Peanut Allergies

Did you know that the majority of fatal and near-fatal allergic reactions in North America are caused by peanut allergy?

The subject of peanut allergy is very important to parents, school administrators and anybody who looks after children. It is time to revisit the subject.

Food allergy affects about six to eight percent of children younger than four years of age. It can affect older children as well.

Peanuts have been with us since they were first cultivated in South America about 2000 to 3000 B.C. But allergy to peanut appears to be a phenomenon of the past two decades.

April 25th issue of the New England Journal of Medicine deals with this subject quite nicely. The author of the article is Dr. Hugh Sampson, Paediatrician from Mount Sinai School of Medicine, New York. Here are some important points from the article:

-In spite of increasing public awareness of food allergy, most patients are not well prepared to deal with severe allergic reactions. Over 80 percent of patients who died from allergic reactions to food were not given appropriate information to avoid accidental food-induced reactions or use self-injectable epinephrine.

-Food-induced severe allergic reaction is often mistaken for severe attack of asthma or an acute cardiac event. Therefore, taking careful history of exposure to an allergen is important. There is no laboratory test to diagnose allergic reaction to food.

-Initial symptoms of peanut or food allergy are: tingling in the mouth and lips, sensation of tightening of the wind pipe, colicky abdominal pain, and nausea and vomiting, flushing of the skin, etc.

-Delay in the initiation of therapy such as injectable epinephrine is associated with a poorer prognosis, although about 10 percent of patients who receive epinephrine early still die.

-Up to one third of patients have a biphasic reaction – that is, these patients seem to have fully recovered when severe spasm of the airway suddenly recurs, requiring patient to go on a breathing machine. This usually occurs within the first four hours of initial treatment and recovery. So all patients should be observed in the hospital at least for four hours after they have successfully responded to initial treatment.

-In 25 to 35 percent of patients with peanut allergy, an allergic reaction to tree nuts (such as walnuts, cashews, and pistachios) will develop even though tree nuts are from a different botanical family.

-In vast majority of the patients the first reaction to peanuts occurs at a median age of 14 months. Many food allergies in children disappear as they grow. But peanut allergy often is a lifelong disorder.

In the next column, we will discuss what parents should do to teach their children about peanut and other food allergies. We will also tell you where to find more information on this subject.

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