User:Nasztalos/sandbox

Article Evaluation Assignment: Each group will hand in a written evaluation of their page by the end of the day Sept 25th, maximum 2 pages long, using the above questions as a guide for your assessment.

Peanut Allergy

The majority of this article’s content is relevant to the article topic; however, a recurring issue throughout the page is that specific, primary source research results are cited. In the “Research” section, for instance, the author mentions an adverse event that happened to one research participant in one study on peanut allergy. This type of information, although related to the article topic, is not necessarily relevant to the reader’s interest in the topic and can be quite distracting. A better approach to this article’s composition would be to include more general information, i.e. information for which a medical consensus has been reached. For example, citing systematic reviews and professional/academic books and guidelines published by experts in the field would produce an article that is more widely applicable to a broader range of readers.

An additional instance in which this article presents irrelevant information is in the “Society and Culture” section. Here, there is a subsection on the research and production of hypoallergenic peanuts. Although this information may be relevant to the overall article topic of peanut allergy, it does not easily fit within the realm of this subtopic, which is meant to encompass social, cultural, and religious themes. Accordingly, the inclusion of this information in this section specifically could be somewhat confusing for the reader.

In terms of this article’s overall tone, it is largely written in a neutral manner, avoiding heavy biases toward a single opinion. However, within the “Epidemiology” section of the article, there is a paragraph of concern comparing American allergy rates for nuts and seafood. This section goes on to speak about media sensationalism regarding peanut allergies. Overall, the paragraph reads with the opinion that peanut allergies are seen as a bigger threat to public health than they ought to be. Phrases like “just 2000 hospitalization” as well as “and only 150 people die each year” employ opinionated language. Opinionated language can also be seen in the “Exposure” section. The first sentence in this section states that “the most obvious route for exposure is unintentional ingestion.” Although this statement may be correct, one cannot state something as being “the most obvious reason” as fact without evidence to back up the claim.

The main issue with over- and underrepresentation of viewpoints in this article is that, again, in most sections only one or two primary sources are cited (for example in the “Diet during pregnancy” section), and in only some sections do these sources present opposing conclusions. Without inclusion of systematic reviews to present a broader scope of data, it is difficult to objectively verify the full extent of the scientific backing for the statements made. Furthermore, it is probable that there is omission of evidence contrary to that presented in the article, especially in sections where only one primary source is cited (for example in the “Timing of exposure” section). Wikipedia has noted this issue because the primary sources, when hovered over with the mouse, indicate that a “non-primary source” is required. Additionally, there is a section of the article titled “Controversy” that relies heavily on the work of one author to portray a particular viewpoint of peanut allergy as a psychological issue. It is odd that this whole section features solely that viewpoint without any refutation. Finally, the article does explore peanut allergies in non-Western countries; however, it provides limited incidence data for these countries. If incidence data is indeed available, even for the continents in general, this more global representation could increase the utility of the article for readers around the world.

With regards to the article’s citations, most of the links seem to work, but not all of them match the Wikipedia citation requirements in terms of scientific rigor. For example, in quite a few cases, primary source research is referenced as stated above, and in others, the citation leads to a news article when context dictates the source should be a systematic review. There are also many instances of phrases or statements lacking citations (e.g. “Residue on surfaces has been known to cause minor skin rashes, though not anaphylaxis”). These are especially important to correct in situations where the information could be glanced over by a parent quickly googling for information about their child’s exposure to peanuts. There is some informal language structure used, which, when coupled with uncited statements leads the reader to feel an undercurrent of bias: e.g. “Empirical testing has discredited some reports of [respiratory reactions in allergic individuals] and shown some to be exaggerated.” Sentences like this need a robust source or should be removed entirely. There are some good references to information like guidelines from the National Institute of Allergy and Infectious Diseases, and inclusion of some systematic reviews from reputable journals as well. Overall, there is a mix of excellent sourcing and bias-free information, alongside many sentences that dangle without citation and consequently lean towards opinion, as well as “facts” that lack a single citation.

