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- Archive of Research Summaries
- The distribution of individual threshold doses eliciting allergic reactions in a population with peanut allergy
- This study was designed to look at the amount of peanut that will elicit an allergic reaction. Twenty-six peanut-allergic patients (median age, 25 years) underwent food challenges with increasing doses of peanut.
- Reactions began within 30 minutes after the patients ate peanuts. Two of the patients had difficulty in swallowing and/or hoarseness, and facial flushing within several minutes. All patients reported their first symptoms as itching or a feeling of swelling in the mouth, and sometimes extending to their ears, within 5 minutes. For patients reporting gastrointestinal symptoms, the onset was within 20 to 30 minutes.
- Researchers found that patients who had severe symptoms had a lower threshold than the patients who experienced mild symptoms, and that 50% of study participants had a subjective (patient reported) reaction after eating the equivalent of 3 milligrams of peanut protein (about 1/50 peanut).
- The threshold doses for subjective reactions were between 100 micrograms (about 1/1500 peanut) up to 1 gram (about 6 1/2 peanuts) of peanut protein. Threshold doses that caused objective (observed) symptoms occurred after patients ingested between 10 and 30 milligrams. No patient reacted to the lowest dose of 30 micrograms.
- The findings of this study also highlight the importance of peanut content being labeled accurately on consumer products.
Source: Journal of Allergy and Clinical Immunology, Vol. 110, No. 6.
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- FAAN-Sponsored Research Study Receives International Award
FAAN's Medical Director, Dr. Hugh A. Sampson, received the 2002 International Award for Modern Nutrition from the Association of Swiss Milk Producers, for his research in milk allergy.
Dr. Sampson was selected from an international field of investigators by a jury of European scientists for his work on characterization of milk allergic disorders, identification and characterization of milk proteins leading to allergic reactions, and novel diagnostic tests for milk allergies.
- Dr. Sampson's work has been funded by grants from the National Institutes of Health, FAAN, and David and Denise Bunning.
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- EpiPen® Jr. vs. EpiPen® in young children at risk for anaphylaxis
- Doctors often wonder how to decide whether to prescribe EpiPen® or EpiPen® Jr. for children whose weight falls between the optimal dosage weights for the two auto-injectors. Parents often ask what would happen to a young child who received a regular EpiPen® instead of the EpiPen® Jr.
- According to this report, scientists studied the rate of absorption of epinephrine in children weighing 33 to 66 pounds.
- Children at risk for anaphylaxis self-injected an EpiPen® or EpiPen® Jr. A doctor monitored blood pressure, heart rate, plasma epinephrine concentrations, and adverse effects before and after the injection. The children with a mean age of 5 years and weighing approximately 40 pounds who injected EpiPen® Jr. reached maximum plasma concentration of epinephrine at about 16 minutes. All children became pale; some also became anxious and experienced shakiness.
- Children who injected the EpiPen® and were 6 years old (the mean age for transferring from the Jr. to full-dose EpiPen®) and weighed approximately 56 pounds reached maximum epinephrine concentration at about 15 minutes. Thirty minutes after the shot, their blood pressure was significantly higher than that of the other group. All children became pale, anxious, experienced shakiness, and heart racing or other cardiovascular (heart-related) symptoms; some also became nauseous and complained of a headache.
- The scientists concluded that EpiPen® caused more adverse effects than EpiPen® Jr., including high blood pressure. However, this is "not a reason to delay or avoid epinephrine injection." The best solution would be to have additional doses of epinephrine available for patients to allow more accurate dosing for children.
Source: Journal of Allergy and Clinical Immunology, Vol. 109, No. 1, 171-175
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- Clinical implications of cross-reactive food allergens
- Individuals with food allergy often wonder if they have to worry about foods that are "related" to the ones to which they are allergic. In a recent review article, Dr. Scott H. Sicherer (a FAAN Medical Advisory Board member and Assistant Professor of Pediatrics in the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY) summarized the rates of cross-reactions among various foods.
- The article highlights several points, among them: (1) some food families are very cross-reactive (tree nuts, fish, shellfish, mammal milk), while others are not (beans, legumes, grains); and (2) allergy tests are often positive for related foods (e.g., a positive test for string bean in someone allergic to peanut), but true allergic reactions when eating the related food (in this case string bean) are comparatively uncommon.
