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.

Stories Behind the Science: Preparing to Fight the Next Epidemic

Updated on Sep 9, 2025 | COVID-19, Featured, Research

Stories Behind the Science: Preparing to Fight the Next Epidemic

Kris White, PhD, Assistant Professor of Microbiology at the Icahn School of Medicine at Mount Sinai (right), and lab member Isidora Suazo, PhD, Postdoctoral Fellow (left), are part of a research network to discover new drugs for a viral epidemic preparedness initiative.

It was June 2022, and Peter White, a lawyer from Point Lookout, Long Island, was in Florida attending a work event. As he was waiting for his flight home, he started to feel sick.

“By the time I landed, I was very sick with a heavy pressure in my chest,” said Mr. White, 67. “Any time I had previously felt like this, it had always, at a minimum, developed into bronchitis or pneumonia.”

Mr. White was worried it was COVID-19, which could spell poor outcomes given his underlying respiratory condition. “When I get a cold, it has a tendency to morph into bronchitis and, at times, pneumonia. I’ve had walking pneumonia several times, as well as regular pneumonia,” he said. “I can’t count the number of times I have had bronchitis.”

His doctor advised him to go to the emergency room to seek treatment for COVID-19. Thankfully, just months prior—in December 2021—the antiviral medication Paxlovid (nirmatrelvir/ritonavir) from Pfizer had become available via emergency use authorization for the treatment of COVID-19.

“I did not feel better right away,” Mr. White recalled. “However, I did not get worse, which was huge given my prior history, and it was a comfort for me that the drug was working.”

“Thankfully, his bout with COVID-19 ended up being uneventful, because he was able to take Paxlovid quickly and clear it out of his system,” said Kris White, PhD, Assistant Professor of Microbiology at the Icahn School of Medicine at Mount Sinai and Mr. White’s son.

“The COVID-19 pandemic really taught us the value of having treatments ready to test and deploy quickly when an epidemic hits,” said Dr. White.

Mount Sinai has been working toward that goal, in part through its involvement in the Antiviral Drug Discovery (AViDD) Centers for Pathogens of Pandemic Concern, established in 2022 by the National Institutes of Health (NIH). Dr. White’s lab is among several at Mount Sinai contributing research as part of the AViDD Centers, developing antiviral drugs to tackle future outbreaks.

Dr. White (second from right) with his father, Peter (second from left), with five of Dr. White’s children and two nieces. Peter caught COVID-19 in 2022, but with Paxlovid antiviral treatment, it did not develop into something severe, for which Mr. White was at high risk.

However, recent cuts to NIH funding have threatened to stall progress. “We were halfway to the finishing point,” said Dr. White. “With our funding cut, it is like we have half a drug—and that is of no good to anyone.”

Read about how antiviral research can help us navigate future epidemics, and challenges the AViDD Centers face.

‘It Could Have
Been A Very
Different Pandemic’

The issue with relying solely on pharmaceutical companies to develop drugs for an epidemic is that until the health crisis is at hand, there is no incentive for them to carry out such research, noted Dr. White.

That was the case with COVID-19—when it hit in early 2020, there were few if any drug candidates to test right away. Pharmaceutical companies and academic institutions scrambled to find new compounds, or repurpose old ones, that could treat the infection.

Pfizer had a lead, PF-07321332, which had potential for targeting SARS-CoV-2, the virus that causes COVID-19. It was developed in 2003 to address the severe acute respiratory syndrome (SARS) outbreak in 2002-2004. But before it could make it into human clinical trials, the outbreak was contained and development was discontinued.

Even promising compounds take time before they can be used on patients. It wasn’t until March 2021 that Pfizer announced it would test PF-07321332 in humans in a phase 1 trial. In June that year, a phase 2/3 trial was carried out to test its effectiveness, and in December, the compound, which had been named Paxlovid, received its emergency-use authorization.

