Here’s What You Should Know About the New Hepatitis B Vaccine Recommendation

Jan 5, 2026 | Children's Health, Family Medicine, Featured, Infectious Diseases, Pediatrics

For several decades, federal guidelines regarding hepatitis B vaccination for infants in the United States had been unchanged and consisted of a first shot given at birth, a second at 1-2 months, and a third at 6-18 months.

In December 2025, the Centers for Disease Control and Prevention (CDC) announced new recommendations for hepatitis B vaccinations. For infants born to mothers who test negative for hepatitis B, the agency recommended the initial shot only at two months or after, and for infants to undergo antibody testing to determine whether the second and third shots are needed.

“The medical community hasn’t changed its stance on hepatitis B vaccinations, however,” says Daniel Caplivski, MD, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine, and Director of the Icahn School of Medicine Travel Medicine Program.

Daniel Caplivski, MD, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai (left), and Roberto Posada, MD, Professor of Pediatrics (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai (right).

“Hepatitis B is a virus that, for many people, once they get the infection, they have it for the rest of their lives,” says Roberto Posada, MD, Professor of Pediatrics (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai. “It can lead to cirrhosis of the liver and liver cancer, both of which are very preventable through childhood vaccination.”

Why are medical experts recommending that infants receive hepatitis B vaccinations at birth and to receive all shots? Drs. Caplivski and Posada explain the rationale behind the schedule and other facts about the virus.

Why should babies be vaccinated for hepatitis B at birth?
Dr. Posada: This recommendation had been in place since 1991. There are a few reasons why medical experts had pushed for hepatitis B vaccination for infants at birth. Usually, we check pregnant women for hepatitis B. But some people might not have access to full prenatal care, or the check sometimes gets missed. A mother in that situation can unknowingly pass hepatitis B on to the child. Vaccination at birth can prevent that.

Another reason is that the opportunity to protect the child is highest at the moment of childbirth. Once a child and mother are discharged, they might not return for follow-up appointments, or do so at the appropriate times. Thus, giving the hepatitis B vaccination right at childbirth at least provides that initial protection.

What’s the risk of waiting to vaccinate infants for hepatitis B?
Dr. Posada: For infants, other than hepatitis B being passed from the mother, the virus can be transmitted to some degree through household exposure to someone who has hepatitis B. For example, sharing utensils, an infant putting a parent’s toothbrush in the mouth—these are not the main ways of contracting the disease, but they can happen. We want to vaccinate the kids in the event there is someone in the household with hepatitis B.

Other than for infants, the main way hepatitis B is transmitted is through sexual transmission or contact with contaminated blood, such as via needles. That’s another reason to vaccinate children before they become sexually active.

Is the hepatitis B vaccine effective at preventing transmission?
Dr. Caplivski: Ever since we adopted the practice of vaccinating infants at birth, the rate of infants and children contracting hepatitis B has dropped to practically zero.

And the success of vaccinating at childbirth has been replicated around the world. In China, after they adopted a three-dose vaccination schedule from birth, the prevalence of hepatitis B carriers under 5 years old fell from 10 percent to around 0.3 percent in 10 years. That’s a lot of lives saved from chronic complications of the disease.

What could be the consequences of contracting hepatitis B?
Dr. Posada: If a baby gets it at birth, they’re very likely to have it for the rest of their life. And because the infection is lifelong, the more chances for cirrhosis, liver failure, or liver cancer to develop in the lifetime. Someone who contracts it at an older age has a higher chance of clearing the infection from the body.

Dr. Caplivski: The long-term consequences of liver failure and cancer are incredibly difficult for a patient. It is a medically intensive disease, but it also has a huge impact on health care expenditures. All of these could be avoided through vaccinations at childbirth.

