Background: The prevalence of peanut allergy (PA) among children has increased significantly over the past decade. Even though the prevalence of PA in Singapore is considered low, peanut is the top trigger for food-induced anaphylaxis in Singaporean children. Objective: To describe the demographic characteristics and clinical features of children with PA. Methods: This is a 5-year retrospective review of children diagnosed with PA based on clinical history coupled with a positive skin prick test to peanut or positive oral food challenge results. Results: There were 269 patients (53.9% males) with a clinical diagnosis of PA. The median age at first allergic presentation for the PA group was 24 months old, with interquartile range of 13-39 months. The most common form of peanut introduced was roasted peanut. The rate of peanut anaphylaxis was 7.1%. Concomitant tree nut sensitization was found in 32.3% of this cohort, predominantly to cashew nut. Majority of them have a personal history of atopy-75.8% with eczema, 63.6% with allergic rhinitis, and 19.7% with asthma. Conclusion: This is the first large review of peanut-allergic children in Singapore. Prospective population-based studies are needed to establish the true prevalence and risk factors associated with the development of this potentially life-threatening condition.

Cytokine release syndrome (CRS) is a type of hypersensitivity reaction which has been previously described with chemotherapy and monoclonal antibodies, but not with antibiotics. We present 2 pediatric cases of Amoxicillin/Clavulanic acid (Augmentin) anaphylaxis resembling CRS. Both our patients presented during the index reaction with symptoms suggestive of an acute systemic inflammatory response mimicking sepsis. Their symptomology was reproducible at drug provocation test as anaphylaxis, but with suboptimal response to intramuscular adrenaline. Their infective workups were unremarkable and illnesses followed a self-limiting course. All these point towards a severe hypersensitivity reaction resembling CRS.

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