“We’ve seen that given the will, we can quickly test the effectiveness and safety of treatments and make them available to the public,” said Dr. White. “Imagine if we had compounds ready to test right at the beginning, it could have been a very different pandemic.”

For Dr. White’s father, that difference was between life and death. “Paxlovid was a game changer for me,” said Mr. White. “Knowing that I was most likely going to suffer, but not die, from COVID-19 was good news. It would have been better if this drug was available sooner rather than later.”

Having treatments available early on not only reduces transmission, disease severity, and mortality rates, but also has an impact on health policy.

“Having such an antiviral could even have mitigated the need for severe lockdowns, or even vaccine mandates,” said Dr. White. For people who might be ineligible for vaccines, or were resistant to such mandates, having a treatment available would have provided options for health providers and policymakers, he explained.

March 2020

The World Health Organization declares COVID-19 a pandemic.
September 2020

Pfizer completes pharmacokinetic study of PF-07321332 in rats.
March 2021

PF-07321332 tested in a first-in-human phase 1 trial.
June 2021

Phase 2/3 trial for PF-07321332 begins.
December 2021

PF-07321332 receives emergency-use authorization from the FDA, is named Paxlovid.

Kickstarting the Process

Dr. White, seen dressed in protective clothing, works with Biosafety Level 2 and Biosafety Level 3 viruses as part of his work. His lab’s research includes drug discovery of new antivirals and building up animal models of viral infection.

Following the authorization of Paxlovid, the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH, realized the benefits of having promising drug candidates ready to be tested at the onset of an outbreak.

“Academic institutions like Mount Sinai were perfectly suited for kickstarting that discovery work,” said Dr. White, whose lab studies viral-host interactions, develops cell culture and animal models of viral infection, and performs other antiviral drug discovery work.

Members of Dr. White’s lab, from left to right: Briana McGovern, BS, Senior Research Associate; Meg Gordon, BA, Research Associate; Dr. White; Dr. Suazo; Jared Benjamin, MS, Research Associate.

“Historically, drug discovery was a process that took billions of dollars, and was usually undertaken by pharmaceutical companies,” said Dr. White. “Now, with technological advances and artificial intelligence, the cost of that process has been brought down to millions of dollars, which is a realm that the federal government can provide funding for.”

NIAID awarded a total of $577 million in 2022 toward the creation of nine AViDD Centers, which collectively work to discover better treatments for SARS-CoV-2 and other coronaviruses, as well as six other pathogen families of concern, which include Ebola, Zika, and other cold-causing viruses. Mount Sinai researchers received a total of $16 million and are involved in four of the nine centers.

Progress
Cut Short

Dr. White handling cell cultures stored in a cold storage unit in his lab.

The AViDD Centers were conceived as a five-year project. However, in March 2025—three years into the Centers’ inception—the Centers for Disease Control and Prevention canceled more than $11 billion in funding earmarked for pandemic response.

This included funding for the AViDD Centers, where researchers had the remainder of their unspent budget terminated immediately, pulling out the rug from under several projects.

“I’ve had to let people go from my lab, and we’re currently working in an unfunded state for the AViDD project,” said Dr. White. “We’re only continuing because we had prepaid for certain things before the funding cutoff.”

The most advanced drug developed thus far was basically a better Paxlovid for targeting coronaviruses, but without the need for the ritonavir component, said Dr. White. This is critical because the ritonavir component severely limits the use of Paxlovid in some patients due to drug interactions with other drugs. That compound is more or less ready for a pharmaceutical company to take over for clinical trial testing, with its patents remaining open access, as directed by the NIH.

“We have an excellent coronavirus drug ready to go to clinical trials, but every other drug for the other viruses—paramyxovirus, filovirus, flavivirus, and more—none of them are even close,” he said.

At best, work on the other viruses are close to getting their animal model efficacy data, which is crucial for moving the drugs into human models, said Dr. White. “Getting animal model data is hard enough in five years. Without funding for the remaining two years, getting that data in just three years is almost impossible.”