According to statistics from the CDC, about 9 in 10 infants who become infected go on to develop lifelong chronic infection. The risk goes down as a child gets older. About 1 in 3 children who get infected before age 6 will develop chronic hepatitis B. Approximately 15–25 percent of people with chronic infection develop chronic liver disease, including cirrhosis, liver failure, or liver cancer.
Is it safe for infants to be vaccinated at childbirth?
Dr. Posada: The vaccine is a recombinant vaccine—meaning it is not a live virus; it is only protein from the virus synthesized in the lab. It cannot cause infection. Other than discomfort at the time of injection, we have had decades of data showing that hepatitis B vaccination at childbirth is safe.
Would the new recommendation by CDC create any access changes?

Dr. Caplivski: Historically, insurers have used CDC recommendations to base their coverage of vaccinations. While the federal entity is retreating from actively recommending hepatitis B vaccinations at childbirth, don’t forget that state departments of health can have their own recommendations and intervene if needed. In the case of New York State, there has been no change in guidelines, and we are still actively recommending hepatitis B vaccinations at childbirth.

What the new CDC action might have caused is a worsening of vaccine skepticism. Even in that situation, it is worth speaking with your pediatrician and health provider to learn more about what is the right course of action for you and your child.

Dr. Posada: Besides talking to your pediatrician, there are other sources of information that are well trusted, such as the American Academy of Pediatrics. It has very good information about childhood vaccines. At the end of the day, as doctors, we want your children to be healthy too.

 

Why Flu Cases Are High Right Now and What You Should Do

Updated on Jan 9, 2026 | Featured, Your Health

Every fall and winter, health care professionals remind people to get the flu shot and take basic precautions. But this season it’s even more important, as flu rates are unusually high.

For example, in late December, the New York State Department of Health reported the highest number of flu cases in a single week since these records were kept, beginning in 2004. The flu season typically peaks in December, January, and February.

In this Q&A, Jennifer Duchon, MD, MPH, DrPH, explains why flu rates are high now, and what you should do about it, especially to protect those most vulnerable, including children under age 5, pregnant persons, adults over age 65, and those with chronic illnesses or weak immune systems. Dr. Duchon is Hospital Epidemiologist and Director of Antimicrobial Stewardship at the Mount Sinai Kravis Children’s Hospital and an Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai.

Jennifer Duchon, MD, MPH, DrPH

What symptoms should I look out for?

Common flu symptoms include:

  • Fever or chills
  • Cough and sore throat
  • Runny or stuffy nose
  • Headache and body aches
  • Fatigue or weakness
  • Vomiting or diarrhea

Symptoms tend to come on more suddenly than other viruses like the common cold, and can linger, especially the cough. Symptoms to worry about are trouble breathing or very fast breathing, persistent chest pain, inability to drink or keep down liquids, confusion, or if a fever or symptoms improve and then suddenly worsen.

Why are more people getting sick with the flu right now?

Flu cases are more widespread this season for a couple of important reasons. Each year, the influenza vaccine is developed in advance of the season, using surveillance data and modeling to predict how influenza strains will change and which strains will circulate. This year, after the vaccine was produced, one of the influenza strains developed changes in some of the viral proteins. These changes in the virus’s proteins mean that one strain of flu that is circulating this year is not as well matched to the vaccine as we would like, making the vaccine less effective in preventing the flu.

What are other factors?

Overall, skepticism about vaccines has increased, resulting in fewer people being vaccinated against the flu. When fewer people are immunized, influenza spreads more easily within communities. Together, these factors contribute not only to a higher number of flu cases, but also to a greater risk of more severe illness, particularly in young children, older adults, and those with underlying medical conditions.

Why is it important to get the flu shot?

Even though the flu vaccine is not a perfect match to the most common strain circulating this year, vaccination is still strongly recommended. This year’s flu vaccine has been shown to reduce the risk of the most serious complications of influenza, including hospitalization, pneumonia, and death—especially in vulnerable populations such as young children, pregnant persons, older adults, and people with underlying medical conditions, such as asthma or heart disease. Children cannot be vaccinated against the flu until they are six months old, so it’s important that the whole household (and caregivers) get vaccinated to protect the most vulnerable members of the family.

What should you do if your family gets the flu?

