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JACI Highlights - July 2008
Good prognosis, clinical features, and circumstances of peanut and tree nut reactions in children managed by a specialist allergy center
Andrew T Clark, MD and Pamela W Ewan FRCP
More and more people are developing allergies to peanuts and nuts. Repeated reactions are common, even after diagnosis. The allergic reactions can be life threatening and, as treatments for preventing or eliminating this allergic disease are not yet available, those with allergies - especially children, their families, caregivers and teachers - suffer a continual fear of the consequences. The heightened, ongoing anxiety can significantly affect quality of life for the family of a nut-allergic child. Risk management plans are available for allergic individuals that can increase a parent's knowledge of how to avoid exposures, deal with allergic emergencies, and help to alleviate the fears for his or her children. In an upcoming issue of the Journal of Allergy and Clinical Immunology, Clark and Ewan discuss a study of the frequency and circumstances of allergic reactions in 785 nut-allergic children who attended an allergy center and received an allergy management plan from an allergy specialist. The children were studied for an average of 5 years. The authors found that only 3% per year had an incident of an allergic reaction from accidental ingestion of nuts. Most reactions were mild or moderate, injected epinephrine was rarely required and never used twice. Preschool children had the lowest number of accidental reactions and none were severe. The study revealed that the allergic reactions occurred most commonly at home or outside of the school setting. Reactions to skin contact to nut allergen were found to always be mild, causing the authors to recommend that avoidance be concentrated on the ingestion of nuts. Under the care of an allergy specialist, the prognosis for children with allergies to nuts is good, with low frequency and severity of further reactions.
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