The drug dispensing robotics system, operated by research associate Mr. Benjamin in this photo, is part of the workflow in which the lab tests new antiviral compounds, said Dr. White. The equipment functions similar to an inkjet printer, and is able to print drugs into a plate format.
Dr. White’s lab had been working on animal models of coronaviruses, flaviviruses, and enteroviruses, and with funding for AViDD Centers abrupted halted, cultures remain in cold storage, waiting for work to resume.
Mr. Benjamin is monitoring the high throughput liquid handler system, which increases the number of samples that can be tested. Throughput is what drives drug discovery, and the lab was able install the equipment thanks to AViDD Centers funding, said Dr. White.

Operating costs for AViDD projects are on a larger scale because they involve high-throughput structural biology and biochemistry that run millions of dollars per year, noted Dr. White. Researchers are reaching out for patchwork funding to keep operations going, including from the Department of Defense, NIH, not-for-profit organizations such as the Drugs for Neglected Diseases initiative, and philanthropy.

Getting continued funding is crucial because viral outbreaks do not take breaks.

“At our labs, we’ve been focusing on Zika virus disease and dengue fever, and these are viral infections we’ve already seen on our shores but still have no treatments for,” said Dr. White.

“At the end of the day, I want to be able to keep my dad and many other people like him safe when—and not if—the next viral outbreak occurs,” said Dr. White. “We were already caught by surprise once with COVID-19. Let’s not have history repeat itself again.”

Advancing Our Understanding of MS: One Researcher’s Quest to Uncover Hidden Brain Changes

Updated on Aug 28, 2025 | Featured, Research

Caption: An image from a standard clinical MRI, left, compared with an image from the same person using advanced methods on a stronger, 7T MRI. Compared to the standard clinical MRI, the research MRI is much clearer and multiple sclerosis lesions (dark spots) are more clearly seen.

How can clinicians better predict who will transition from relapsing to progressive Multiple Sclerosis (MS)? And can we use imaging techniques to diagnose MS more accurately and to select the right treatments for individual patients?

“These are questions people with MS and their doctors struggle with frequently, and so we hope to at least begin to answer them through our research,” says Erin S. Beck, MD, PhD, Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai and a neurologist at the Corinne Goldsmith Dickinson Center for Multiple Sclerosis.

Erin S. Beck, MD, PhD

Dr. Beck, whose research program explores the intersection of neuroimaging, immunology, and clinical  care, is seeking answers using advanced magnetic resonance imaging (MRI).

“At the heart of our work is a commitment to advancing both science and patient care,” says Dr. Beck. “By deepening our understanding of cortical lesions and the inflammatory processes that drive them, we are helping to shape a more precise and informed future for MS diagnosis, treatment, and care.”

For MS patients, the implications of this work are significant. If these imaging methods are validated, cortical lesion detection could become part of routine MRI protocols within the next several years. This could enable earlier and more accurate diagnosis, improve predictions of how a patient’s disease will unfold, and support more personalized treatment decisions.

Dr. Beck’s lab studies how lesions in the brain and spinal cord form, evolve, and repair in MS and other related diseases. A central focus of her lab’s research is understanding MS lesions in the cortex, the outer layer of the brain, which helps to control most of the brain’s functions. While white matter lesions are well-established markers of MS activity, they explain only part of the disease.

Cortical lesions, though harder to detect with standard imaging, are increasingly recognized as widespread in MS and closely tied to physical disability and cognitive impairment, particularly in progressive forms of the disease. It is unclear whether current MS treatments, which work by stopping new lesions from forming in the rest of the brain, are also effective at stopping cortical lesion formation.

Using state-of-the-art imaging technologies—including more powerful, 7 tesla (T) MRI scanners—Dr. Beck combines MRI with cerebrospinal fluid (CSF) and blood analysis to investigate the formation, repair, and clinical significance of cortical lesions. Her research integrates imaging with measures of inflammation, aiming to discover how immune processes contribute to lesion development and disease progression.