If someone in your family develops flu symptoms, focus on the basics:

  • Rest and good hydration are essential.
  • Fever-reducing medications such as acetaminophen (Tylenol®) or ibuprofen (Motrin®) can help with aches and fever when used as directed.
  • Antiviral medications such as Tamiflu® and Xofluza® can be prescribed by a health care provider. When started early, these medicines can shorten the duration of illness and reduce the risk of severe complications.

It is also important to limit the spread of the virus. Anyone who is sick should wear a mask. They should stay home from school, work, and activities, at least until symptoms are improving and they have been fever free without the use of fever-reducing medications for more than one day. Within the household, practicing good cough etiquette, frequent handwashing, and cleaning commonly touched surfaces can help protect other family members. Most people can recuperate from the flu on their own. If symptoms are severe, worsening, or if the person is at higher risk for complications, you should contact your doctor.

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Mount Sinai Cardio-Oncology Program Receives Highest Designation for Excellence

Updated on Jan 8, 2026 | Cancer, Cardiology, Featured, Heart Health

Gagan Sahni, MD, right, Director of Mount Sinai’s Cardio-Oncology Program, with Chime Lhamu, NP

The Cardio-Oncology Program at The Mount Sinai Hospital, under the directorship of Gagan Sahni, MD, has once again been awarded Gold Center of Excellence status. This renewed designation extends through 2028, marking another three years of internationally recognized excellence.

This is the highest designation of certification from the International Cardio-Oncology Society (IC-OS), the largest international platform for physicians and nurse practitioners dedicated to cardiovascular care of cancer patients.

In 2022, Mount Sinai became the first institution in New York State to be awarded Gold status as a Cardio-Oncology Center of Excellence by IC-OS. Some 53 cardio-oncology programs nationwide and 27 worldwide have been awarded this recognition acknowledging exceptional cardiovascular care of oncology patients. This international honor by IC-OS is awarded at three levels—bronze, silver, and gold. To receive a Gold certification, the institution must fulfill stringent requirements across six scoring categories, including patient volume, research and publications, interdisciplinary care, education, committee involvement, and program building. It is valid for three years and signifies the program has demonstrated outstanding professional contributions to Cardio-Oncology.

“Many cancer treatments—which includes chemotherapy, radiation, and immunotherapy—can adversely affect the heart, and it is imperative that the appropriate patients are referred to a specialist in the field of Cardio-Oncology in a timely way,” explains Dr. Sahni, Associate Professor of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai.

“My specialty focuses on early prevention, detection, treatment, and management of the potential cardiac effects of cancer treatments, so that the patients are able to safely continue their therapies. These cardiac adverse effects may include a myriad of conditions such as congestive heart failure, hypertension, arrhythmias, blood clots, angina, and pericardial effusion—a buildup of fluid around the heart. All of these conditions should be addressed promptly by a specialist who is familiar with the effects of cancer therapies and coordinates tailor-made cardiology care with the patient’s oncologist.”

The Cardio-Oncology clinic at Mount Sinai was established in 2013 by Dr. Sahni, who is a Fellow of the International Cardio-Oncology Society, one of fewer than 20 physicians in the world awarded this distinction for her contributions to the field. The program provides personalized cardio-oncology consultations to more than 2,500 cancer patients annually from The Tisch Cancer Center and across the Mount Sinai network with inpatient, outpatient, and telemedicine consultations. This includes nearly a decade of close multidisciplinary collaborations with oncologists, radiation oncologists, onco-surgeons, onco-generalists, onco-nephrologists, onco-neurologists, onco-endocrinologists, and nurse practitioners.

“This designation of Gold Center of Excellence recognizes the dedication of the Cardio-Oncology team at The Mount Sinai Hospital in advancing specialized heart care for our cancer patients at a nation-leading level, and we are proud to be able to provide state-of-the-art specialty care to them,” says Dr. Sahni.

Physicians can make Cardio-Oncology appointments for their patients by calling 212-241-4977.