Further to this, another underlying issue with this Wikipedia article is its use of outdated sources. One of the article’s most heavily cited sources is a review article published in 1995 by C. Loza and J. Brostoff, and another primary research publication dates back to 1997. The majority of the other sources were published in the early 2000s (2000 to 2010). Reliance on these older publications gives the article a highly outdated point of view that does not encompass the most recent scientific, cultural, and societal developments in the topic of peanut allergy. Some recent topics that are missing include the implementation and rise of zero-peanut tolerance schools in the US and Canada, recent peanut substitute products on the market such as soy-based butter, as well as the recently implemented guidelines surrounding the risk of developing peanut allergy in babies (National Institute for Allergy and Infectious Disease, 2017).

In terms of this Wikipedia article’s “Talk” page, discussion has revolved around some of these common threads, such as the lack of sufficient research to back up various claims and relying largely on a few articles, particularly in the “Cause” section. There is also skepticism surrounding the reliability of the cited death rates. There are multiple suggestions of further sections that could be added, including the chemical mechanisms of allergic reactions and treatments, related allergens, and peanut allergy misconceptions. Some expansion on severity of allergies and various routes of exposure, including how common varying severities are, was also brought up. Changes in prevalence of peanut allergies over time is a large area of interest, which is only mentioned briefly under “Epidemiology”, and is not strongly explained nor supported by evidence. There is a lot of discussion surrounding the question of why peanut allergies are much more common in the developed world, which would be worth exploring to try to provide clarification. Finally, one user suggested that better information could be found under the “Allergies” section under the Wikipedia page for peanuts to enhance this page.

In conclusion, this article presents limited, outdated, and largely primary source information on the signs and symptoms, potential causes, diagnosis, prevention, treatment, and the epidemiology of peanut allergy. As a group, we plan to contribute more rigorous sourcing to the article (i.e. citation of systematic reviews and expert guidelines) as well as further and more up-to-date information in the sections that are lacking clarification and/or only report one viewpoint. Finally, we plan to add more relevant information to the “Society and Culture” (i.e. peanut allergy misconceptions) as well as the “Epidemiology” (i.e. incidence rates of peanut allergy globally and over time, along with various explanations for the disparities) sections.

ARTICLES

“Consensus communication on early peanut introduction and the prevention of peanut allergy in high risk infants” Fleisher et al. 2015, World Allergy Organization Journal -alright well this article is a banger for sure as it is a consensus statement representing a whole range of different Academies/Colleges/Societies around the world relating to immunology and allergies; we can use it for the wiki article because it is a set of guidelines recommendations that provides the second “filter” for reviewing primary research -the article is focused on peanut exposure during the first year of life, so that is something we could add into the article, HOWEVER it is focused on high-risk infants only; ideally it would be for all infants but nonetheless I still think it is valuable to add -the article also has some other useful info in it regarding prevalence

“BSACI guideline for the diagnosis and management of peanut and tree nut allergy” G. Stiefel et al., 2017 Clinical & Experimental Allergy -up to date, non-primary source with tonnes of info on diagnosis and treatment which we can use to supplement what is already there or if necessary completely update it!

http://onlinelibrary.wiley.com/doi/10.1002/mnfr.201700446/epdf Allergy to  Peanut,  Soybean,  and  other  Legumes:  Recent  Advances  in  Allergen Characterization, Stability to Processing and IgE Cross-Reactivity Speaks on 16 different types of allergens that may affect allergies Speaks on processing peanuts to impact allergy

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009014.pub2/full Systematic review on allergen-specific oral immunotherapy as a treatment for peanut allergy. However this is not a very strong study because only one small RCT was found to fit the review criteria, and it did not show positive results for oral immunotherapy as a method of desensitizing patients to peanut allergies.

