Severity and threshold of peanut reactivity during hospital‐based open oral food challenges: An international multicenter survey

Arkwright, Peter D.; MacMahon, Jayne; Koplin, Jennifer J.; Rajput, Shelly; Cross, Stephanie; Fitzsimons, Róisín; Davidson, Neil; Deshpande, V. N.; Rao, Naveen; Lumsden, Colin; Lacy, David; Allen, Katrina J.; Vance, Gillian; Mwenechanya, James; Fox, Adam; Erlewyn-Lajeunesse, Michel; Mistry, Hitesh; Hourihane, Jonathan

doi:10.1111/pai.12959

Cited by 38 publications

(33 citation statements)

References 31 publications

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“…While populational thresholds can help identify peanut‐allergic patients with the lowest reaction thresholds and can be used to guide legislation for more comprehensive and standardized PAL, they do not help to quantify the risk of a reaction for a given peanut‐allergic individual when consuming products with PAL. Indeed, many patients have a high reaction threshold during OFC: up to 50% of children with peanut allergy react at a cumulative dose of more than 300 mg peanut protein 25 …”

Section: Can We Use Individual Threshold To Stratify Risk Of Reactingmentioning

confidence: 99%

Can my child with IgE‐mediated peanut allergy introduce foods labeled with “may contain traces”?

Graham

Caubet

Eigenmann

2020

Pediatric Allergy Immunology

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Peanut IgE‐mediated food allergy is one of the most common food allergies in children with a prevalence that has increased in the past decades in Westernized countries. Peanut allergies can trigger severe reactions and usually persist over time. Peanut‐allergic children and their families are often confronted to processed foods with precautionary allergen labeling (PAL) such as “may contain traces of peanuts,” which are frequently used by the food industry. Patients are generally confused as to whether eating such foods entails a risk of allergic reaction, which can ultimately lead to dietary restrictions and decreased quality of life. Thus, guidance toward eviction of foods with PALs such as “may contain traces of peanuts” is a recurring problem that peanut‐allergic patients address during pediatric allergy consultations with varying attitudes among allergists. Many studies have evaluated peanut contamination in foods with PALs, with generally less than 10% of foods containing detectable levels of peanuts, albeit heterogeneous amounts, with in rare occasions levels that could trigger allergic reactions in certain patients. The risk of reacting to foods with traces varies significantly with threshold, with patients with the lowest reaction thresholds at highest risk, and a dramatic reduction of risk as threshold increases. Thus, risk stratification based on individual reaction threshold may help stratify patients’ risk of reacting to foods with PAL. In clinical practice, a single‐dose 30 mg peanut protein oral food challenge may be an option to stratify peanut‐allergic patients’ risk when introducing foods with PAL, as illustrated by three clinical cases.

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Section: Can We Use Individual Threshold To Stratify Risk Of Reactingmentioning

confidence: 99%

Can my child with IgE‐mediated peanut allergy introduce foods labeled with “may contain traces”?

Graham

Caubet

Eigenmann

2020

Pediatric Allergy Immunology

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“…According to a recent publication, in which children with equivocal peanut allergy underwent oral peanut challenge, a third (n = 525) of 1634 challenged children with suspected peanut allergy (78%) or precautionary avoidance of peanut without suspicion (22%) reacted positively [9]. While 28% of the reactions were elicited by the administration of 25 mg of peanut (equivalent to around 1/50th of a peanut kernel), 38% of the children only reacted after a dose of over 1 g of peanut (equivalent to a whole peanut).…”

Section: Eliciting Doses Differ From Individual To Individualmentioning

confidence: 99%

Is the concept of “peanut-free schools” useful in the routine management of peanut-allergic children at risk of anaphylaxis?

et al. 2020

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Summary Background Parents of school-age children with food allergies and potential anaphylactic reactions want their children to have an unburdened and risk-free everyday school life. Thus, particularly in the case of peanut allergy, demands for peanut-free schools are put forward. Results and discussion The position paper of the food allergy working group of the German Society for Allergology and Clinical Immunology (Deutsche Gesellschaft für Allergologie und klinische Immunologie) highlights why the concept of peanut-free schools does not protect peanut allergic children, but rather bears potential disadvantages and risks for all those involved. The focus on peanut as a potential trigger of anaphylactic reactions ignores other relevant triggers. Conclusion In order to address the fears and concerns of patients, parents, and school staff, it is mandatory to develop various coping strategies. These should enable and ensure the safety and participation of food-allergic pupils in classes and other school activities. Therefore, it is important to implement adequate measures for allergen avoidance and emergency treatment for students with confirmed food allergies.

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“…While there is probably no universal solution, Graham et al address the problem with three common clinical vignettes representative of patients with food allergies. The concept of trace management implicates risk management, a theme that has been addressed earlier in this journal by several studies 2‐4 …”

mentioning

confidence: 98%

Improving asthma care in preschool children

Eigenmann

2020

Pediatric Allergy Immunology

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Severity and threshold of peanut reactivity during hospital‐based open oral food challenges: An international multicenter survey

Cited by 38 publications

References 31 publications

Can my child with IgE‐mediated peanut allergy introduce foods labeled with “may contain traces”?

Can my child with IgE‐mediated peanut allergy introduce foods labeled with “may contain traces”?

Is the concept of “peanut-free schools” useful in the routine management of peanut-allergic children at risk of anaphylaxis?

Improving asthma care in preschool children

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