Learn more about the Cardio-Oncology Program at The Mount Sinai Hospital

Mount Sinai Nurses: Inspiring the Next Generation Through Unique Learning Opportunities

Updated on Dec 18, 2025 | Featured, Nursing, School

2025 Student Nurse Intern graduates

With a laser focus on cultivating the next generation of nurses, the Mount Sinai Health System leads the way with two unique and popular programs for students. Both provide an invaluable, hands-on, hospital-based experience to those on a path to becoming a nurse. The Summer Student Nurse Internship is available to nursing students who have completed at least one year of nursing school, and the Nursing Pathway Program is open to high school students who may be interested in a nursing career.

Summer Student Nurse Internship

This year, Mount Sinai received 800 applications for its Summer Student Nurse Internship Program. Nearly 150 college students were accepted into the program, representing 40 nursing schools from throughout the United States. Each intern was paired with a registered nurse mentor who they shadowed throughout the 10-week summer program, working nearly full-time hours and on a paid basis.

“Because of the length of the internship, student nurses are able to gain a deeper understanding of how the nurses work, how the unit functions, and what their role will be like as a nurse on the units that goes far beyond what they get from a textbook or clinical rotation,” says Kathleen Schulz, MA, RN, Nurse Education Manager, Nursing Education and Professional Development.

From left: Sophia Cimino, student; David Reich, MD, Chief Clinical Officer of the Mount Sinai Health System; Beth Oliver, DNP, RN, FAAN; and Maria Vezina, EdD, RN, NEA-BC, FAAN. Sophia was honored for outstanding performance.

In the summer of 2023, Rhoda Rae Bonglo, RN, BSN, interned at The Mount Sinai Hospital on a postpartum mother-baby unit as a rising senior at the University of Alaska Anchorage. She described her internship experience as a bit of a shock in the beginning.

“Nursing school is much more theory-based, and while we have clinicals, that’s a once-a-week experience, usually following a different RN each time,” she says. “By contrast, the Mount Sinai internship helps you transition as a new grad by bringing the textbook and the classroom to life. I was able to work with the same clinical nurse for three months, three times a week. This gave me some continuity and an invaluable way to learn tips, insights, and how to organize my day as a full-time nurse.”

All aspects of the student nurse internship program are aimed at supporting these future nurses at a critical time in their career path. For example, a series of weekly Enrichment “Lunch and Learn” Sessions provided insights into interviewing, creating resumes, transitioning to practice, exploring advanced practice nursing, and other critical topics. There are also structured reflection opportunities for the interns to meet, hear about one another’s experiences, and build relationships. Mount Sinai continues to expand the practice settings available to the interns, this year adding positions in the OR, hospital-at-home program, behavioral health and ambulatory settings.

Following graduation, Ms. Bonglo applied for a position with the Health System and now works in the Heart Failure Unit at The Mount Sinai Hospital. “I knew without a doubt that’s where I wanted to work,” she says. “I knew the culture, I knew the systems, and I had a few connections with the staff. My internship made for a much smoother start to my nursing career.”

Nursing Pathway Program

Now in its third year, the Nursing Pathway Program is managed by Mount Sinai Nursing in partnership with the Mount Sinai Office for Health Data, Outcomes and Engagement Strategy (HDOES). Developed for local New York City high school students, this six-week summer internship program introduces sophomores, juniors, and seniors in high school to the field of nursing through immersive, hands-on experiences.

“At Mount Sinai, we recognize that the future of nursing begins long before a student enters nursing school,” says Beth Oliver, DNP, RN, FAAN, Chief Nurse Executive, Senior Vice President, Cardiac Services, Mount Sinai Health System. “The Nursing Pathway Program allows us to reach talented, compassionate high school students early—helping them see the incredible opportunities within our profession. By nurturing their curiosity and confidence, we are building a stronger, more diverse nursing workforce to serve our communities for generations to come.”

Graduates from the 2025 High School Pathways Program

This year more than 100 high school students participated in the program, primarily identified through a long-standing collaboration with Grant Associates and NYC Public Schools. Among them were children of Mount Sinai 1199SEIU members, whose placements were made possible through support from Human Resources Labor Relations and an established partnership with the 1199SEIU Child Care Funds & Child Care Corporation—demonstrating a continued commitment to grow from within. Participants were selected based on their grade point average and an application essay. They were then paired with nurse managers and gained exposure by shadowing nurses and patient care associates, observing team meetings and safety huddles, engaging in select non-clinical patient care activities, and more.