One of her lab’s key contributions is the development of MRI methods to improve cortical lesion detection using widely available 3T MRI scanners. These include IR-SWIET, a novel MRI method specifically optimized for visualizing cortical lesions. The lab is currently testing whether IR-SWIET could be useful for MS diagnosis and for monitoring response to treatment.

Her investigations also extend to patients with Radiologically Isolated Syndrome (RIS)—those whose MRI scans show MS-like lesions despite having no symptoms. Through advanced imaging and CSF studies, she hopes to identify biomarkers that distinguish individuals likely to develop clinical MS from those who will remain symptom-free.

Dr. Beck earned her MD/PhD from Columbia University. Following her neurology residency at New York–Presbyterian/Columbia and a neuroimmunology fellowship at the National Institutes of Health, she joined Mount Sinai’s faculty in 2021. Since then, she has been building her research program at the intersection of neuroimaging, immunology, and clinical MS care.

Dr. Beck’s research has been recognized with awards such as a Clinician Scientist Development Award and a Career Transition Fellowship from the National MS Society. Her findings have been published in leading journals, including Brain Communications, Investigative Radiology, and Human Brain Mapping.

By Julia Bonem, a volunteer at the Corinne Goldsmith Dickinson Center for Multiple Sclerosis

Learn more about the Corinne Goldsmith Dickinson Center for Multiple Sclerosis

Can a Special Diet Help Those Living With Multiple Sclerosis?

Updated on Sep 26, 2025 | Research, Your Health

For those living with Multiple Sclerosis (MS), can a special diet potentially help slow the progression of the disease?

This a question that researchers at the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai are studying, and whether a specific diet could reduce substances in the blood linked to inflammation.

“Ultimately, we want to know if we can offer MS patients a program that will empower them to live healthier by permanently changing their eating habits,” says Ilana Katz Sand, MD, a clinician and researcher who is the Center’s associate director and lead study investigator.

The new study is a randomized controlled trial of a special dietary pattern for MS, and is funded by a National MS Society grant.

Ilana Katz Sand, MDThe Mediterranean-Intervention for Neurodegenerative Delay (MIND) dietary pattern has components “that are of potential benefit in terms of limiting neuroinflammation and promoting neuroprotection,” says Dr. Katz Sand.

Since joining the Center staff in 2013, she has been studying how dietary choices affect MS evolution while seeing patients. She and her research team conducted a pilot study of a modified Mediterranean dietary program a few years ago.

“Preliminary data showed this type of diet is helpful” for MS, says Dr. Katz Sand, who serves as co-director of the Center’s Wellness Program. She is also a Professor of Neurology at the Icahn School of Medicine at Mount Sinai.

The MIND pattern emphasizes eating fish, green leafy vegetables, lentils, nuts, olive oil, berries, and seeds. Processed foods, particularly red meat, and consuming butter, pastries, and baked goods should be limited.

Neurologists depend on individuals volunteering to participate in research projects that potentially may help advance understanding and treating MS. Dr. Katz Sand’s team is seeking 100 Center patients for the new study. Prospective study participants will first complete a questionnaire about their current eating habits. The study database contains a module that will randomly assign people to either the MIND pattern or to maintaining their current diet for one year.

“Participants hoping to be assigned to one group or the other don’t get to choose. The computer will make the group assignment for us,” she says. This enrollment process reduces potential bias and helps ensure proper distribution by age, gender, and ethnicity between the groups. “It’s really important to us that the study population looks like the population of people who are living with MS,” she says.

Dr. Katz Sand recognizes that asking people to commit to their randomization assignment “for a year is a long time,” but that duration is crucial for evaluating the MIND pattern’s impact on individuals through bloodwork and other assessments. The team is also interested in how difficult participants find it to follow this pattern.

“Ultimately, we want to know we have a nutrition program that people can stick with permanently. It’s really more of a lifestyle than a ‘diet’,” she says.