- The issue of cross-reactivity in food families can be very complicated and requires a careful evaluation by your physician.
- The following chart summarizes the study findings.
If Allergic to:
Risk of Reaction to at Least One:
Risk Percentage:
A legume (peanut)
Other legumes (peas, lentils, beans)
5%
A tree nut (walnut)
Other tree nuts (brazil, cashew, hazelnut)
37%
A fish (salmon)
Other fish (swordfish, sole)
50%
A shellfish (shrimp)
Other shellfish (crab, lobster)
75%
A grain (wheat)
Other grains (barley, rye)
20%
Cow's milk
Beef (hamburger)
10%
Cow's milk
Goat's milk (goat)
92%
Cow's milk
- Mare's milk
- (horse)
4%
Source: Journal of Allergy and Clinical Immunology, Vol. 108, No. 6, 881-890
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- Interpretation of Food Labels by Parents of Food-Allergic Children
- This study was presented as an abstract and was also the focus of a press conference at the recent annual meeting of the American Academy of Allergy, Asthma & Immunology.
- The scientists wanted to determine the accuracy of label reading among parents of children with food allergy. The study group was comprised of parents visiting the pediatric allergy practice at Mt. Sinai School of Medicine.
- Only four of 60 (7 percent) parents of children with milk allergy were able to correctly identify milk on the 14 products listing milk protein. Six of 27 (22 percent) parents of children with soy-restricted diets were able to correctly identify soy protein in all nine products.
- FAAN members tended to have perfect scores (90 percent versus 65 percent for non-members).
- Labels for wheat, egg, and peanut allergy avoidance diets were also tested. While most parents were able to correctly identify wheat or egg words on the ingredient labels, peanut was correctly identified by only 44 of the 82 (54 percent) parents restricting peanuts. The most common error was parents missing the label statement containing "trace peanuts."
- Editor's note: This study supports the findings of FAAN's labeling study conducted at the 2000 FAAN Conferences. The bottom line is: Current ingredient labels are not easy to understand by those who must read these labels for health and safety purposes. Education is key to avoiding a reaction.
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- Multicenter Study of Emergency Department Visits for Food Allergy
- This study, funded in part by FAAN, reports the results of a chart review study to describe the management of food allergy in four emergency departments (ED) in Massachusetts, New York, and Ohio.
- The reviewers looked at 112 charts for patients who had experienced a food allergy reaction. Foods that caused the reactions included fruit, nuts, shellfish, and fish.
- The investigators found that 38 percent of the patients treated their allergic reaction, most often with antihistamine, at home up to three hours before arriving at the ED. Once there, 77 percent received antihistamine, 50 percent received steroids, 19 percent received epinephrine, 2 percent received other medications.
- The majority of the patients (91 percent) were discharged to home after treatment. Before leaving the ED, 73 percent received prescriptions for antihistamine, 33 percent were prescribed steroids, and 11 percent received prescriptions for epinephrine.
- This study showed that although guidelines exist for the emergency management of food allergy, "adherence to these guidelines appears low."
- Journal of Allergy and Clinical Immunology, Vol. 107, No. 2, Abstract 649, S196.
- Editor's Note: FAAN is working with physicians to develop educational seminars for ED staff.
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- Reactions in Restaurants
- The study, "Peanut and tree nut allergic reactions in restaurants and other food establishments", reported as an abstract in the April/May '01 issue of Food Allergy News, was recently published in the Journal of Allergy & Clinical Immunology, Vol. 108, No. 5. Results of the study showed that restaurants and food service establishments pose a risk for a reaction to allergic individuals, particularly because of cross contact or hidden ingredients. Asian foods and desserts were the two most commonly-cited causes of reactions with this study population.
- At the FAAN 2001 Conferences, attendees were given a survey asking about their experiences in restaurants. A total of 534 surveys were distributed; 487 were returned (91 percent). The survey revealed a number of points:
- Almost half of these individuals have had an allergic reaction to a food served in a restaurant.
- The most common foods that caused the reactions were milk, peanuts, tree nuts, and eggs.
- Approximately 80 percent of participants avoid bakeries and Chinese and Thai restaurants.
- More than 70 percent of those responding reported avoiding ice cream establishments and Japanese and Indian restaurants.
- The most common concerns were cross contact, lack of awareness by restaurant staff, and restaurant staff not taking food allergy seriously.