“Some of the most gratifying feedback we get comes from parents who share that the experience totally changed their child’s perspective,” says Mackenzy Scott, MBA, RN, CPHQ, Associate Program Director, ​Quality and Safety, Cardiac Services. “They emerge really gung-ho about a career in nursing.”

Popular components of the program include a visit to the Mount Sinai Phillips School of Nursing, where the high school students gain a feel for a critical step in the pursuit of a nursing career. During weekly “Summer Wednesday” presentations, interns from throughout the Health System gather to learn directly from nurses about the various roles and specialties within the profession.

“The Summer Wednesday series was intentionally designed to expand the interns’ understanding of health equity and care delivery by exposing them to presenters from across the Health System, including nursing, medical illustration, data analytics, environmental health, communications, and more,” says Tiffany Keith, MSW, Assistant Director, Mount Sinai Office for Health Data, Outcomes and Engagement Strategy. The sessions typically included morning presentations facilitated by subject matter experts, followed by afternoon panel discussions and interactive intellectual exercises.

“Many of the students mentioned how reassuring it was to hear about the nurses’ varying career journeys,” says Olivia Boos, Pathways Coordinator and Administrative Assistant, Nursing Operations and Cardiac Services.

All involved agree the interns also bring a welcome burst of energy and enthusiasm to their assigned care settings. “It’s important to recognize that it’s not only them learning from us, but we are learning from them,” Mr. Scott says.

To promote this two-way learning, interns are asked to create a summer project—a proposed initiative or idea based on their summer experience—that they present at the program graduation. This year, interns shared their perspectives on artificial intelligence; supply tracking systems; mental health awareness; the importance of preventive care; advancing health equity; and extending mobile health to New York City neighborhoods.

The Mount Sinai Health System administrators of the High School Pathways Program

“It was incredibly fulfilling to watch students discover the many career paths in nursing,” Ms. Keith says. “Not only are they learning about their passions, but they are also drawing parallels between health equity and their own lives and thinking critically about ways to close health care gaps. It was an honor to experience this program through the eyes of the participants.”

“Mount Sinai nurses are leaders,” says Maria L. Vezina, EdD, RN, NEA-BC, FAAN, Vice President and Chief of Nursing Practice, Education, Advanced Practice Nursing Credentialing, and Labor Relations Partnerships for the Mount Sinai Health System. “They serve as exemplars of what it means to be a strong, skilled, and compassionate nurse. And it’s even more gratifying to see how they inspire young minds to shine.”

A Young Mother Is Celebrating the Holidays After a Health Scare Led to Lifesaving Care at Mount Sinai

Updated on Dec 13, 2025 | Featured

Lindsay MacOdrum visited Times Square shortly before she and her family, including her son Tommy, 9, took a bike ride in Central Park, where she went into cardiac arrest and collapsed. She was able to recover and return to her life in Canada thanks to her stepson Maddox, 17, who began CPR, and to the quick actions of emergency responders and doctors at Mount Sinai Morningside.

Lindsay MacOdrum and her family have a lot to be thankful for this holiday season—a new chance at life after an unexpected health scare almost turned deadly during a family trip to New York City.

And it could have happened to virtually anyone.

The 41-year-old mother and elementary school teacher was visiting from Canada last June with her family. During a bike ride in New York’s Central Park, she went into cardiac arrest and collapsed in front of her kids. Her teenage stepson immediately began CPR (he just learned it a week before for a job as a camp counselor). She was rushed to Mount Sinai Morningside. Emergency responders thought her chances of survival were slim. Her parents would later fly in to say their goodbyes.

But thanks to the quick actions of paramedics and doctors in the Emergency Department, and then a medical procedure that discovered an undetected heart condition, she is now back home and her heart is functioning normally.