Participants randomly selected to follow the MIND diet will receive a welcome kit that includes a variety of spices, a large bottle of high-quality olive oil, walnuts, and other helpful food items, a MIND cookbook developed by Center dietitian Jessica Gelman, RD, and a one-year Fresh Direct delivery pass.

“We hope those items will make incorporating changes into their diet a little easier,” says Dr. Katz Sand. In addition, the MIND pattern group will come together for monthly educational sessions and online discussions with her and Ms. Gelman about aspects of the diet and sharing with one another what is going well and what is challenging with the program.

For patients randomly assigned to maintain their current eating habits, online educational seminars will cover a number of topics, including emerging disease modifying therapies.

At the end of the year, those who were assigned to maintain their regular eating habits will also receive the MIND welcome kit and grocery membership so they can adapt to following the MIND pattern.

Several Mount Sinai labs will be involved due to the size and scope of this study. The primary endpoint of the study is a blood biomarker called neurofilament light chain (NfL) that is a measure of neuroinflammation and neurodegeneration important to assessing MS worsening.

“Everyone has NfL in their blood, with a set of reference values by age. This marker grows with increasing age. The value tends to be higher in people who have MS, and greater in times of more active inflammation,” says Dr. Katz Sand. “We are hoping the dietary intervention will help decrease the NfL levels.”

To more fully understand what happens to the body when making a big dietary change, other labs specializing in metabolomics, gut microbiota, immune phenotyping, and telomeres will examine the MIND dietary pattern’s impact. The team also will assess the diet’s effect on fatigue, mobility, mood, quality of life, and preventing disease progression in MS.

Dr. Katz Sand anticipates the study “will show the MIND dietary pattern makes a positive difference in the lives of people living with MS.” Information garnered will enable MS providers “to advocate for our patients, to get people the support they need to improve their diet and thereby their health.”

Enrollment will continue through October 2026. The deadline for collecting and processing all lab work is October 2027. The final report with analyses of the study’s findings will be delivered by spring 2028.

To apply to participate, contact Claire Wigley, the lead clinical research coordinator, at claire.wigley@mssm.edu.

By Kenneth Bandler, a multiple sclerosis patient, advocate, and member of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis Advisory Board

 

Learn more about the Corinne Goldsmith Dickinson Center for Multiple Sclerosis

Stories Behind the Science: A New Way Forward With Food Allergies

Updated on Aug 15, 2025 | Allergy, Featured, Research

Stories Behind the Science: A New Way Forward With Food Allergies

The Esteves family on vacation, from left to right: Craig, Violet, Holly, Jackson, and Sailor Esteves.

Eating out for Jackson Esteves, 10, from Bayville, Long Island, had always been a gamble for him and his parents. With severe food allergies of various kinds—peanuts, dairy, sesame seeds, to name a few—having a meal in a restaurant, or even at a friend’s house, came with challenges and stress.

When Jackson’s parents were told that it could be possible to address at least his peanut allergy and make it less severe, they were ecstatic. “When the opportunity to participate in this trial was presented to us, we jumped,” said Holly Esteves, Jackson’s mother.

Jackson was enrolled into a study, named CAFETERIA, which explored whether it is possible for people who are allergic to peanuts—but are able to take small amounts—to be desensitized to the allergen through a form of immunotherapy that gradually exposes the individuals to peanut butter.

The study, funded by the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, found that participants who received allergist-supervised treatment with peanut butter were able to tolerate more peanut butter than before, without any allergic reactions.

“Our study results suggest a safe, inexpensive, and effective pathway for allergists to treat children with peanut allergy who can already tolerate the equivalent of at least half a peanut, considered a high-threshold peanut allergy,” said Scott Sicherer, MD, Director of the Elliot and Roslyn Jaffe Food Allergy Institute at Mount Sinai Kravis Children’s Hospital.

The findings, published in NEJM Evidence, suggest multiple ways forward for the research team.