- Detection of Peanut Allergens in Breast Milk of Lactating Women
- In order for an allergy to develop, the individual must first be sensitized to the food. A large number of children who develop peanut allergy have their first reaction the first time they are given a peanut-containing product (usually a dab of peanut butter).
- In this study, researchers investigated the possibility that peanut protein could pass into breast milk. Twenty-three lactating women, aged 21 to 35 years ate 50 grams of dry roasted peanuts (about 60 peanuts or 1/3 cup). Breast milk samples were collected at hourly intervals. Peanut protein was found in the breast milk of 11 of the mothers. In 10 mothers, it was detected within two hours after she ate peanuts, in one mother it was detected six hours later. Both of the major peanut allergens Ara h1 and Ara h 2 were detected.
- Researchers concluded that peanut protein is secreted into breast milk, thus sensitizing the baby who is at risk for developing an allergy*. This may explain why up to 85 percent of children have a peanut allergy reaction the first time they eat a peanut-containing product.
Journal of the American Medical Association, Vol. 285, No. 13
- *A baby born into a family with allergies.
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- Differences in patients with persistent and transient cow's milk allergy
- Cow's milk allergy is believed to affect 2.5 percent of children under 2 years old. Most of these children, about 80 percent, will outgrow their allergy by the time they are 3 years old. This study was designed to try to determine the difference between children who outgrow milk allergy at an early age and those who don't.
- This study, funded in part by FAAN, showed that casein, the major allergen in milk accounting for 80 percent of the protein, plays an important role in persistent cow's milk allergy. Scientists found that older children and adults who are milk allergic have higher levels of casein-specific IgE antibodies than do younger children.
- The study suggests that doctors may be able to screen for specific IgE antibodies to portions of the caseins to determine if a child is likely to outgrow his or her milk allergy. Those who are not likely to outgrow the allergy may be considered for immunotherapy, when it becomes available.
Source: Journal of Allergy and Clinical Immunology, Vol. 107, No. 2, 379-383.
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- School readiness for children with food allergies
- This study was designed to look at how well prepared public schools in Michigan are to take care of food-allergic children.
- Information was collected from 109 (out of 2,082) schools, representing 66,598 students. More than 50 percent of the schools reported having at least 10 food-allergic students. The most common food allergies were to milk and peanuts, followed by tree nut, shellfish, egg, and wheat.
- The survey showed the following: lack of structured, school-wide education (most parents educate only the classroom teacher); deficiencies in avoidance strategies (only 21 percent of the schools educated their staff about label reading, particularly important for school projects); lack of written emergency action plans; and lack of easy access to epinephrine.
- The investigators concluded that schools need to educate their staff schoolwide, improve prevention and avoidance measures, and make sure epinephrine is readily available and that the staff knows how to administer this life-saving drug. They recommended that school staff use resources such as FAAN, the American Academy of Allergy, Asthma & Immunology; and the American College of Allergy, Asthma & Immunology.
Source: Annals of Allergy, Asthma & Immunology, Vol. 86, 172-176.
- Note: Remember that for a limited time, schools can receive FAAN's comprehensive School Food Allergy Program FREE. To register your school, click here.
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- Comparison of Chinese and American Cooking Methods on Allergenicity of Peanut
- Peanut allergy is not as prevalent in China as it is in the United States, in spite of the fact that the Chinese eat about the same amount of peanuts per capita. Previous studies showed that the protein content between peanuts grown in the United States versus those grown in other countries is very similar.
- Scientists turned their attention to the different cooking methods used for peanuts between the U.S. and China in an attempt to explain the difference in the prevalence of peanut allergy. In the U.S., peanuts are typically prepared by dry roasting, while in China they are fried or boiled.
- They found that Chinese methods of preparing peanuts reduce peanut allergencity as compared with the dry roasting practiced widely in the U.S. This may be one explanation for the difference in the prevalence of peanut allergy between China and the U.S.
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Journal of Allergy and Clinical Immunology, Vol. 107, No. 2, Abstract 460, S139.