“The reason she was able to walk out of the hospital and why she is now living her life is because she had early CPR,” says Dan Pugliese, MD, a cardiologist at the Mount Sinai Fuster Heart Hospital at Mount Sinai Morningside, who cared for Ms. MacOdrum. “You don’t need to be a doctor or a nurse to be able to do CPR and save a loved one or a stranger.”

“It’s very rare for someone like her who is young, active, and in great physical shape to experience this,” says Dan Pugliese, MD, a cardiologist at the Mount Sinai Fuster Heart Hospital at Mount Sinai Morningside who cared for Ms. MacOdrum, told the Toronto Sun. About one in 1,000 people in the United States experience such a sudden cardiac incident, according to Dr. Pugliese, a specialist in heart rhythm disorders.

For Ms. MacOdrum, the episode was a powerful reminder not to ignore unusual medical symptoms, as well as the importance of learning CPR. “It’s a miracle that I am alive,” she told the newspaper.

“The reason she was able to walk out of the hospital and why she is now living her life is because she had early CPR,” adds Dr. Pugliese. “You don’t need to be a doctor or a nurse to be able to do CPR and save a loved one or a stranger.” Another reason she was able to recover fairly quickly was that she was in good physical condition.

Ms. MacOdrum had always lived an active lifestyle. A former soccer player, she has been an avid runner and works as a physical education teacher. She thought she was the epitome of health. She and her family lived in a picturesque small town about 50 miles from Toronto.

She was shocked to learn later that she had been living with a heart condition.

Looking back on her situation, she recognizes she had symptoms that she didn’t realize were associated with a heart problem.

Weeks earlier, she had to pause during her daily runs because she was out of breath. She felt tired when she was teaching.

In June, the family traveled to the New York area so that her nine-year-old son Tommy could play in a hockey tournament in New Jersey.  Days before the incident, she felt shoulder pain while watching her son’s tournament. She figured she was just exhausted and sore.

On Sunday, June 15, the family decided to take an afternoon bike ride in Central Park. Suddenly, she didn’t feel well. She got off the bike, and laid down. Her face turned blue/grey and her husband thought she was having a seizure. She lost consciousness and her stepson Maddox, 17, began chest compressions while a bystander called 911. A doctor and a nurse continued performing CPR for another six minutes before an ambulance arrived, according to the newspaper account.

She would subsequently go into sudden cardiac arrest and had no pulse for 30 minutes. Paramedics shocked her heart five times in the ambulance on the way to the emergency room. Her situation was dire. She regained her pulse at Mount Sinai Morningside, but she was in a coma, on a ventilator in the ICU.

Five days later, she started to improve. A cardiac MRI detected an undiagnosed cardiomyopathy (weakening of the heart muscle) which led to the arrhythmia (irregular heart beat) that caused the cardiac arrest. After the team of cardiologists in the ICU helped her recover, Dr. Pugliese performed a procedure to place a defibrillator in her heart to shock it back into a normal rhythm if it detects another dangerous arrhythmia to prevent another life-threatening event.

After 12 days in the hospital, she was able to fly home, with a nurse sitting next to her on the plane, according to the newspaper account. Now, months later her heart is functioning normally at over 50 percent compared to 30 percent when the incident took place, when measuring the efficiency of how the heart pumps blood.

She is walking about five miles a day, doing some light weight training, and riding on her exercise bike. She hopes to start running again soon and return to work in January. And she wants others to learn from her experience. If something suddenly feels out of the ordinary, she’s urging women to take this seriously and see a doctor. Her doctor agrees.

“If there’s a pattern of you feeling different, that something is not quite right, that’s a clue to go and get it checked out,” says Dr. Pugliese. “As cardiologists, we’re happy to see a patient to make sure we are not missing something. And if we do find something, we know what to do.”

It’s especially important because doctors now understand that heart issues can affect a diverse group of people.

“There is this pervasive myth that young women don’t develop heart disease, that it’s only old men who smoke cigarettes and have high cholesterol,” he adds. “But that’s not the case. There are many different types of heart disease that can develop, and not all heart disease starts with chest pain.”

