A LEAP FORWARD IN EVALUATION OF PEANUT ALLERGY IN A CHILD WITH SEVERE ATOPIC DERMATITIS

Abstract

<h3>Introduction</h3> Children with atopic dermatitis (AD) are at higher risk of peanut allergy. However, children with AD may have more elevated measures of sensitization including serum IgE (sIgE) and skin prick testing (SPT) at baseline without necessarily having clinical allergy. Here we describe the case of a child who despite having AD and significantly elevated sIgE and SPT to peanut, passed an oral food challenge (OFC). <h3>Case Description</h3> Our patient is a 16 month-old who presented for evaluation of severe eczema and food allergy. He introduced peanut in the form of Bamba at home, which coincided with an atopic dermatitis flare, although cutaneous symptoms were not noted to be immediate. An intensive skin care regimen was initiated with clinical improvement. SPT to peanut was positive with a wheal of 7 × 5 mm. His total sIgE was 10,229 kU/L, sIgE to peanut was 39.7 kUA/L and sIgE to Ara h 2 was 1.72 kUA/L. A 5 dose OFC to peanut butter was negative. His parents were instructed to incorporate peanut butter into his diet regularly. <h3>Discussion</h3> Given the importance of early exposure in preventing the development of clinical allergy, it may be worth considering an OFC for children without clear history of immediate type 1 hypersensitivity reactions to peanuts, even with elevated measures of sensitization. Close attention to skin care is also necessary prior to OFC so that a cutaneous reaction to the culprit food is not confused with a background eczema flare that may have occurred without food exposure.