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« Nasal Saline: Moisturize or Rinse? | Main | Devices For Self Injection of Epinephrine »
Saturday
May122007

Peanut Allergy: What We Know

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Easy to avoid? Just read on.

George Washington Carver was a highly intelligent African American artist, poet and scientist who spent many years doing research on peanuts in the 1800s. He discovered over 300 uses for the peanut as well as 100 uses for the sweet potato. Of course, had he developed peanut allergy in childhood, he would have never been able to carry out the multitude of experiments which led to his amazing discoveries. In fact, had he been markedly sensitive to peanut, just being in the same room or lab where the experiments were carried out, may have caused fatal throat swelling or suffocating respiratory symptoms. I believe, had Carver known peanut allergy would be so widespread 150 years later, he would have worked out a cure.

Peanut allergy is the most common severe food allergy of childhood. 1.5 million Americans are allergic to peanut. Some studies have estimated a doubling of the number of children with peanut allergy in this country in past years.

There is increased risk of developing peanut allergy in children born to parents that have food allergy, or a history of food allergy. Peanut allergy should be suspected if there is a rash, choking, gagging, itching, hives (welts), or complaints of throat swelling, tongue swelling or difficulty breathing after eating peanuts or a food with peanuts in it. Other symptoms may include stomach pain, cramping and diarrhea, swelling of other areas of the body, dizziness or fainting. These are most but not all of the possible symptoms.

If someone has any unusual sensation or feeling after eating peanuts (or any food) they should avoid it until discussed with their doctor. Young children may simply stop eating or spit the food out. It is important to consider whether the rejection may be because of throat discomfort, particularly in the case of peanut or a food with peanut or other high risk food in it (tree nuts, shellfish or other sea food).

When peanut allergy is suspected, it should be confirmed by either a skin prick test or a blood test. Sometimes both tests are ordered in order to be certain whether there is allergy. Once confirmed, strict avoidance is key. Careful reading of food labels and asking waiters and waitresses about whether a dish or food has peanut in it is essential.

An “Alert” bracelet or necklace is recommended for older children or adults. An Epinephrine containing device is usually prescribed, just in case there is accidental exposure.

About 50% of severe reactions that occur in the U.S. are by accidental exposure. Unfortunately 50-100 deaths occur annually in the U.S. from peanut allergy. 80% of fatalities and life threatening food reactions in children are related to peanut (in the U.S.).

Realize that mild initial or multiple reactions may precede a more severe life threatening reaction. Fatal and near fatal reactions have occurred on the apparent first ingestion of peanut but this is not common.

It is important to learn as much as you can about peanut allergy and how to avoid them if you or your child is allergic to them. I have included a website that goes into further detail below.

Although only about 20 to 25% of children lose their hypersensitivity to peanut over time, I recommend (to my patients) re-testing every 3-5 years in milder cases, to allow for some easing up on the restrictions if indeed tests become negative. There are reports of some people having negative allergy tests (to peanut) after having previous allergic reactions (and earlier tests positive), followed by eating peanut without problems, but then later on having an allergic reaction to peanut. This means that hypersensitivity can go away but then perhaps return in some individuals. We therefore have the majority of our patients understand that peanuts should be avoided indefinitely, to be safe.

Should children allergic to peanut avoid all nuts?

You may not get the same answer from 2 different allergists. I recommend (especially in the case of children) avoiding all nuts which include the family of tree nuts (pecans, almonds, walnuts…) even if they were previously well tolerated. Cross contamination may lead to accidental exposure. Cross contamination may occur if other types of nuts are processed in the same machines or containers as peanut. There may be cross contamination with utensils.

Did you know that peanuts are not real nuts?

True nuts are tree nuts (listed above). Peanuts are in the legume family (peas, soybean, and other beans). Fortunately, many people allergic to peanuts are still able to eat other members of the legume family, such as beans (but there are exceptions). Restriction orders should be reviewed by your doctor.

There are many investigators working on other ways to treat peanut allergy. Our approach to this problem may change in future years.

The website for more information is:

www.mayoclinic.com/health/peanut-allergy/DS00710

Want to learn more about George Washington Carver?

Go to: www.lib.iastate.edu/spcl/gwc/home.html

Next week: Nasal Saline Treatment: Moisten, Rinse or Irrigate?

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