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Early Exposure to Peanuts Can Help Reduce the Risk of Developing Allergies in Children

Updated on Dec 2, 2025 | Allergy, Featured, Research

Over the past decades, doctors and researchers have learned a lot about food allergies, conducting many studies that have helped us get closer to understanding why such allergies might occur and, potentially, preventing them from developing.

The current understanding is that exposing young children to peanut protein may reduce the likelihood that they develop peanut allergies as they grow up. The National Institute of Allergy and Infectious Diseases (NIAID) issued guidelines recommending early introduction of peanut-containing foods to infants in 2017.

“Over the past two to three decades, we have learned a lot, and allergists and pediatricians have changed their thinking and recommendations as new evidence and studies point us one way or another,” says Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute at Mount Sinai Kravis Children’s Hospital, who was also involved in the development of the NIAID 2017 guidelines.

How might peanut allergies—or food allergies in general—develop in people, and how might introducing peanuts at a young age help reduce this allergy risk? How can parents safely introduce peanut products to their young children? Dr. Sicherer explains the science and research behind this topic.

Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute, and Chief of the Serena and John Liew Division of Pediatric Allergy and Immunology in Mount Sinai’s Department of Pediatrics.

Do we know what causes peanut—or food—allergies in general?
There are many ways to answer this question, but to answer broadly, it boils down to two things: environment and genetics.

Environment can include diet, the way we live, where we live, what the child and household are doing. Is there a dog in the house? How are we using antibiotics and soaps? Was the baby born by cesarian section? There is evidence that seems to link higher rates of allergies to babies born by C-section. The list could go on and on.

The genetics side has also been extensively studied. We had done studies at Mount Sinai on the role genetics might play in peanut allergies, comparing identical and fraternal twins, and found that genetics has a lot to do with it. We found a lot of heritability of allergies, where having a family history of it is also a risk factor for the baby.

Has the rate of peanut allergies in children increased over time?
Our institute at Mount Sinai looked at this rate over an 11-year period. We started in 1997, where we did a random survey of households across the United States, and asked about children and adults having peanut allergies. We did that same survey in 2002 and 2008 as well.

In 1997, we found the reported rate for children with a peanut allergy to be 0.4 percent, or1 in 250 children. In adults, that rate was 0.7 percent, or 1 in 150 adults. In 2002, that rate for children doubled to 0.8 percent, or 1 in 125 children, and the rate for adults was roughly the same, at 0.6 percent.

In 2008, we did the survey again, and I was shocked by the number for children, which was 1.4 percent, or 1 in 70 children. That’s almost a tripling from 1997, while the rate for adults in 2008 remained the same.

At first, I wondered if there was an issue with our survey. But it should have been accurate because our method was the same across the years. I was convinced when our 2008 findings were matched with studies coming out of Australia, Canada, and England at that time, which were reporting prevalence rates of more than 1 percent for children as well. So it did seem there was a real increase between 1997 and 2008.

What might have caused this increase?
One way to think about this phenomenon would be to think first about the mechanism behind allergies, which is the immune system. Our immune system has evolved over thousands of years and various exposures to the environment to fight off germs and pathogens. It has a tough job of destroying these dangerous invaders while having to recognize and smartly ignore innocent proteins, like those in foods, or types of bacteria that are helpful to our bodies.

What if the ground rules changed quickly, and the immune system was faced with relatively sudden changes that made it harder to adapt and attack the right potential dangers entering our body?

The “hygiene hypothesis” posits that our modern, industrialized society could be a cause for the increased allergy rates. Exposure to fewer or different germs, while making us healthy in some ways, could result in the immune system going out of balance and attacking things it should be ignoring, like allergens including pollens, animal dander, and foods. Add to that the many other changes in our modern world, we have a perfect storm for trouble.

Furthermore, back in the 1990s and 2000s, the prevailing understanding—based on early studies—was for mothers, if they had babies who were at high risk of developing allergy, to avoid allergens during pregnancy and breastfeeding. They were also recommended to avoid feeding babies cow milk until age one, eggs until age two, and fish and nuts until age three—these were from the American Academy of Pediatrics (AAP) in the year 2000.