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- Allergic Reactions to Foods in the School
- This study of 50 patients from an allergy clinic was conducted via phone. Eight of the children were home-schooled. Of the 42 other children, 67 percent attended school, and 33 percent attended preschool. Twenty-four children (57 percent) had accidental ingestions in the past two years. Sixteen reactions in nine children occurred in school; 63 percent in elementary school and 33 percent in preschool. Peanuts, milk, eggs, and celery were among the foods that caused the reactions. In seven cases, parents were unable to identify the food that caused the reaction. Reactions occurred in: classrooms with eating areas (5), regular classrooms (4), and cafeterias and playgrounds (2 each), and unknown (3). The majority of reactions were treated with antihistamines by the school nurse. In over 80 percent of the reactions, treatment was provided within 10 minutes. Parents had provided written instructions and medications in 91 percent of the cases for elementary schools and in 93 percent for preschools. Close to 70 percent of the parents provided all meals for their children. Researchers concluded that 25 percent of all reactions in the past two years for this study group occurred at school.
Journal of Allergy Clinical Immunology, Abstracts, January 2000, S182
- Editor's Note: This study has a number of points worth remembering: 1. foods such as milk and eggs can cause allergic reactions, 2. reactions can occur outside the cafeteria, 3. reactions are likely to occur in spite of best efforts at avoidance, 4. therefore, it is important that school staff have a written plan in place to ensure quick treatment of an allergic reaction.
Food Allergy News, Vol. 9, No. 6
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- Carrot Allergy
- While not a common allergy in the United States, carrot allergy is believed to affect as many as 25 percent of patients with food allergies in Central Europe, according to a study. However, carrot allergy had never been confirmed by double-blind, placebo-controlled food challenges (DBPCFC; considered the gold standard of allergy testing), and the specific carrot IgE proteins had never been studied.
- Scientists in Switzerland conducted DBPCFC and prick skin tests to carrots, celery, birch, and mugwort pollen in 26 patients with a history of carrot allergy to identify the allergens that cause these reactions, and to determine if there is cross reactivity with other allergens.
- Twenty of the 26 patients had a positive DBPCFC to carrots and showed a cross reactivity with birch pollen, as well. Carrot allergy is also associated with sensitivity to celery, spices, mugwort, and birch pollen.
Source: Journal of Allergy & Clinical Immunology, Vol. 108, No. 2
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- Clinical Features of Cashew Allergy
- The purpose of this study was to review the clinical features of cashew allergy.
- Investigators surveyed 51 patients, including 7 adults. Eighty-eight percent had other allergic disease, including asthma, atopic dermatitis, or rhinitis. Seventy-eight percent believed they reacted to cashew the first time they ate it. Fourteen of the patients had peanut allergy, 18 were allergic to pistachios, and 18 were allergic to other tree nuts.
- Ninety-eight percent of the reactions began within 30 minutes of ingestion; 68 percent began within 5 minutes. Fifty percent of the group reported having severe reactions. Seventy percent have only had one cashew-induced reaction. Only five individuals have had more than two reactions.
- Investigators concluded that cashews cause fewer accidental allergic reactions than peanuts, but the reactions are equal to those caused by peanuts in terms of speed of onset and severity.
Journal of Allergy & Clinical Immunology, Vol. 105, No. 1, S141.
Food Allergy News, Vol. 9, No. 5.
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- Comparison of Chinese and American Cooking Methods on Allergenicity of Peanut
- Peanut allergy is not as prevalent in China as it is in the United States, in spite of the fact that the Chinese eat about the same amount of peanuts per capita. Previous studies showed that the protein content between peanuts grown in the United States versus those grown in other countries is very similar.
- Scientists turned their attention to the different cooking methods used for peanuts between the U.S. and China in an attempt to explain the difference in the prevalence of peanut allergy. In the U.S., peanuts are typically prepared by dry roasting, while in China they are fried or boiled.
- They found that Chinese methods of preparing peanuts reduce peanut allergencity as compared with the dry roasting practiced widely in the U.S. This may be one explanation for the difference in the prevalence of peanut allergy between China and the U.S.
Journal of Allergy and Clinical Immunology, Vol. 107, No. 2, Abstract 460, S139.
- Corn Allergy Study Update
- In August 1999, FAAN published information in Food Allergy News and on our website about a corn allergy study being conducted at Tulane University. Dr. Samuel Lehrer has provided us with the following update on his study:
- Although a number of adults and children believe they are allergic to corn, only a few anecdotal reports describe corn allergy in medical journals. Hence, many members of the medical profession are skeptical about the existence of corn allergy.
