Ashley Dombkowski talks about her job with a kind of reverence we'd all like to have.
The co-founder of Before Brands, a San Francisco-based start-up, wants to prevent food allergies in children before they take hold. She says she has a nephew with severe food allergies, and that familial connection makes her job, as she put it, "life's work."
The question is whether or not Before Brands's method to achieve their stated mission will succeed.
The problem, to be sure, is real. Food allergies among children in the United States have become much more prevalent in the 21st century. Around 6 million U.S. children under the age of 18 have food allergies, which amounts to one in every 13 kids, according to the nonprofit Food Allergy Research and Education. Of those, about one-third are allergic to more than one food. All this represents a 50 percent increase in food allergies among U.S. children during the period from 1997 to 2011.
Before Brands wants to reduce that trend with a product called Spoonful One. The product is a powder that, as described on the company's website, is "designed to introduce all the foods most commonly associated with food allergies: peanut, tree nuts, milk, egg, fish, shellfish, wheat, soy and sesame. Plus, the pediatrician-recommended dose of Vitamin D."
Sprinkle one packet of the powder on whatever your kid is eating, once per day, and, the company claims, that exposure will reduce your child's risk of developing an allergy to the sampled foods.
The site says parents can start giving their kids Spoonful One "anytime once your child is eating solid foods – especially critical during the first year." Parents can sign up for subscriptions that last three, six, or 12 months. The cheapest (per day) option is to sign up for a year, which costs $912.50 in full.
Dombkowski comes from the biotech industry, where companies mainly focus on treating existing ailments. Here, she hopes to be proactive about preventing allergies in healthy kids.
To do this, she teamed up with her co-founder, Kari Nadeau, the director of Stanford University's Sean Parker Center for Allergy and Asthma Research, whose university profile page describes her as "one of the nation's foremost experts in adult and pediatric allergy and asthma."
In an email, Nadeau said she couldn't answer questions about Spoonful One because her Stanford lab patented and licensed the product to Before Brands, and the university received royalties in the process.
But the company's chief medical officer, Wendy Sue Swanson, said the product is based on research done at Stanford and elsewhere. Swanson said Nadeau wanted Spoonful One to include a range of foods to which kids might become allergic, in order to better reduce the risk of a range of allergies.
Allergy specialists not associated with the company agree that exposure to these foods early in life may be able to prevent children from developing allergies.
How to do that, though, is a matter of debate.
In 2015, a study shook up the world of food allergy science. Known as the LEAP study (Learning Early About Peanut allergy), its results showed that consuming peanuts from a very young age can stop the development of a peanut allergy in kids who had a high risk of developing one. A subsequent study "demonstrated that regular peanut consumption begun in early infancy and continued until age five reduced the rate of peanut allergy in at-risk infants by 80 percent compared to non-peanut-consumers."
Swanson said experts had long told parents to avoid giving their young kids peanuts, but the LEAP study and a subsequent study known as LEAP-ON were so profound that the National Institute of Allergy and Infectious Diseases (NIAID) issued new guidelines, advising parents to introduce "peanut-containing foods" to their kids as young as four months old.
Those guidelines pertained only to peanuts, because LEAP had only examined peanuts, which is one reason some food allergy specialists aren't sold on Spoonful One.
Joyce Yu, a food allergy specialist and an assistant professor of pediatrics at Columbia University, said that the product makes sense in some ways. Spoonful One is, when you get down to it, a bunch of crushed up nuts, egg, and seafood, amongst other things. Parents could theoretically do something similar at home (if they manage to figure out the right portions of each to crush), but it'd take a time investment, and, as Yu alluded to, many busy parents would struggle to fit the mashing of various foods into their daily or weekly schedules.
But Yu is concerned that Before Brands is hitching their product to the LEAP study, which, although influential, is still just one study that deals with one type of food, not the range of food found in Spoonful One.
"If doctors know these other foods also cause allergies, why not try to prevent them with early exposure, too?"
"It's not like you have 500 studies out there," she said, meaning studies about how different amounts of different proteins effect the development of food allergies.
Michael Pistiner, the director of food allergy advocacy, education and prevention at the Food Allergy Center at Massachusetts General Hospital For Children, emphasized that LEAP's results pertained only to kids between four and eleven months old with a high risk of developing a peanut allergy.
LEAP participants ate peanut puff snacks "equivalent to six grams of peanut protein each week," Pistiner said. The NIAID guidelines based off that study recommend similar intake -- two grams each taken three times a week.
Each serving of Spoonful One, according to a nutrition label posted on the company's site, contains less than one gram of all proteins combined, per serving. Taken every day, that amounts to less than seven grams of total protein per week.
"It may not be enough protein," Pistiner said. "The current[ly] available studies suggest higher amounts of peanut protein. It's unclear what the effects of significantly lower doses will be."
Swanson says the company understands that the study only pertains to peanuts, but they've decided to try to be on the forefront of where they believe the data is pointing them. If doctors know these other foods also cause allergies, why not try to prevent them with early exposure, too? And Nadeau, as Swanson emphasized, is a "pre-eminent allergist."
"This is the first attempt and the first approach and the first product," Swanson said. "But it wasn't carelessly done."
Pistiner recommends parents talk with their child's doctor before they use Spoonful One, and that those doctors be up-to-date on the latest guidelines put out by the NIAID.
Topics Health