Under the section “Prevention” - similar to a 2016 source from the article though Alkis Togias, Susan F. Cooper, Maria L. Acebal, Amal Assa'ad, James R. Baker, Lisa A. Beck, Julie Block, Carol Byrd-Bredbenner, Edmond S. Chan, Lawrence F. Eichenfield, David M. Fleischer, George J. Fuchs, Glenn T. Furuta, Matthew J. Greenhawt, Ruchi S. Gupta, Michele Habich, Stacie M. Jones, Kari Keaton, Antonella Muraro, Marshall Plaut, Lanny J. Rosenwasser, Daniel Rotrosen, Hugh A. Sampson, Lynda C. Schneider, Scott H. Sicherer, Robert Sidbury, Jonathan Spergel, David R. Stukus, Carina Venter, Joshua A. Boyce, Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Summary of the National Institute of Allergy and Infectious Diseases–Sponsored Expert Panel, In Journal of the Academy of Nutrition and Dietetics, Volume 117, Issue 5, 2017, Pages 788-793, ISSN 2212-2672, https://doi.org/10.1016/j.jand.2017.03.004. (http://www.sciencedirect.com/science/article/pii/S2212267217302289) Recommendations for introducing peanuts to diet, especially concerning high-risk infants who have eczema or egg allergy

http://www.sciencedirect.com/science/article/pii/S2213219817300090?via%3Dihub Should peanut be banned in schools? Presents pros and cons of peanut restrictions in schools based on a review of various studies

http://www.jacionline.org/article/S0091-6749(16)31188-5/fulltext#sec12 Advances in Food Allergy 2015 Epidemiology (increase in prevalence, higher prevalence in certain ethnic groups) Risk factors, prevention, diagnosis, treatment Summaries of multiple articles that address one or many of these topics

http://www.dietitians.ca/Member/Resources-from-A-Z/Infant-Nutrition/Intro-AllergenicFoods-to-Infants-Jan2017.aspx Dietitians of Canada. Introduction of Allergenic Foods to Infants, especially Peanuts: Interim Guidance for Canadian Dietitians. January 2017. Up-to-date Review of guidelines Canadian-specific information Covers some of the Treatment, Prevention, and Risk sections

Student: Eigenmann, P. A., Lack, G., Mazon, A., Nieto, A., Haddad, D., Brough, H. A., & Caubet, J. (2017). Managing Nut Allergy: A Remaining Clinical Challenge. The Journal of Allergy and Clinical Immunology: In Practice, 5(2), 296-300. doi:10.1016/j.jaip.2016.08.014

I began my search using the Trip medical database and running a basic search with the term “peanut allergy”. This returned three systematic reviews and a few published guidelines mostly from the Canadian Paediatric society. However, I found that the publications found on this database were either over 5 years old or overlapping with sources that our group had already selected (one of these being the new 2017 guidelines for peanut allergy oral immunotherapy from the NIAID). I then turned to PubMed in search of sources that could fill out some of the more barebones parts of the original Wikipedia article. The section I wanted to dig deeper into was the effect of the peanut allergy epidemic on society, specifically widespread peanut bans in schools across the country. I found a systematic review by Wang and Fleischer named “Should Peanut Be Banned in Schools?” by searching “peanut allergy school” in PubMed, which was highly relevant to my research question. Unfortunately, the article was based on a pros/cons/synthesis structure, and felt too subjective to be a good Wikipedia source. However, this article did lead me to my final source selection - as it was from the “Recommended articles” links of this article that I came upon my selected review.

I chose this review for a number of reasons. Firstly, it covers topics that are particularly poorly described or even lacking in the original Wikipedia article, such as the epidemiology of peanut allergy (geographical distribution for example), and issues of cross-reactivity with other nuts. Secondly, it provides an objective description and individual pros/cons of the various peanut allergy diagnosis techniques, which would be highly relevant to the average Wikipedia reader. Finally, it matches all the Wikipedia medical source criteria of being recent (published Mar-Apr 2017), being highly reliable and non-biased (it is a cumulative systematic review of a large number of primary and secondary sources). It is not a summary of preliminary research findings, rather it is a summary of well-established current knowledge in the field of food allergy research.