“There are still many things we need to know to really broaden the impact of this research,” said Dr. Sicherer, who is also Chief of the Serena and John Liew Division of Pediatric Allergy and Immunology in Mount Sinai’s Department of Pediatrics.

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.

“Can we apply this to other allergens? How do we know what the right threshold of tolerance should be? How do we identify whether patients are right for this kind of treatment? The road ahead is an exciting one,” said Dr. Sicherer.

Read below to learn more about how the CAFETERIA study helped Jackson live a fuller life, the next steps for researchers, and what it takes to get there.

A constant state
of hypervigilance

Jackson and Holly Esteves.

Jackson had lived with an allergy diagnosis pretty much since birth.

“It is a constant in our lives. I live with a seriousness that I used to be able to escape, but eventually, being in a perpetual state of high alert takes its toll,” said Ms. Esteves. Every day, several times a day, she worries that her son will encounter an allergic reaction. “I often feel worn down and tired from the worry, but I remember to slow down, breathe, and find gratitude in the little things.”

Over time, the Esteves family learned to adjust to a “never normal.”  “It’s not necessarily easier, it is just what we’re accustomed to,” said Ms. Esteves.

That means that when Jackson goes to school and camp, he carries his own lunch and safe snacks. Going to a friend’s birthday party? He has to bring his own meal and cupcake.

“When we travel, we also need a kitchen accommodation to prepare food,” said Ms. Esteves. “I’ve learned how to order in restaurants, how to engage in constructive conversations with school and camp staff, and really how to advocate for my son always.”

The CAFETERIA study kicked off in August 2019, and Jackson was one of 73 participants in the trial. Participants were randomly and equally assigned to either the ingestion group—starting with one-eighth of a teaspoon of peanut butter, and eventually increasing to one tablespoon—or avoiding peanut products entirely.

After 18 months, both groups were tested on how much peanut they could eat without an allergic reaction. Among those who completed the study, all 32 children in the ingestion group could tolerate two and a half tablespoons of peanut butter. Only 3 of 30 children in the avoidance group could tolerate that amount.

Jackson, who was in the ingestion group, had no issues with the escalation doses. He is currently working with Dr. Sicherer to address his other allergies.

“Today, Jackson is safely eating peanut butter. Not only were we able to open up his diet, but we forged a bond with the Mount Sinai community who deeply understand the need for innovation, treatment, and prevention of food allergy disease,” said Ms. Esteves.

Figure A of this diagram shows the percentage of each respective group that achieved desensitization to peanut product at the end of the trial. Figure B shows the percentage of each respective group that retained that desensitization after being subject to peanut product avoidance. Figure C shows the total dose of peanut product individuals in each respective group was able to tolerate from baseline to the end of the trial. Figure D shows the size of wheals of participants in each group when subject to a skin prick test, from baseline to the end of the trial.

“I am incredibly grateful for our trial experience, for the wonderful professionals who took care of us, and for the research that I hope will help thousands, if not millions, of people,” she said.

And the CAFETERIA study didn’t offer just Jackson a new lease on life—it took a weight off Ms. Esteves too. “I used to lead conversations with an apology for being a bother about Jackson’s allergies, but not anymore. Now I lead with compassionate command,” she said.

“I used to lead conversations with an apology for being a bother about Jackson’s allergies, but not anymore. Now I lead with compassionate command.” —Holly Esteves, Jackson’s mother.

What it takes
to get to the next stage

Dr. Sicherer at the the Elliot and Roslyn Jaffe Food Allergy Institute.

With the CAFETERIA study concluded, Dr. Sicherer and his team are already contemplating next steps. The biggest question: can this method of immunotherapy be replicated in other food allergies?

A clear, direct way to test that would be a formal multicenter study in different types of food, said Dr. Sicherer. “That would be a huge undertaking—a clinical trial like that would require, perhaps, in the ballpark of $15 million, and years to run.”

But should the team’s hypothesis prove right, it could change how allergists can treat and advise children with high-threshold food allergies.

