Clinical Features of Acute Allergic Reactions to Peanut and TreeNuts in Children

Abstract

Sicherer SH, Burks AW, Sampson HA. Pediatrics. 1998;102(1). URL: http://www.pediatrics.org/cgi/content/full/102/1/e6To describe the clinical features of acute reactions during initial and subsequent allergic reactions to peanut and tree nuts.One hundred twenty-two children with a median age of 8 years at the time of the study were included.All patients completed a detailed questionnaire and had serum analyzed for specific IgE to peanut and a panel of tree nuts by the CAP radioallergosorbent test (RAST) system.Sixty-eight children had reactions only to peanut, 20 had reactions only to tree nuts, and 34 had reactions to both peanut and tree nuts. Of those reacting to tree nuts, 34 had reacted to 1, 12 had reacted to 2, and 8 had reacted to 3 or more types of nut. Initial reactions most often occurred at home and were considered to have occurred with the first exposure in 72% of cases. The median age of the initial reaction was 24 months for peanut and 62 months for tree nuts. Eighty-nine percent of initial reactions involved the skin, 52% the respiratory tract, and 34% the gastrointestinal tract; 2 organ systems were affected in 31% of initial reactions and all 3 systems were affected in 21%. Subsequent accidental reactions had occurred in 55% of peanut-allergic children and 30% of tree nut-allergic children over a median period of 5.5 years. Overall, symptoms with subsequent reactions were similar to those observed in the initial reactions.Allergic reactions to peanut and tree nuts frequently occur on the first known exposure and may be life-threatening. Allergies to tree nuts occur in approximately one third of peanut allergic children. Accidental exposures are common after diagnosis, especially outside the home, and often require emergency treatment. Early diagnosis followed by education on avoidance and treatment is imperative.This is an important study that really brings home the tendency for allergic reactions to peanut and tree nuts to occur early and to be severe, even life-threatening, from the start. All of these children must be equipped with epinephrine and a clear plan as to how and when it is to be used.