What constitutes an epidemic? If a ten-fold increase in the incidence of an illness (from 416,000 to 4,500,000 in the space of 12 years) does not, what does? These are the figures for the incidence of peanut allergy in children in the USA in 1997 and 2009 and they must surely suggest that this is no ordinary allergy. This is the core argument of Heather Fraser’s gripping new book, The History of the Peanut Allergy Epidemic. The peanut phenomenon is something separate from the generally acknowledged rise in allergy/atopy and, if only one cares to look, its genesis and its progress are there for all to see. But no one – scientists, medical researchers, biochemists, doctors, legislators and, especially, pharmaceutical companies – has cared to look. The overview below gives the bones of Heather Fraser’s thesis but for anyone with more than just a passing interest in peanut allergy her immensely detailed, carefully referenced book is both essential reading – and essential ammunition for those battling to come to terms with and to manage this horrendous condition. The book can be had as a soft back book, or as an E-book. At C$19.99 plus shipping for the printed book and at a mere £7.63 as an E-book it is excellent value. Check in at Heather’s website – www.peanutallergyepidemic.com to buy the book and for more information about both Heather and the book’s genesis. Heather’s tale relates very specifically to the United States of America and Canada, but the pattern is repeated throughout the Western World and wherever WHO guidelines are followed. The story has several strands… Anaphylaxis Although not known by that name, anaphylaxis has been known from ancient times – an illustration in an Egyptian tomb from around 3,000 BC shows a man suffering from an anaphylactic reaction to a bee sting. In the early years of the 20th century, Charles Richet showed that although it was very difficult to create an anaphylactic reaction to a food that was eaten, and was therefore modified and neutralised by powerful stomach acids and the process of digestion, it was very easy to sensitise an animal to a specific protein by injecting that protein. A second, smaller dose would then cause a serious, even fatal, allergic/anaphylactic reaction. Around the same time, Nicholas Arthus and Richard Otto showed that it was possible to produce an anaphylactic reaction to virtually any protein – meat, milk, egg, peanut, diptheria – by injecting it. Remember this…

Early vaccination The mass population movements from the country to the city which occurred in the late 18th and early 19th century created dense overcrowding which, combined with poor hygiene, was the ideal breeding ground for animal pathogens and the spread of deadly diseases such as smallpox for which there were no cures. However, in the late 18th century it was discovered that allowing the pus from an infected cow to seep in through a scratch on the skin, appeared to deliver some degree of immunity. Vaccination (‘pertaining to a vacca’ or cow) was born. Over the course of the 19th century several significant developments took place: • The invention of the hyperdemic needle allowed the vaccine to be delivered more hygienically, safely and effectively by injection rather than by infecting the skin. • Extra ingredients (all patented) were added to the vaccines to extend their shelf life and made them more effective: mercury based antifungals oil-based adjuvants* carrier gels from boiled animals etc *Adjuvants – ingredients which prime the body so that it is more sensitive to the vaccine, thereby reducing the amount of the active substance needed, although it has never been entirely clear how this process happens. Peanut is an excellent adjuvant as it is potentially highly allergenic and therefore very good at priming the immune system – although its use must also risk not just priming the immune system but sensitising it.

Serum sickness It was recognised from very early on that up to 10% of vaccinations (up to 50% in children) would cause what was known as ‘serum sickness’ – a little understood set of symptoms that included fevers, rash, diarrhoea, falling blood pressure, joint pain and breathing difficulties. These could last for days, for weeks or for ever and, occasionally, proved fatal. However, so great was the fear of diseases such as smallpox and diptheria that most people were prepared to take that risk. Work by Clemens von Piquet and Bela Schick in 1906 showed that the symptoms of serum sickness were almost identical to a hypersensitivity (allergic) reaction to food proteins, bee stings etc. They noted that the adverse reaction appeared 10–30 days after the second injection, depending on the person vaccinated. By the end of the 19th and beginning of the 20th centuries vaccine manufacture was big business.