“A decade ago, allergists used to tell patients to completely avoid a food they were allergic to, even if they had a threshold before getting a reaction,” said Dr. Sicherer. “With the findings from the CAFETERIA study, it could be a future where patients could work with their doctors to start small, and eventually overcome their allergy.”

Specialists in the field have indicated interest in this new possibility, noted Dr. Sicherer. In a survey his team did, many allergists said they were open to recommending that patients with high-threshold allergies attempt a food escalation challenge.

Basic science
matters too

Supinda Bunyavanich, MD, MPH, MPhil, Mount Sinai Professor in Allergy and Systems Biology, has a lab focused on studying systems biology in allergy and asthma.

Even as the team is applying for grants from the National Institutes of Health (NIH) to fund that trial, researchers at Mount Sinai are working on parallel questions that the CAFETERIA study couldn’t address.

“Pharmaceutical companies have long focused on developing options for people who have low-threshold food allergies—meaning they react even to the slightest amount,” said Dr. Sicherer. “But not all patients with allergies are the same. What if they have higher thresholds, then how do we know which strategy—be it our protocol from the CAFETERIA study, or the commercial drugs—is best suited for them?”

There are two Food and Drug Administration-approved treatments for food allergies: Palforzia, peanut allergen powder, used as ingested immunotherapy for children with confirmed peanut allergies, and Xolair® (omalizumab), an injected antibody therapy used to reduce the risk of allergic reactions in case of an accidental exposure.

“Furthermore, we need a better way of identifying allergy thresholds in patients other than by feeding patients increasing amounts of a food to see when symptoms start,” said Dr. Sicherer.

A key to answering those questions: biomarkers. Researchers at the Elliot and Roslyn Jaffe Food Allergy Institute and elsewhere in the Icahn School of Medicine at Mount Sinai are tackling biomarkers at all levels, from basic science to human models. Some ongoing allergy research at labs at Mount Sinai include:

  • Hugh Sampson, MD, Kurt Hirschhorn, M.D./The Children’s Center Foundation Chair in Pediatrics, focusing on the humoral immune system and the proteins it makes that cause allergic reactions.
  • Maria Curotto de Lafaille, PhD, working on B cells and food allergies.
  • Erik Wambre, PhD, Director of Technology and Business Development at the Human Immune Monitoring Center at Mount Sinai, working on T cell responses in food allergies.
  • Supinda Bunyavanich, MD, MPH, MPhil, Mount Sinai Professor in Allergy and Systems Biology, studying systems biology in allergy and asthma, including the microbiome.

Dr. Sicherer (left) with Hugh Sampson, MD (right), Kurt Hirschhorn, M.D./The Children’s Center Foundation Chair in Pediatrics, whose lab focuses on the humoral immune system and the proteins it makes that cause allergic reactions.

These teams are firing on all cylinders to gather support. “Even philanthropic support can lead to something greater,” said Dr. Sicherer. “After all, that’s how the CAFETERIA study got started.”

To get NIH funding, one needs preliminary data as part of the application. In 2015, the Elliot and Roslyn Jaffe Food Allergy Institute launched the Food Allergy Treatment and Research Center, which is supported by philanthropy. The research center had a high success rate with a pilot study that was the precursor of the CAFETERIA study. With those findings, Dr. Sicherer applied for NIH funding in 2017, and was awarded the grant in 2018.

In a way, the journey of this research has similarities with the treatment protocol, where patients escalate from one dose to the next, eventually getting their desired outcome, noted Dr. Sicherer.

“In this case, it began with small philanthropic support, leading to a small study and idea, which then led to the CAFETERIA study,” he said. “I can’t wait to see where it goes next.”

A Top Mount Sinai Neuroscience PhD Student Writes a Winning Essay as She Proposes Mentorship Initiatives Encouraging a Love for Science and Medicine in Rural America

Jul 31, 2025 | Featured, Research

“The question is, how many potential scientists are lost because they have never seen a path forward?” says Anna Bright, a Neuroscience PhD student. “What if, instead of stumbling upon a passion by chance, students had direct access to mentors who could illuminate the possibilities before them?”