With this source, I plan to expand the section of the Wikipedia article on the social impacts of the peanut allergy epidemic. I will also use it to include information on cross-reactivity with other nut allergies, which is a relevant topic the Wikipedia article is missing. This source will also be helpful in fact-checking and potentially rewriting the information on the various diagnosis techniques of peanut allergy.

Student: Cabanillas, Beatriz; Jappe, Uta; Novak, Natalija (September 5, 2017). "Allergy to Peanut, Soybean, and other Legumes: Recent Advances in Allergen Characterization, Stability to Processing and IgE Cross-Reactivity". Molecular Nutrition & Food Research. Retrieved October 9, 2017. The aim of the search was to find some further information regarding the mechanism and cause of peanut allergies. In the original Wikipedia article, there is one sentence regarding 3 proteins that may act as allergens. This article was found using a simple PubMed for articles related to “peanut allergens.” Filters for reviews and articles published within 5 years were selected for the search. One of the articles that came up in the search titled “Immune mechanisms of food allergy and its prevention by early intervention” was explored as a possible source. The article went on to cover various hypothesis for the cause of food allergies however it did not focus on peanuts specifically. Ultimately this review article was not selected as the information was too broad in scope. This article, however, may useful for another section of the Wikipedia article regarding prevention and treatment of peanut allergies. Although the article we have chosen speaks about other legume allergies, the review is written in a matter that teases out the differences between them while specifically highlighting the proteins involved in peanut allergies. Furthermore, this article is appropriate as it reaches several of Wikipedia’s reliable medical source criteria. It is a review article (secondary source) which summarizes several studies providing an overview on the topics addressed. The article uses up to date information and has been accepted for publication on September 5, 2017 in the journal of Molecular Nutrition and Food Research. Furthermore, the authors also claim no conflict of interests. Wikipedia has published their guidelines for what sections should be included in a medical article published on their site. Two of these sections are the causes of a medical condition as well as Treatment/prevention. When reading the peanut allergy Wikipedia article the “Causes” and “Treatment/Prevention” provide insufficient information. The information contained in this review will be used to flush out the “Causes” section. This review speaks about 16 different allergens in peanuts which are arranged in 5 superfamilies’ and will provide insight into the biochemical causes of this food allergy. Furthermore, this information contained in this review will be used for the “Treatment/Prevention” section of the Wikipedia article as it speaks to several ways peanuts can be processed (boiled, fried etc.) and its impact on reducing allergenic effects.

Student Fleischer, D.M., Sicherer, S., Greenhawt, M., Campbell, D., Chan, E.S., Muraro, A., Halken, S., Yitzhak, K., Ebisawa, M., Eichenfeld, L., and Sampson, H. (2015). Consensus communication on early peanut introduction and the prevention of peanut allergy in high risk infants. World Allergy Organization Journal, 8(76), doi: 10.1186/s40413-015-0076-x

My initial search strategy involved looking for systematic reviews and meta-analyses on peanut allergy and its connection to exposure to peanuts during infancy. I first searched in the online Cochrane Database of Systematic Reviews. I used various search terms such as “peanut allergy”, “infancy”, and “exposure” but was unable to find any reviews pertaining to my topic. I decided to check PubMed and was immediately brought to “Timing of Allergenic Food Introduction to the Infant Diet and Risk of Allergic Autoimmune Disease”, a systematic review and meta-analysis published in 2016 by Ierodiakonou et al. Unfortunately, I quickly realized this article was already sourced in our Wikipedia article (however its information pertaining to my search focus was limited as it did not focus solely on peanut allergy, hence the necessity of my additional search). Instead of a systematic review, I decided to see if I could find any official “guidelines” from a college/academy/society of allergy specialists that were centered more around peanut allergy. I could not find any of these guidelines in PubMed, so instead turned to Google Scholar where a search of “peanut allergy infant guidelines” brought me to the article by Fleischer et al. that I have selected for our bibliography.