Track back to anaphylaxis… Despite Richet’s work in the early 20th century, the possibility that the injection which delivered the vaccination could also induce anaphylaxis was never considered. The incidence of egg allergy from the 1930s onwards within the vaccinated population was never connected with use of egg in the manufacture of vaccines, also introduced in the 1930s. A mysterious outbreak of cotton seed allergy in the US which started in the 1930s, peaked in the 1940s and died out in the 1950s, was never connected with the use made, during that period only, of cottonseed oil as an excipient in the manufacture of vaccines.

Penicillin The discovery and subsequent wide use of penicillin during World War II had revolutionised medical treatment but the miracle drug had a major drawback in that doses only lasted for a couple of hours. In 1945 it was found that, by mixing penicillin with beeswax and peanut oil, its release into the body could be slowed and dose intervals could be lengthened to 24 hours. In 1948, sticky beeswax was replaced with aluminium monostereate suspended in peanut oil to create PAM, a hugely popular drug which had been injected into around 37 million Americans by 1957. Logged, but not noted, was the fact that around 2.5% of the children injected with the original beeswax/peanut oil combination developed an allergy to penicillin and that by 1957, up to 10% of the US population were allergic to the penicillin injection. In the 1960s, new vaccines were developed which extended shelf life even further. One of the most successful was the Merck Adjuvant 65-4, licensed for use in the UK in 1974 and is still in use today, which included up to 65% of peanut oil.

Oil excipient/adjuvant – why peanut? Peanut oil was not the only oil which could have been, or was, used in vaccine manufacture but it did have significant advantages: • It was home grown so was cheap and its use was popular with the peanut farmers. • It was an excellent adjuvant – see above. • Theoretically, since the oil used was refined, it did not carry any risk of allergenicity but, research did not always support the claim that refining removed all protein residues from the oil, nor was the quality of the oil used very reliable.

Risk analysis / risk protection Although it was little publicised, the medical profession had always been aware that vaccination by injection carried the risk of inducing allergy but, as in the early days of cow pus vaccination and serum sickness, the risk was felt to be outweighed by the benefits. However, by the early 1980s, the incidence of vaccine damage had grown significantly; by 1985 no less than 231 lawsuits were pending against vaccine companies. The risk of being sued was starting to outweigh the benefit of profitable manufacture and pharmaceutical companies were pulling out of vaccine making so fast that the US was facing a serious vaccine shortage. To tempt them back into the field, in 1988 the Vaccine Injury Compensation Programme was introduced by which prospective litigants first had to prove their case in a federal court before they could sue a pharmaceutical company for damages, thereby effectively protecting the latter from 95% of vaccine litigation. However, in this attempt to shore up the vaccine system, what no one seriously contemplated was the possibility that using a substance as potentially allergenic as peanut in injections which were not only to become universal over the next 20 years but were to dramatically increase in number and be administered at an ever younger age, could create an epidemic of allergy which could rival the original diseases in their power to harm. And by the time anyone did, not only had the vested interests in vaccination become so massive that even contemplating such a possibility had become unthinkable but there were no unvaccinated populations left to use as controls in any meaningful assessments of risk.

Treating allergy – a commercial bonanza Vaccines had proved to be very profitable for the pharmaceutical companies in the early years of the 20th century and, once they had been protected from litigation by those who believed they or their children had been damaged by vaccination by the Vaccine Injury Compensation Programme, the pharmaceutical companies ‘went back into’ vaccine manufacture with a will. But this time there was an added bonus. Although the connection between the two was never made, the increase in allergy across the board during the 1970s and 80s, including potentially fatal anaphylaxis, offered a whole new market to pharmaceutical companies and, indeed to the food industry. The development of the Epipen in the 1980s, delivering the only known antidote to an anaphylactic attack, proved to be a commercial goldmine while managing allergy presented endless opportunities for new drugs and new treatments. Meanwhile, the ‘freefrom’ food industry (now, in 2010, worth billions of dollars world wide) was born – creating foods which would be free of peanuts, nuts, dairy, wheat and any of the any food products which were thought to cause allergy.

