Peanut Allergy: Case of an 11-Year-Old Boy with a Selective Diet

Abstract

Current statistics estimate the prevalence of food allergy in the United States to be approximately 6% in children and 3% to 4% in adults ( 1 Rona R.J. Keil T. Summers C. Gislason D. Zuidmeer L. Sodergren E. Sigurdardottir S.T. Lindner T. Goldhahn K. Dahlstrom J. McBride D. Madsen C. The prevalence of food allergy: A meta-analysis. J Allergy Clin Immunol. 2007; 120: 638-646 Google Scholar ). Although eight food proteins are considered responsible for 90% of all allergic reactions (cow's milk, soybean, egg, wheat, peanut, tree nut, fish, shellfish [ 2 Hefle S.L. Nordlee J.A. Taylor S.L. Allergenic foods. Crit Rev Food Sci Nutr. 1996; 36: S69-S89 Google Scholar ]), allergy to peanut requires special consideration for several reasons ( 3 Nasser A. Shirina A. Vadas P. Peanut allergy: An overview. Allergy Asthma Clin Immunol. 2008; 4: 139-143 Google Scholar ). The age of onset of peanut allergy is young (median age of onset is approximately 24 months), and reactions are immediate and often severe. When combined with tree nut allergy, peanut allergy is responsible for the 80% of the 100 to 200 food-induced anaphylactic fatalities every year in the United States ( 4 Sicherer S.H. Sampson H.A. Peanut and tree nut allergy. Curr Opin Pediatr. 2000; 12: 567-573 Google Scholar , 5 Bock S.A. Munoz-Furlong A. Sampson H.A. Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol. 2007; 119: 1016-1018 Google Scholar ). Sicherer and colleagues recently reported that the prevalence of peanut allergy in the United States has more than tripled between 1997 (0.4%) and 2008 (1.4% of the US population, or more than 3 million Americans) ( 6 Sicherer S.H. Muñoz-Furlong A. Godbold J.H. Sampson H.A. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol. 2010; 125: 1322-1326 Google Scholar ). Peanut allergy is potentially life-long, although there is evidence that approximately 20% of individuals with peanut allergy will become clinically desensitized ( 7 Fleischer D.M. The natural history of peanut and tree nut allergy. Curr Allergy Asthma Rep. 2007; 7: 175-181 Google Scholar ). It must be noted, however, that up to 8% of those who have established tolerance may become re-sensitized after a negative prick skin test (PST) and negative food challenge, especially without regular exposure to peanuts ( 8 Kerr P. Peanut resensitization after negative skin tests and negative oral challenge. J Allergy Clin Immunol. 2004; 113: S151 Google Scholar ). Of additional concern are quality-of-life issues and behavioral and emotional repercussions that can result from having a potentially life-threatening condition ( 9 Sicherer S.H. Noone S.A. Munoz-Furlong A. The impact of childhood food allergy on quality of life. Ann Allergy Asthma Immunol. 2001; 87: 461-464 Google Scholar , 10 Munoz-Furlong A. Daily coping strategies for patients and their families. Pediatrics. 2003; 111: S1654-S1661 Google Scholar ). L. S. Somers is a senior clinical pediatric nutritionist, Children's Memorial Hospital, Department of Clinical Nutrition, Chicago, IL.