This article was selected because it focuses solely on exposure to peanuts and the prevention of peanut allergy in high-risk infants. Considering that severe peanut allergy can cause anaphylaxis, preventing the allergy in the first place is likely to be a topic of interest, especially in infants that are high-risk. Currently the Wikipedia article on peanut allergies has extremely limited information on this sub-topic. This article was also selected because it is eligible to be used as a citation in a Wikipedia article based on the WP:MEDRS guidelines. Firstly this article is relatively recent (published within the past three years) and thus provides up to date information, especially considering a more recent major consensus statement/guideline on the topic was not found in subsequent searches. Secondly, this article is a non-primary source as it discusses data from primary sources, adding an additional phase of peer review. Thirdly, this article summarizes an international scientific consensus. It represents evidence-based guidelines agreed upon by no less than ten professional bodies of allergy/immunology experts. This consensus is strengthened in that it represents an international perspective with some of these groups located in North America, Europe, and Asia.

Overall this article will be helpful to our project because it will add a solid secondary source to the Wikipedia page on peanut allergy. This source will allow us to expand the currently vague and limited “Timing of exposure” section of the page.

Student Wood, R.A. (2015). Advances in food allergy in 2015, Journal of Allergy and Clinical Immunology, Volume 138, Issue 6, 1541–1547 http://www.jacionline.org/article/S0091-6749(16)31188-5/references

This review was found using a PubMed search, specific to review articles published within the last 5 years, using the key words “peanut allergy epidemiology.” I searched epidemiology specifically because as a group we had located several sources discussing the development and diagnosis of peanut allergies, but had found little information on epidemiology, which is one of the sections of the Wiki page that we hope to address. There were not many review articles specifically on peanut allergies. One that I found, titled “Allergen-specific oral immunotherapy for peanut allergy” by Nurmatov et. al. was deemed to be too weak to include within our research because, although it demonstrated thorough systematic review strategies, it only identified a single study which fit its selection criteria, which was a randomized control trial consisting of only 28 participants. Another source I considered using was the “Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Summary of the National Institute of Allergy and Infectious Diseases–Sponsored Expert Panel” by Togias et. al. This set of guidelines was well supported by 64 publications, which were all reviewed for their quality, as well as an expert panel. However, the reason I decided against this article was because it primarily addressed prevention of peanut allergies, a subject which was well-covered in other articles we had selected. In contrast, the article I have selected provides a broader body of information on peanut allergies, including epidemiology, risk factors, diagnosis, treatment, and other topics. Aside from this breadth of information, including epidemiological factors which are important for our Wiki page, I also selected this article based on its quality. It was published in a reputable journal, The Journal of Allergy and Clinical Immunology, by a researcher from a reputable University, John Hopkins University School of Medicine.

This article fits Wikipedia’s reliable medical sources criteria as a review article including only original research. Additionally, it was published less than one year ago, in December 2016. This article should be considered reliable based on its journal of publication, and because the author is a third-party reviewer, with no association with the articles he is reviewing.

Although this article addresses food allergies as a whole, it also reviews studies of the peanut allergy in particular. As discussed, the epidemiology section of the Wikipedia page could benefit greatly from this article, which discusses differences in prevalence of peanut allergies between different ethnic groups, different geographical regions, and urban versus rural living environments. The treatment section of the current Wiki article is also lacking incredibly. The article I have selected details multiple treatment strategies, including oral immunotherapy, sublingual immunotherapy, EPIT, and others, which could add considerably to the Wiki page.