Ramping up the vaccination programme In the late ‘80s only 55-65% of pre-school children in the US were vaccinated. Research suggested that the Hib vaccine against meningitis was very successful and seemed to have reduced the incidence of the disease significantly, so the first Bush government introduced a programme to raise pre-school vaccination levels to 90% by 2000. The programme was intensified by the Clinton administration and promulgated throughout the western world by the WHO. To achieve this: • A whole series of new vaccines, most bound to toxic carrier proteins to ensure that infant systems reacted appropriately, flooded onto the market. • The age at which the children were vaccinated was gradually reduced from two years to two months. (In Japan, be it noted, no vaccinations are given before the age of two.) • The number of vaccines give to an infant in the first 18 months of life increased from 10 to 29, the first dose being administered only hours after birth. • For the convenience of families (thereby ensuring greater compliance) and to reduce the pain for the infants, up to five vaccines were combined into a single shot, although the medical profession admitted that they had little idea what unexpected side effects might be created by combining different vaccines. There had been no longitudinal studies looking at possible long-term effects of combination vaccines.

Explosion of peanut allergy and peanut allergy awareness In the early 1990s there was a dramatic rise in the number of peanut allergic infants who had reached school age, catapulting peanut allergy awareness into the headlines as schools struggled to find ways to safely accommodate peanut-allergic children within a peanut-eating class. This sudden acceleration of peanut allergy around 1990 coincided with those paediatric vaccination schedule changes, including the rolling of the novel conjugate Hib B along with another four vaccines into one needle, all without benefit of long-term study. The changes had been made simultaneously in the countries that coincidentally had a spike in peanut allergy, just in children. The Isle of Wight cohort studies showed a shocking doubling of the allergy by the mid-1990s from 0.5% of preschoolers to 1.1%. Emergency hospital admissions also reflect the sudden rise. And, although given little attention, the eye-witness accounts of kindergarten teachers in the early 1990s suddenly faced with a flood of food allergic children, all point to this time as the beginning of the epidemic. And along with the increasing awareness of the problem came the endless – and fruitless – speculation about causes: why only children? Why only in Western societies? What if the peanuts were boiled rather than roasted? Was it as a result of TH cell imbalance? Was the hygiene hypothesis relevant? How about the parasite/helminth theory? Was it hereditary? Was the increase in Caesarean births and the effect on intestinal flora relevant? Why more boys than girls? And still the numbers continue to grow. In 1997 0.6% of the US population of children under five had peanut allergy; by 2002 this had doubled to 1.2%; by 2009 over 2% of children under 18 living in the US, the UK, Canada and Australia were peanut allergic and there was a one in 50 chance that a child, especially a male, living in a westernised country, would develop peanut allergy. And, until now, no one has made the connection – or if they have, they certainly have not done so publicly… As Heather Fraser says: Medical literature has illustrated that the only means by which mass allergy has ever been created was by injection. With the pairing of the hypodermic needles and vaccines at the close of the 19th century, allergy and anaphylaxis made their explosive entry into the western world. Serum sickness from this new procedure was the first mass allergic phenomenon in history. Epidemic allergy to penicillin reminiscent of the ‘days of serum sickness’ emerged with its mass application following WWII. And with it came peanut allergy. Penicillin was administered using POB, the Romansky peanut oil formula. The continued use of refined peanut oil in drugs and vaccine adjuvants resulted in the slow growth of the allergy primarily in children until the late 1980s when its prevalence exploded. Extensive and sudden changes to childhood vaccination precipitated the new mass allergy to peanut. So buy the book – read it – tell your friends about it – tell your doctor about it – write to your MP about it – write to the newspapers about it! This could be the first step to a new awareness and, maybe, a breakthrough in this ever growing tragedy. Buy the new edition (2015) of The Peanut Allergy Epidemic in the UK here and here in the US. First published in September 2009 If you found this article interesting, you will find many more articles on peanut and tree-nut allergy here, and reports of research into the conditions here.

You can also find articles on anaphylaxis here, cow's milk allergies here, egg allergy here, histamine intolerance here and articles on a wide range of other allergic and intolerance reactions to a wide range of other foods here. Back to top