When Anna Bright, a Neuroscience PhD student at Mount Sinai’s Graduate School of Biomedical Sciences, was growing up in rural Tennessee, it was not easy to imagine a career in science. Who would be her role model?

“My story is not unique,” says Ms. Bright. “Countless rural students face similar struggles, navigating their education with limited exposure to careers beyond their immediate surroundings. The question is, how many potential scientists are lost because they have never seen a path forward? What if, instead of stumbling upon a passion by chance, students had direct access to mentors who could illuminate the possibilities before them?”

Today, Ms. Bright is leading an outreach effort to implement mentorship initiatives in rural school systems that connect students with alumni who have pursued advanced degrees in science and medicine.

Ms. Bright passionately wrote about her outreach effort in an essay, “Sending Science Down Yonder,” that she submitted recently for the international 2025 Essay Contest sponsored by the Lasker Foundation. In July, she was named one of the four co-winners. Participants were asked to write about a specific innovation in education or training that would help ensure a sustainable, inclusive, and successful future biomedical research workforce. Click here to read her essay and to watch short videos about her interests and experiences as a young scientist. 

“Beyond the initial excitement of being named a winner, I mostly felt grateful to have my story shared with a wider audience,” Ms. Bright says. “This is tangible evidence that my personal experience struggling to find how someone of my socioeconomic background could fit into the academic world is something worth telling—and ideally, correcting, for the next generation of scientists.

“Today, well over halfway into my PhD, I still have moments where I doubt I belong in this space. This is a reminder that educational resources need to be extended to students who still encounter barriers to higher education—whether that be financial, cultural, or systemic. I would like to thank my lab members and my mentor, Joel Blanchard, for cultivating such a supportive and creative space for conducting science.”

Ms. Bright is a fourth-year student in the lab of Joel Blanchard, PhD, Associate Professor of Neuroscience, and Cell, Developmental and Regenerative Biology, whose research group engineers 3D models of human brain tissue from stem cells and applies them to understanding and therapeutically targeting risk factors for Alzheimer’s disease (AD), Parkinson’s disease, and other forms of cognitive impairment.

 “We are particularly interested in how glial cells and brain vasculature play a role in neurodegeneration,” she says. “We explore how genetic and environmental factors affect astrocytes, microglia, oligodendrocytes, and the blood-brain barrier in ways that trigger pathology.”

Her thesis project centers around how APOE4, a gene variant and the largest genetic risk factor for AD, affects oligodendrocyte development and myelination. “The primary role of oligodendrocytes in the brain is to produce myelin, the fatty blanket wrapped around axons to promote health and signaling. Myelin degeneration is one of the earliest pathologies in AD, so understanding why it breaks down in this disease could open the door for novel preventative methods.”

In July, she was the first author on a review paper in Nature Cell Biology that included Dr. Blanchard and two researchers affiliated with the Massachusetts Institute of Technology and Harvard University.

“We reviewed literature connecting oligodendrocyte and myelin deficits to AD,” she says. “A wide range of evidence implicates this cell type in AD onset and progression, and we discuss seminal studies establishing oligodendrocyte biology as a key player in AD, proposed underlying mechanisms, emerging techniques in myelin research, and next directions for this field of study.”

Says Dr. Blanchard: “Anna brings a rare combination of creativity, persistence, and a deep sense of purpose to her work. Her research on how APOE4 affects oligodendrocyte development is breaking new ground in our understanding of Alzheimer’s disease, while her passion for mentorship and outreach shows her commitment to shaping the future of science. We’re incredibly proud to see her recognized with this award. It reflects both her scientific contributions and the positive impact she is already having on the next generation.”

Learn more about the Graduate School of Biomedical Sciences at Mount Sinai

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