- Because of this, our study was designed not only to determine whether or not corn allergy exists, but also to use that information to determine which corn proteins are responsible for causing the allergic reaction.
- Prospective subjects with a clear history of reactions to corn were recruited from allergists in North America, through our web page, and from those referred by FAAN. Following further screening, only those reporting typical allergic reactions to corn, with positive corn skin tests, were invited to participate in our corn challenge study.
- To document the existence of corn allergy, a double-blind placebo-controlled study is in progress. The challenge consists of two phases: one involves incremental amounts of corn given at 30-minute intervals, and the other involves placebo given at similar doses and intervals. Each phase is separated by 2 hours in random order so neither the patient nor the physician knows which phase is administered first. The corn flour or placebo (ground and baked lentils) is mixed with applesauce, apple juice, peach puree, and sugar to mask the taste. If no reaction to the corn or the placebo occurrs during the blinded phase, the patient is given an open challenge of corn chips, then popcorn.
- Of the 16 subjects tested to date, 5 had objective symptoms to corn. Each had a different reaction: hives; wheezing; itching eyes and nose; mouth swelling; or anaphylaxis (hives, vomiting, diarrhea, and low blood pressure). Only 30 percent of patients with a history of corn allergy and positive skin tests to corn reacted when challenged, and only 12 percent (2/5) did so in the blinded portion of the study. This study indicates that although corn allergy may be rare, when it occurs, it can be severe.
- Fatalities Due to Anaphylactic Reactions to Foods
- This report, published in the Journal of Allergy and Clinical Immunology Vol. 107, No. 1, documents 32 cases of fatal food allergy-induced anaphylaxis that occurred between 1994 and 1999 and that were reported to a national registry established by the American Academy of Allergy Asthma & Immunology with the assistance of FAAN.
- Cases were reported by FAAN members, the media, and doctors. Working with our Medical Director Dr. Hugh Sampson and Medical Advisory Board member Dr. Allan Bock, we gathered information about the circumstances under which the reactions occurred, the previous history of reactions, the asthma and allergy history, treatment given at the time symptoms began, and the food believed to have caused the allergic reaction.
- Although the individuals ranged in age from 2 to 33 years, only three were under age 10, the majority were adolescents or young adults.
- Peanuts accounted for 63 percent (20) of the deaths, tree nuts (Brazil nut, pistachio, pecan, walnut, and unknown nut) accounted for 31 percent (10), and milk and fish were responsible for two of the deaths in the younger children.
- Only 10 percent (3 of 32) had epinephrine with them at the time of their reaction. In two patients, the first wave of symptoms went away within 30 minutes for one individual and in over an hour for the other. After feeling better, the symptoms returned and quickly overcame them.
- The food came from:
47%
restaurants and other food service facilities
25%
packaged food
22%
home made
6%
other
- The allergy causing food was "hidden" in:
- Entrees
12%
Chinese
6%
Mexican
26%
non-ethnic
- Desserts and Snacks
22%
baked goods
19%
snacks
9%
candy
3%
ice cream
3%
unknown
- As would be expected, the individuals ate food they thought was safe. They were caught off-guard and were not prepared to handle a severe reaction. Almost all the patients had asthma in addition to food allergy.
- There were two unusual cases. One young man, who knew he was allergic to peanuts, died after eating pistachio nuts. He did not know he was allergic to them. The other was a 2-year-old who died after eating Brazil nuts. He was not known to have any allergies or asthma.
- Medical professionals, especially primary care providers, must be aware of food-induced anaphylaxis. Manufacturers, restaurant staff, caregivers, schools staff, and the general public should be educated about food allergy and anaphylaxis and the importance of proper labeling and ingredient information.
- What You Can Do to Protect Yourself:
- 1. be on guard for unsuspected ingredients
- 2. always be prepared to handle an allergic reaction
- 3. recognize early symptoms
- 4. carry EpiPen® unit at all times (if prescribed)
- 5. teach others how they can help
- 6. get to an emergency facility at the earliest signs of a reaction
Source: Food Allergy News, Vol. 10, No. 3
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- Impact of Food Allergy on Quality of Life
- The purpose of this study was to evaluate the impact of food allergy on the patient and family.
- A 50-question children's health questionnaire, designed to measure social and emotional issues affecting the family, was chosen because it had previously been used to study families with other medical conditions (asthma, juvenile rheumatic arthritis, epilepsy, etc.). An additional 10 questions specific to food allergy were added to the survey.
