ANAPHYLACTIC REACTION AFTER EARLY INTRODUCTION OF PEANUTS IN A FEBRILE INFANT

Abstract

Introduction The “Addendum Guidelines for the Prevention of Peanut Allergy in the United States” provides recommendations for early dietary peanut introduction in infants in efforts to prevent development of peanut allergies. Specific recommendations are guided by risk factors and subsequent allergy testing, as indicated. Case Presentation A 6-month-old male with mild eczema was referred to an allergist due to brother's history of anaphylactic food allergies. Skin-prick testing (SPT) for egg, dairy and peanut were negative. Family began introducing peanut several weeks later and within 1 week he tolerated approximately ¼ g of peanut protein on 4 occasions. Later that week, patient developed a fever and URI symptoms. The next day he consumed approximately ¼ g peanut protein and developed perioral hives, facial flushing and difficulty breathing within 15 minutes. Parents delivered antihistamine and an epinephrine injection. In the emergency department he was well-appearing with minimal urticaria. He was treated with steroids and admitted for observation. Specific peanut IgE was elevated (2.90) as were peanut components Arah2 (4.52) and Arah3 (0.36). Patient followed up with his allergist who recommended strict peanut avoidance. Discussion As SPT is only 95% sensitive for detecting peanut allergy, it is important to confirm tolerance with initial consumption of 2g peanut protein before freely introducing peanuts into an infant's diet. If introduced at a lower dose, the infant may develop an unexpected reaction in the setting of a febrile illness where systemic reactions have been observed in previously tolerated doses or with consumption of a larger dose.