Here’s why I said I’m cautious about the results from this paper: bsky.app/profile/ckee...

4. The network was pediatric providers - were allergists included? Would diagnoses made by allergists be captured in the data?

Here is why: bsky.app/profile/ckee...

3. What happens if you use different criteria for peanut allergy, such as dropping the requirement for epinephrine prescription? Or dropping the visit diagnosis code?

2. What happens if you adjust for provider/pediatrician practice? From the supplemental data it looks like the geographic distribution of kids changed over time.

If I were a reviewer- I would ask: 1. What is the change in food/peanut allergy in children of other ages over time - is it also decreased, which would be inconsistent with the main hypothesis that the decrease is related to infant feeding.

My hypothesis is that the criteria for detecting peanut allergy in this study is not sensitive and could vary over time and by location in ways unrelated to the actual prevalence of food allergy.

Why is the rate of food allergy so much lower in black children, a finding that is not consistent with other data? Why is the rate in everyone so low, again inconsistent with other data?

Within the study there are also some head scratchers - the rate of other food allergies also dropped a lot (milk 23%, fish 59%, shellfish 43%). Why?

Similar decreases in peanut allergy have not been shown in other high quality studies despite higher peanut introduction

First, if the >40% decrease in peanut allergy that they found was due to increases in early introduction of peanut, early introduction would have to be nearly universal. This is not what we see! www.clinicalkey.com#!/content/pl...

Previously we identified a novel link between having IgE to food allergens and cardiovascular disease, then replicated it in an NIH funded cohort. We are now following this up with more in depth human studies and a mouse model. All of this is because of NHANES.

In my work on the epidemiology of food allergies and asthma, we have used NHANES countless times. Among the things planned for the current NHANES was the most comprehensive assessment of the epidemiology of food allergies.

I bought an ebike about 2 years ago and ride the 2 miles to work everyday (UNC). I completely gave up parking more than a year ago and have saved more than double the cost of the bike in parking alone. ~1700 miles with only one repair (flat tire).

He seems to have missed that funding in his book and wsj op-Ed, which is framed as a story of a heroic outsider against the NIH establishment.