- Four hundred randomly selected members of FAAN who had children between 5 and 18 years of age were mailed a questionnaire. The first 191 responses, received within three weeks of the mailing, were analyzed.
- The mean age of the food-allergic children was 10.8 years of age. Fifty-six percent were allergic to one or two foods, the remainder to more than two foods. Thirty-seven percent also had asthma; 15 percent had atopic dermatitis; 35 percent had both asthma and atopic dermatitis; and 13 percent had neither asthma nor atopic dermatitis.
- The investigators found that food-allergic families believe their child's general health was reduced compared to most other children and food allergies limited family activities; while the level of emotional stress on the parents was higher than other families with asthma, epilepsy, etc.. Within the food allergy group, families coping with atopic dermatitis and/or asthma, and an allergy to more than two foods, found it even harder to cope.
- Investigators concluded that childhood food allergy has a significant impact on general health perception, emotional distress in parents, and family activities.
Food Allergy News, Vol. 9, No. 4
- The Natural History of Peanut Allergy
- Studies from Europe have indicated that some children outgrow their peanut allergy, long considered a lifelong allergy. The purpose of this study was to evaluate children who are peanut-allergic and outgrow their allergy.
- The study included peanut-allergic children 4 years and older, attending the Johns Hopkins Pediatric Allergy Clinic and one private clinic, who had not had a reaction in the past year and had a CAP-RAST® to peanut of less than 20kU/L. (See Food Allergy News, Vol. 7, No. 4.).
- Thirty-eight patients, ages 4 to 12, qualified for the study. Their peanut allergy had been diagnosed by skin and RAST test in 17 cases, skin test alone in 12 cases, RAST test alone in 8 cases, and peanut challenge in one case.
- Skin tests were repeated for 13 of the 38 patients prior to the food challenge. In 4 cases the test was negative. The patients participated in a double-blind placebo controlled food challenge, and some had open challenges. Of the 38 patients, 26 patients had a negative challenge test and are believed to have outgrown their peanut allergy.
- Peanut IgE levels for those who had outgrown the allergy versus those who had not were similar at the time of diagnosis or challenge. The severity of the initial reactions was also similar&endash;&endash;both groups included patients with moderate to severe anaphylaxis.
- Researchers concluded that patients with very low peanut IgE levels (71 percent of patients with <2kU/L had a negative challenge) should be challenged in a medical setting to determine whether they can tolerate peanuts.
Journal of Allergy & Clinical Immunology, Vol. 105, No. 1, S189.
Food Allergy News, Vol. 9, No. 5.
- Natural History of Peanut Allergy In Young Children
- The objective of this study was to report the frequency and nature of reactions to peanut after diagnosis of peanut allergy.
- Eighty-two children who had peanut allergy diagnosed before their fourth birthday were followed for a median of 5.6 years (range 1.2 to 22.1 years) and contacted annually to gather information about peanut allergy-induced reactions.
- Thirty-three percent of the children had a reaction within two years of follow-up, 51 percent by 3 years, and 75 percent by 10 years. Forty-nine percent had only skin symptoms during their first reaction, 60 percent of these children had a subsequent reaction. Almost 80 percent of them had respiratory and/or gastrointestinal symptoms during these reactions.
- Investigators concluded that the majority of children will have an allergic reaction to peanuts within three years of diagnosis. Additionally, children with only skin symptoms can go on to develop respiratory or gastrointestinal symptoms in subsequent reactions.
- Peanut Allergic Reactions in Schools
- In this study, conducted via phone, the researchers interviewed 100 randomly selected families from the National Peanut and Tree Nut Allergy Registry who indicated that reactions had occurred in schools.
- There were a reported 124 reactions, 115 to peanuts and 9 to tree nuts. Sixty four percent of the reactions occurred in child care or preschool settings. Of the reactions in elementary school, close to 70 percent occurred in public schools. In 25 percent of the cases, the reaction at school was the first indication of peanut allergy.
- Reactions were caused by ingestion (60 percent), skin contact (24 percent), and inhalation (15 percent). However, in the majority of the inhalation reactions, ingestion and/or skin contact could not be ruled out. Craft projects using peanut butter were responsible for 60 percent of skin reactions and 44 percent of inhalation reactions. Reactions occurred during parties or special celebrations in 24 percent of the cases.
