Evidence emerging from recent investigations suggests a substantial rise in peanut allergy over the last 10 to 15 years, particularly in the United States and other Western countries. Symptoms of peanut allergy often emerge with the first exposure. In addition, adverse reactions can be severe and even life-threatening. Unfortunately, peanut allergy generally persists indefinitely. Only approximately 20% of patients are subsequently able to tolerate peanuts following initial diagnosis.
The diagnostic approach to peanut allergy includes laboratory or allergy skin tests to identify allergy to peanut proteins. Recently, new lab tests for peanut allergy have been developed which can measure 5 specific peanut allergens, providing a more detailed risk profile to predict who is most likely to suffer a severe allergic reaction. However, a positive test reveals sensitization only and does not confirm clinical allergy. An oral food challenge supervised by a physician in a clinical setting may be required to confirm the diagnosis.
Although there is no cure at the present time for peanut allergy, recent developments may herald a shift in the current management of peanut allergy. In 2008, a study was published which explored the difference in the rates of peanut allergy between Jewish children in London versus those living in Israel. The basis of the study was the observation that peanut allergy was not as significant a problem in Israel as it was in the United Kingdom. The results of the study suggested that peanut allergy rates were 10 fold higher in London than in Israel. The only difference between the groups was that the Israeli children had peanut introduced into their diet at age 9 months in contrast to English children, who did not begin to ingest peanuts until age 3 years. To further explore this phenomenon, the Learning Early About Peanut Allergy (LEAP) trial was conducted, focusing on high risk infants. Participants specifically included children who had egg allergy or severe eczema. About half of the participants consumed small amounts of peanuts while the other half did not. The group consuming peanuts experienced a relative risk reduction of 80% compared to the avoidance group. The results of the study suggest that children who have peanut introduced early under similar circumstances without any adverse reactions should continue to eat peanuts as frequently as possible in gradually increasing amounts.
To learn more about peanut allergy, consult your trusted Allergy Partners physician or visit allergypartners.com
William Harris, M.D.
Allergy Partners of Orange County