Student Food allergy. BMJ Best Practice. August 2017. http://bestpractice.bmj.com/best-practice/monograph/639.html. Retrieved October 09, 2017

We began the search for our citations by identifying which sections of the existing Wikipedia article on peanut allergy were lacking reliable, secondary source references. Considering the sections identified, I chose to look for clinical guidelines on the signs and symptoms and diagnosis of peanut allergy. Starting on the Queen’s library website, I navigated to the “Medicine” page through the “Research by Subject” feature. There, I selected the Trip database under the “Databases” section, knowing that this search tool allows one to filter results by evidence type. On Trip, in the search bar, I entered “diagnosis of peanut allergy”. This search returned over 500 results. In order to narrow my search, I selected “All Secondary Evidence” in the filter column with the hope that the filtered results would include widely-accepted, evidence-based guidelines on the topic. I did not select “Guidelines” as a filter even though it was present in the list because I did not want to mistakenly exclude guidelines that may be published in a different format (e.g. amongst a synopsis of the allergy). It was within this result list that I found the BMJ Best Practice entry on “Food allergy”.

Although I eventually chose the BMJ Best Practice source, I did consider a few other sources in the Trip database result list, including an article entitled “[European Academy of Allergy and Clinical Immunology] food allergy and anaphylaxis guidelines: diagnosis and management of food allergy” as well as one entitled “Diagnosing and managing common food allergies: a systematic review”. The former article listed all clinical recommendations related to peanut allergy along with their evaluated level of evidence and recommendation grade. This structure made the article very lengthy and difficult to parse out the recommendations that were of the highest level of evidence and consensus. The latter source claimed that its readers should consider review bias in its recommendations, as the studies that were included in the review were of limited quality and lacked homogeneity. Additionally, this study was from 2010, which is older than Wikipedia’s recommended five-year window for citations.

I decided on the BMJ Best Practice source because it presented clinically relevant, evidence-based information on food allergy in a clear and concise format. Although peanut allergy was not the primary focus of the article, the article identifies that peanut allergy is a type of food allergy and can be diagnosed and managed under the broader guidelines for food allergy. Also, this source was updated fairly recently (in August 2017), showing its authors’ commitment to providing the most up-to-date consensus information on the topic. This source meets Wikipedia’s reliable medical sources criteria because it is a secondary source combining the results of multiple primary and other secondary sources, it has been updated less than five years ago, and it is a practice guideline published by a widely accepted scientific and health authority (BMJ).

I plan to use this source to edit information and provide a secondary source reference in the “Signs and Symptoms” and “Diagnosis” sections of our Wikipedia article. It will act as a means for including clinical guidelines in our article, to ensure the most appropriate and widely accepted information on peanut allergy is presented.

Student Chan ES. Paediatrics & child health: Dietary exposures and allergy prevention in high-risk infants: A joint statement with the Canadian Society of Allergy and Clinical Immunology. 12/2013;18(10):545.

In PubMed, I used the following search without quotation marks: “food allergy pediatrics”. I also restricted the search using the following fields: less than 5 years old, and one of meta-analysis, systematic review, guideline, or government publication. I used this broad search because I felt as though searching for “Peanut Allergy” guidelines would be too specific, and wanted to make sure I captured any peanut allergy guidelines that might be embedded within a larger set of guidelines.

Other reviews, guidelines and addendums appeared - of which the applicable ones were either (a) discussed by my group members, or (b) already included in the original Wikipedia article. I was able to dismiss other items immediately as they were clearly not applicable (i.e. other allergies or primary research).

I chose my article because it was issued as a joint statement with the Canadian Society of Allergy and Clinical Immunology, and was also issued as a Position Statement by the Canadian Pediatric Society. Since both societies had to approve the article, I felt as though it was going to have been well-vetted. The Canadian Pediatric Society also indicates that the article was first published in 2013 and then reaffirmed in 2016, which gave me more confidence in the article’s accuracy and relevance.