- In close to 20 percent of the 124 cases, the parent was the first to notice the reaction, usually at the end of the school day. The majority of the reactions required medication, primarily antihistamine, although 19 reactions required epinephrine. Of these, epinephrine was administered by school nurses (6), teachers (4), and parents or other school staff (9).
- In close to 80 percent of the instances, teachers were most likely to take control of the reaction because a school nurse was not present. An emergency care plan was in place in only 33 percent of the cases. It was followed correctly close to 75 percent of the time. Three of the reactions occurred in spite of a peanut ban.
- Journal of Allergy Clinical Immunology, Abstracts, January 2000, S182
- Editor's Note: This study makes a few points worth noting: 1. Peanut-allergic reactions are commonly caused by foods used in school activities, 2. reactions occurred in spite of a peanut ban, 3. school staffs needs to be educated in recognition, prevention, and treatment of reactions and given written documentation for how to do so, 4. two thirds of the children did not have a written plan for handling an allergic reaction; as a result, medical care was sometimes delayed until the parent arrived.
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- Peanut Allergy in Twins
- Following is a brief overview of research presented at the annual meeting of the American Academy of Allergy Asthma & Immunology in the spring of 2000. This study is the result of surveys we sent to FAAN members. Thanks again for your quick response.
- Peanut Allergy in Twins
- The objective of this study was to determine whether genetics play a role in the development of peanut allergy. Scientists hope that by learning more about the genes that cause these diseases, better diagnostic and therapeutic interventions would become possible.
- Investigators recruited pairs of twins, with at least one twin reporting peanut allergy. Fifty-eight sets of twins, 44 fraternal and 14 identical, were included in the study. The rate of shared peanut allergy was compared between identical twins (who share all of their genes) and fraternal twins (who share about half of their genes).
- The researchers found that identical twins were much more likely to share peanut allergy than fraternal twins (65 percent versus 7 percent). Thirty-five of the 58 pairs had other siblings. None of the siblings had peanut allergy. Investigators concluded that there is a significant genetic influence on peanut allergy.
Food Allergy News, Vol. 9, No. 4
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- Results of Survey on Ingredient Statements
- Attendees at the 2000 Annual FAAN Food Allergy Conferences were given a survey about ingredient statements. What they had to say could affect what food manufacturers say on their label.
- Seventy-two percent of the 760 attendees completed the survey. The vast majority (88 percent) of attendees were family members of food allergic-individuals (FAIs), 12 percent were food-allergic individuals (some parents and their children were food-allergic) and 4 percent were neither (nurses, dietitians, etc.). More than half (61 percent) of the respondents were primarily concerned about peanut allergy, 29 percent allergy to milk; 15 percent to tree nuts and 12 percent to egg. No other allergen accounted for more than 3 percent of the respondents.
- The subjects were asked a number of questions about allergen information on ingredient statements. When asked if they had ever called food manufacturers for more information about a product's ingredients--81 percent of the respondents said they had. They were seeking more information than was given on the label.
- The respondents indicated overwhelmingly that allergen statements on food labels affect their purchasing behavior. Over 96 percent reported they never buy products that say "contains allergen" (where allergen is the ingredient to which the FAI is allergic); 92 percent never buy the product if it has the phrase "may contain allergen;" almost 87 percent never buy the product if it says "processed on equipment shared with allergen". But not all precautionary statements keep people from buying a product. Over a third said they do buy the product if it says "manufactured in a plant that also processes allergen."
- The results also showed that FAAN members think ingredient statements are difficult to understand. The survey asked whether they agreed or disagreed with a series of statements about food labels.
- Twelve percent thought ingredient statements were easy to understand; less than 9 percent thought they were simple enough; only 2.4 percent thought they gave enough information about allergens; only 2 percent thought they could be understood by a new babysitter; and less than 1 percent thought a 7-year-old could understand them.
- Ingredient statements provide information that is vital to those with food allergies. FAAN members don't get enough information to satisfy their needs, their purchasing behavior is significantly affected by the allergen information on the food label, and the information provided is too difficult to understand. Clearly, work needs to be done by the FDA and food manufacturers to improve the allergen information on ingredient statements.
Food Allergy News, Vol. 10, No. 1.
Food Allergy News, Vol. 9, No. 4
Food Allergy News, Vol. 9, No. 6
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