Can we predict severe reactions during peanut challenges in children?

Erp, Francine C. van; Knulst, André C.; Kentie, Petra A.; Pasmans, Suzanne G.M.A.; Ent, Cornelis K. van der; Meijer, Y.

doi:10.1111/pai.12107

Cited by 35 publications

(33 citation statements)

References 39 publications

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“…Also patient 2 presented with serious gastrointestinal problems having in addition to a high titer of sIgE against Ara h 2 coeliac disease as a co-morbidity. Although a number of four patients does not allow us to draw conclusions concerning the predictive value of Ara h 2 these observations underline the findings of van Erp et al [7] who have shown that Ara h 2 is predictive for a positive outcome in a food challenge, but its relation to severe reactions is insignificant [8]. One year after reaching maintenance patient four had accidently taken a considerable higher amount of peanut protein resulting in an itchy throat.…”

Section: Discussionsupporting

confidence: 40%

Searching for a Safe, Cheap and Simple Protocol to Desensitize Children with Peanut Allergy. Patient Data of Four Children with Peanut Allergy Undergoing Oral Immunotherapy (OIT)

Paassilta¹

2015

IJCAM

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Objectives: To find a safe, effective and easy-to-perform method to desensitize children with peanut allergy. Design:Patients with anaphylactic reactions to peanut protein (Sampson Grade 1-3) were investigated for peanut IgE, AraH2 positivity and underwent lung function test with exercise challenge before entering an open food challenge (OFC) test. Oral immunotherapy (OIT) with incremental doses was started under a protective medication of levocetirizine with an amount of peanut protein lower than the reaction threshold in the OFC. Maintenance was reached with a dosage of 250 mg peanut protein (2 kernels) and OIT was continued with this amount on a daily basis. Levocetirizine was discontinued after two months symptom free period on maintenance dosage.Settings: Blood samples, lung function tests OFC and initial dose of OIT were carried out in an outpatient setting able to deal with anaphylactic reactions.Patients: Four patients, three males and one female, aged 6-12 years with systemic reactions to peanut in an open challenge test under went OIT. Patients revealed co-morbidities such as asthma, atopic eczema, other food allergies, pollen allergy and coeliac disease in addition to peanut allergy.Interventions: During OIT, patients had repeatedly phone contacts with a physician. If extensive side effects occurred, the dosage was stepped down to the dosage formerly tolerated.Results: All four patients reached the maintenance dose of 250 mg peanut protein (2 kernels). The interval between starting OIT and reaching maintenance was 7-35 weeks. Adverse reactions during OIT were considerably mild and consisted of GER, mild to moderate stomach pain and an itchy throat and treated with antihistamine. No one needed adrenalin for the symptoms during OIT. Conclusions:OIT was effective in patients with mild to moderate anaphylaxis due to peanut allergy using an uncomplicated, individually tailored protocol.

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Section: Discussionsupporting

confidence: 40%

Searching for a Safe, Cheap and Simple Protocol to Desensitize Children with Peanut Allergy. Patient Data of Four Children with Peanut Allergy Undergoing Oral Immunotherapy (OIT)

Paassilta¹

2015

IJCAM

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“…Severity appears to relate to the amount of nut ingested [44]. Hospital-based challenges are not helpful in predicting severity of accidental reactions [45][46][47].…”

Section: Risk Factors For Severe Reactionsmentioning

confidence: 97%

BSACI guideline for the diagnosis and management of peanut and tree nut allergy

Stiefel

Anagnostou

Boyle

et al. 2017

Clin Experimental Allergy

119

134

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SummaryPeanut nut and tree nut allergy are characterised by IgE mediated reactions to nut proteins. Nut allergy is a global disease. Limited epidemiological data suggest varying prevalence in different geographical areas. Primary nut allergy affects over 2% of children and 0.5% of adults in the UK. Infants with severe eczema and/or egg allergy have a higher risk of peanut allergy. Primary nut allergy presents most commonly in the first five years of life, often after the first known ingestion with typical rapid onset IgE-mediated symptoms. The clinical diagnosis of primary nut allergy can be made by the combination of a typical clinical presentation and evidence of nut specifc IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test. Pollen food syndrome is a distinct disorder, usually mild, with oral/pharyngeal symptoms, in the context of hay fever or pollen sensitisation, which can be triggered by nuts. It can usually be distinguish clinically from primary nut allergy. The magnitude of a SPT or sIgE relates to the probability of clinical allergy, but does not relate to clinical severity. SPT of ≥ 8 mm or sIgE ≥ 15 KU/L to peanut is highly predictive of clinical allergy. Cut off values are not available for tree nuts. Test results must be interpreted in the context of the clinical history. Diagnostic food challenges are usually not necessary but may be used to confirm or refute a conflicting history and test result. As nut allergy is likely to be a long-lived disease, nut avoidance advice is the cornerstone of management. Patients should be provided with a comprehensive management plan including avoidance advice, patient specific emergency medication and an emergency treatment plan and training in administration of emergency medication. Regular re-training is required.

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“…Furthermore, challenges are usually terminated at the onset of objective and generally mild symptoms, so the relationship between dose and severity is poorly described. The available data (from studies that have included those with previous anaphylaxis) suggest that peanut-allergic individuals with a history of anaphylaxis are not more sensitive to low doses than those without (29,(41)(42)(43). In a unique study, Wainstein et al performed food challenges in 27 peanut-allergic children; in contrast to other studies, challenges were not stopped following the onset of mild symptoms, but allowed to progress (44).…”

Section: Dose Of Allergenmentioning

confidence: 99%

Can we identify patients at risk of life‐threatening allergic reactions to food?

Turner

Baumert

Beyer

et al. 2016

Allergy

200

207

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Anaphylaxis has been defined as a 'severe, life-threatening generalized or systemic hypersensitivity reaction'. However, data indicate that the vast majority of foodtriggered anaphylactic reactions are not life-threatening. Nonetheless, severe lifethreatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life-threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food-allergic children also have asthma, yet almost none will experience a fatal food-allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food-induced allergic reactions.

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Can we predict severe reactions during peanut challenges in children?

Abstract: Although predictors of positive FCO could be identified, none of the studied risk factors could predict a severe reaction during peanut challenge. When challenging a child sensitized to peanut, clinicians should be prepared and equipped to handle any reaction in all cases.

Cited by 35 publications

References 39 publications

Searching for a Safe, Cheap and Simple Protocol to Desensitize Children with Peanut Allergy. Patient Data of Four Children with Peanut Allergy Undergoing Oral Immunotherapy (OIT)

Searching for a Safe, Cheap and Simple Protocol to Desensitize Children with Peanut Allergy. Patient Data of Four Children with Peanut Allergy Undergoing Oral Immunotherapy (OIT)

BSACI guideline for the diagnosis and management of peanut and tree nut allergy

Can we identify patients at risk of life‐threatening allergic reactions to food?

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