and there’s no danger in that.”

A 2008 study published in the Journal of Allergy and Clinical Immunology put that in more scientific terms, finding peanut allergy to be 10 times more prevalent among British children than Israeli ones. Although the study did not demonstrate causation, it also found that 69% of Israeli infants consume peanut products by the time they are nine months old, compared to just 10% of their British counterparts. (The participants in both groups were Jewish, to minimize any underlying genetic differences.)

It’s not just Israeli kids either. A study last year found that most food allergies were more prevalent among well-educated Canadians born in Canada than among immigrants. An earlier study indicates the likelihood of an environmental component, showing that a high prevalence of “allergic diseases” like hay fever and asthma in Asian immigrants was strongly associated with how long the immigrants had been living in Australia.

Dr. Gideon Lack, a professor of pediatric allergy at King’s College London and one of the researchers behind the Israel-UK study, is the principal investigator of a current British clinical research study that aims to determine whether the best way to prevent peanut allergy is through avoidance or early consumption. Called LEAP, which stands for Learning Early About Peanut Allergy, the study is following 640 children at high risk of developing allergies from infancy through age 5. The randomly assigned avoiders were not allowed to eat foods containing peanuts until age 3, while those in the consumption group are being fed different kinds of peanut products—including Bamba—three times a week. The findings are expected to be ready at some point next year, after which a one-year follow-up study will be conducted.

Lack says it’s too early to tell which way the data are blowing and told me the results could end up solidly in the gray area, with no clear advantage being conferred to the population at large by either avoidance or consumption. But a relatively rapid change in public health policy could be in the offing, he predicted, if the study ends up showing huge benefits of either avoidance or consumption that affect all types of populations—those with and without a strong family history of allergy, for example—and demonstrates that either practice has a long-term effect.

Bamba’s hardly expecting results to help its entry overseas. “In Israel, Bamba is a unique local phenomenon that took years to develop; Osem doesn’t expect that to be the reaction in international markets,” says Nadav Cohen Keidar, a spokesman for the company, which is now majority-owned by Nestle. Although Bamba is already being sold in the United States and England, sales in those countries are geared toward the kosher market, many of whose customers are already familiar with the product.

One issue in the puffs’ favor is that despite the peanut allergy craze, Americans have not stopped buying nuts. On the contrary, the nuts category will be seeing the most growth within the salty snack sector by 2015, reaching volume growth of 2.49% by that year, according to an April 2011 market indicator report on the US snack industry prepared by Canada’s International Market Bureau. “Nuts are gaining in popularity with the consumer and are predicted to continue experiencing high growth rates unseen since 2004,” the market report found, attributing the success to consumer awareness of the high protein, fiber and antioxidant characteristics of nuts.

Culture, including food culture, can take a long time to change. Before writing off American grocery shelves, peanut puff producers ought to keep in mind the upstream battle of sushi. Once upon a time, The Story of Sushi author Trevor Corson told Slate in 2007, the Japanese concoction was rejected as a possible import because everyone “thought it would be too disgusting for Americans to try.”