This article falls under the category of statement by major medical bodies, immediately making it of high enough stature to consider utilizing for this project (i.e. it is not opinion or primary research). The article itself carefully lays out the current state of knowledge about introducing peanut and other allergens to children, comparing what was known to what is the most up-to-date information available. The article concludes with a list of recommendations that synthesize the information in the article.

For our project, this article will play an important role when we discuss the timing of peanut introduction to children. In its current state, the Peanut Allergy Wikipedia entry has just two sentences under the “Timing of Exposure” heading. Hopefully we will be able to flesh out that section to be a little more useful with the help of this article and other scientific bodies’ guidelines.

Sample Citation:

Actual Talk Page Entry: Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:

- Society and Culture: We propose that the following sentence is added “The high severity of peanut allergy reactions, as well as the increasing prevalence of peanut allergy in the Western world have led to widespread public attention. As a result, many school policies within North America have been implemented to completely ban the presence of all peanuts and tree-nuts in schools. However, it remains unclear whether the complete ban of peanuts and tree-nuts in schools is warranted, in comparison with the potential decrease in quality of life associated with food bans. - In the epidemiology section: “Peanut allergies in the Western world are more common among non-white, minority populations” - In epidemiology, “In Western countries, the incidence of peanut allergy is between 1-3%. There has been a sudden increase in number of cases in the past 10-15 year period.” - We propose to add an “Outcomes” subsection under the “Treatment” section, as this subsection is recommended in Wikipedia’s suggested outline for articles on diseases, disorders, or syndromes. This subsection would contain the following: “In terms of the natural history of one’s allergy to peanuts, this allergy tends to resolve in childhood less often than allergies to soy, milk, egg, and wheat. Accordingly, re-evaluation of peanut allergy is recommended on a yearly basis for young children with favourable previous test results, and every few years or longer for older children and adults.” - The “Timing of exposure” section lacks specifics describing its evidence. We propose the following change: There is evidence that consuming peanut proteins between 4–11 months of age decreases the risk of developing peanut allergies by the age of 5 years in high risk infants by 11-25%. - We propose adding a section on how peanuts are cooked may act as a risk factor for peanut allergy. “Boiling peanuts acts to decrease IgE-binding capacity as the boiling processes causes loss of Ara h2, Ara h6, or Ara h 7 proteins. Furthermore, the structural folding of these proteins are also altered contributing to the decreased IgE-binding capacity. Alternatively, roasting peanuts lead to increased IgE-binding capacity compared to raw peanuts. Some proposed mechanisms are increased effects of Ara H 2 on trypsin inhibition leading to decreased digestibility and increased Ara h 8 stability both contributing to increased allergenicity. - Under the section entitled “Diet During Pregnancy”: The reference for the first sentence, Reference #15 (Frazier AL, Camargo CA, Malspeis S, Willett WC, Young MC. Prospective Study of Peripregnancy Consumption of Peanuts or Tree Nuts by Mothers and the Risk of Peanut or Tree Nut Allergy in Their Offspring. JAMA Pediatr. 2014;168(2):156–162. doi:10.1001/jamapediatrics.2013.4139) is a primary source, and should be removed. In place of that first sentence, we propose the following sentences: “The Canadian Pediatric Society and Canadian Society of Allergy and Clinical Immunology issued a joint statement in 2013, reaffirmed in 2016, in which they acknowledged there is conflicting evidence on whether maternal diet during pregnancy has any effect on development of allergies due to a lack of good studies. However, they recommended no restrictions be placed on maternal diet during pregnancy on the basis of allergy development, due to the general risk of malnutrition as an unintended consequence.”

You can close your talk page post with a polite note of "thanks" and let the community know that you are appreciate their time and welcome any feedback or suggestions that they may have. Sign your page with 4 x~ (Nasztalos (talk) 14:42, 4 November 2017 (UTC)) (this adds your Wiki signature) like this JenOttawa (talk) 23:54, 30 October 2017 (UTC)