By 2008, there were new studies showing that delayed introduction of allergenic foods might increase the risk of developing allergies. Around that time, I joined the AAP committee to rescind the previous recommendations.

What studies support early introduction of peanuts for reducing allergy risk?
A notable study started when Gideon Lack, MD, MSc, a professor of pediatric allergy at King’s College London, observed that in Israel, infants were often fed a peanut butter snack, Bamba, and that diagnoses of peanut allergies there were low. He conducted a study, published in Journal of Allergy and Clinical Immunology in 2008, that found that Israeli infants aged 8 to 14 months consumed a monthly median of 7.1 grams of peanut protein, and had a prevalence of peanut allergy of 0.17 percent. In the UK, the same age group consumed a monthly median of 0 grams of peanut protein, and the peanut allergy prevalence was 1.85 percent.

This prompted a landmark clinical trial, substantially funded by NIAID, called the Learning Early About Peanut (LEAP) study. The study assessed how infants ages 4 months to 11 months old with eczema and/or egg allergy—and thus at high risk for developing peanut allergies—would fare if fed peanut snacks until 60 months of age, compared with a group that avoided peanut products. The results, published in The New England Journal of Medicine in 2015, found that the prevalence of peanut allergies among those following the advice was 17.3 percent in the avoidance group, whereas the consumption group’s prevalence was 0.3 percent.

What do medical professionals and organizations recommend now?
In 2008, NIAID established a committee—which Hugh Sampson, MD, the Kurt Hirschhorn, M.D./The Children’s Center Foundation Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai, was part of—to develop guidelines for the diagnosis and management of food allergies. At the time, the committee, like the AAP, didn’t make any active recommendations regarding early introduction of allergenic food, other than not delaying them in a set of guidelines in 2010.

When the LEAP study results came out, NIAID updated its guidelines in 2017—Dr. Sampson and I were authors—this time encouraging early peanut introduction, and with instructions about how to do it. There’s a resource called Appendix D that describes how to get peanuts safely into the diet, because peanuts and peanut butter can be a choking hazard for babies. Professional medical organizations, including the AAP and the American Academy of Family Physicians, have since adopted similar recommendations on the early introduction of peanuts. Additional guidelines extrapolate the advice to other common allergens—like milk, egg, and tree nuts—for them to be included in the diet in infant-safe forms on a regular basis, essentially treating solid foods as equivalent whether they are common allergens or not.

How can I begin introducing peanuts early for my child, safely?
If you’re nervous or worried, it’s helpful to talk to your pediatrician. They can walk you through ways of smoothing out peanut products into water, pureed fruits, or vegetables to give them safely. They’ll also be able to let you know how often and how much to feed your baby, as it does require a routine diet for it to confer a protective effect.

The bottom line is: If your baby is otherwise healthy and hasn’t had any problems with food allergies, typical food allergens can be added to a diverse diet, just like any other food in its safe form.

However, if your baby is already showing signs of allergy or problems with various foods, absolutely talk to your pediatrician, who may work with an allergist to fine-tune a path forward. The exciting thing is we do have treatments for food allergy now, and there are many great things happening in the field. Talking to your doctor can help your child lead a healthy, fulfilling life without the overhanging fear of triggering food allergies.

Appendix D instructions for home feeding of peanut protein for a low-risk infant

General instructions Feeding instructions
1. Feed your infant only when they are healthy; do not feed if they have a cold, are vomiting, or have diarrhea or other illnesses. 1. Prepare a full portion of the peanut-containing food.
2. Give the first peanut feeding at home, not at a daycare center or restaurant. 2. Offer your infant a small part of the peanut serving on the tip of the spoon.
3. Make sure at least one adult is able to pay full attention to the infant, without distractions. 3. Wait 10 minutes.
4. Make sure to spend at least two hours with the infant after feeding, to watch for any signs of allergic reaction. 4. If there’s no allergic reaction after the small taste, then slowly give the remainder of the peanut-containing food at the infant’s usual eating speed.

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