Author: noorali

In the last column, we discussed some important aspects of peanut allergy. Today, we will concentrate on prevention, immediate management and where to find more information on this important subject.

As in the last column, we will use information provided by Dr. Hugh Sampson, paediatrician, Mount Sinai School of Medicine, New York, in his article published in the New England Journal of Medicine.

Sharon Pudwell, a local parent of a child with peanut allergy, has also given me information to share with you.

Dr. Sampson says that children with peanut allergy, their parents and caregivers, must be educated to:

-to avoid accidentally ingesting peanuts
-learn to recognize early signs of an allergic reaction
-learn to give medication as soon as symptoms develop.

Parents and children should check all food labels. They should avoid high-risk situations such as foods served in buffets and ice-cream parlours and unlabeled candies and deserts.

Symptoms of allergic reaction can appear within few minutes to few hours. Pudwell says that some of the early symptoms are: itchy eyes, nose, and face; flushing of face and body; swelling of eyes, face, lips, tongue and throat; hives, vomiting, diarrhoea, wheezing, a feeling of fear and apprehension; weakness and dizziness; inability to breathe and eventually loss of consciousness. The condition may end in shock and death.

Treatment of acute reaction (anaphylaxis) by patient and family members include injection of epinephrine (depending on patient’s history and symptoms) with EpiPen Autoinjector and oral liquid diphenhydramine (an anti-allergic medication). Patient should be transported to hospital emergency immediately. Let emergency physician take over the care. Patients should be observed in the emergency department for at least four hours after they have recovered.

Dr. Sampson says that considerable amount of education material is available from the Food Allergy and Anaphylaxis Network (telephone number, 1-800-929-4040; web site www.foodallergy.org). This web site contains written emergency plan (every allergic child should carry one) and appropriate doses of liquid diphenhydramine and self-injectable epinephrine

Locally, Pudwell had started a support group. She says, “My support group no longer meets. I do not know personally how many people in this area suffer from peanut allergies. I still take an active part in education (in schools) and am available to anyone who would require support”.

She adds, “You can give my name and phone number (527-0997). Here are a few sites I use for up-to-date information: www.peanutallergy.com; www.cadvision.com/allergy; www.anaphylaxis.org. These are all excellent web sites for resources, alerts, food recalls, and discussion boards”.

Pudwell suggests the following rules:
-carry Epi-pen
-wear a medical alert bracelet
-carry a cell phone
-do not ever share foods – eat only foods you have prepared yourself or in a child’s case only food your parents have prepared for you.
-read and re-read labels
-be aware of your surrounding

Pudwell says, “To believe that the world can be free of peanuts is unrealistic, or to single out a child as somehow not quite equal to another because of allergies is unfair. We believe children must learn to live with the knowledge of their allergies, and be taught from a very young age the coping skills they will need for a safe and healthy survival”.

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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.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!