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PEANUT ALLERGY

PEANUT ALLERGY. RETROSPECTVE STUDY 1992-2001 John Weisnagel, M.D. NUMBER OF FIRST TIME CONSULTATIONS from Sept. 1992 to Dec. 2001. Adults (aged 12 yrs and over): 11,856 Children (under 12 yrs of age): 7,164. PATIENTS ALLERGIC TO PEANUT. Adults: 126 (1.06%)

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PEANUT ALLERGY

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  1. PEANUT ALLERGY RETROSPECTVE STUDY 1992-2001 John Weisnagel, M.D.

  2. NUMBER OF FIRST TIME CONSULTATIONS from Sept. 1992 to Dec. 2001 Adults (aged 12 yrs and over): 11,856 Children (under 12 yrs of age): 7,164

  3. PATIENTS ALLERGIC TO PEANUT Adults: 126 (1.06%) Children: 582 (8.12%)

  4. PATIENTS ALLERGIC TO PEANUT Yearly incidence Adults Children 1993: 15/1706 (0.88%) 39/617 (6.32%) 1994: 7/1541 (0.45%) 53/757 (7.00%) 1995: 15/1419 (1.06%) 47/832 (5.65%) 1996: 12/1296 (0.93%) 69/763 (9.04%)

  5. PATIENTS ALLERGIC TO PEANUT Yearly incidence (cont'd) Adults Children 1997: 12/1130 (1.06%) 81/881 (9.19%) 1998: 14/1027 (1.36%) 69/671 (10.28%) 1999: 10/1103 (0.91%) 61/737 (8.28%) 2000: 21/753 (2.79%) 139/1336 (10.4%) 2001: 20/786 (2.54%) 27/276 (9.78)

  6. CHILDREN ALLERGIC TO PEANUT FAMILY HISTORY Allergy on mother's side: 201 Allergy on father's side: 156 Allergy on both sides: 100 No family hx of allergy: 97

  7. CHILDREN WITH PEANUT ALLERGY • Other reported allergies • Other food allergies reported • Other atopic disease associated • Age at time of initial reaction • Symptoms reported • Treatment of initial reaction • Peanut allergic children with asthma

  8. OTHER ALLERGIES REPORTED CATS: 78 ANIMALS (no other details given): 23 PENICILLIN: 8 HOUSE DUST: 7 SULFAS: 6 RABBIT: 3 METAL: 2

  9. OTHER ALLERGIES ACCORDING TO SKIN TESTS • CATS: 246 • POLLEN: 218 • HOUSE DUST MITES: 193 • DOGS: 175 • MOLDS: 94 • HORSES: 60 • RABBITS: 54

  10. CHILDREN WITH PEANUT ALLERGY • Other reported allergies • Other food allergies reported • Other atopic disease associated • Age at time of initial reaction • Symptoms reported • Treatment of initial reaction • Peanut allergic children with asthma

  11. OTHER FOOD ALLERGIES REPORTED EGG: 133 22.85% NUTS: 94 16.15% MILK: 33 5.67% LEGUMES: 8 1.37% KIWI: 6 1.03% FISH: 5 0.86% PEAS: 4 0.69% APPLE: 3 0.52% SESAME: 2 0.34% SHRIMP: 2 0.34%

  12. OTHER FOOD ALLERGIES REPORTED (cont'd) CARROT: 1 0.17% MUSHROOM: 1 MUSTARD: 1 SOY: 1 PEACH: 1 POTATO: 1 TOMATO: 1 BLUEBERRIES: 1 SUNFLOWER SEEDS: 1

  13. OTHER FOOD ALLERGIES ACCORDING TO SKIN TESTS EGG: 131 HAZELNUT: 57 MILK: 31 WALNUT: 26 CASHEW: 15 SOY: 14 SESAME: 13 ALMOND: 10 SUNFLOWER SEEDS: 7 WHEAT: 6 BANANA: 6 BRAZIL NUT: 3 PECAN: 4 POPPY SEED: 1

  14. CHILDREN WITH PEANUT ALLERGY • Other reported allergies • Other food allergies reported • Other atopic disease associated • Age at time of initial reaction • Symptoms reported • Treatment of initial reaction • Peanut allergic children with asthma

  15. OTHER ATOPIC DISEASE ASSOCIATED • ASTHMA: 239 39.52% • ATOPIC DERMATITIS: 93 15.98% • RHINITIS: 88 15.12% • RHINITIS & ASTHMA: 52 8.93%

  16. CHILDREN WITH PEANUT ALLERGY • Other reported allergies • Other food allergies reported • Other atopic disease associated • Age at time of initial reaction • Symptoms reported • Treatment of initial reaction • Peanut allergic children with asthma

  17. AGE AT TIME OF INITIAL REACTION 2 mos: 2 4 mos: 1 5 mos: 1 6 mos: 8 7 mos: 7 8 mos: 13 9 mos: 8 10 mos: 13 11 mos: 17 12 mos: 75 13 mos: 7 14 mos: 6 15 mos: 9 18 mos: 63 19 mos: 4 20 mos: 4 21 mos: 1 2 yrs: 44 2.5 yrs: 22 3 yrs: 18 3.5 yrs: 7 4 yrs: 10 5 yrs: 7 6 yrs: 2 7 yrs: 3 8 yrs: 3 9 yrs: 4 10 yrs: 3

  18. AGE AT TIME OF INITIAL REACTION (cont'd) "as a baby": 27 "before age one": 7 "before age 2": 17 "before age 3": 2 "at a very young age": 15 Age not given in history: 99

  19. CHILDREN WITH PEANUT ALLERGY • Other reported allergies • Other food allergies reported • Other atopic disease associated • Age at time of initial reactionr • Symptoms reported • Treatment of initial reaction • Peanut allergic children with asthma

  20. SYMPTOMS REPORTED INITIAL REACTION HIVES (localized or generalized): 358 61. 51% PRURITIS (skin, eyes, lips, etc): 224 38. 49% ANGIOEDEMA (lips, mouth, tongue, throat, eyelids): 179 30. 76% THROAT, MOUTH OR TONGUE PRURITIS: 125 21. 48%

  21. SYMPTOMS REPORTED INITIAL REACTION (cont'd) VOMITING: 78 13.40% HIVES & VOMITING.: 27 4.64% HIVES, VOMITING & OEDEMA: 8 1.37% DIFFIC. SWALLOWING : 6 1.03% HIVES & ANGIOEDEMA: 1 0.17%

  22. CHILDREN WITH PEANUT ALLERGY • Other reported allergies • Other food allergies reported • Other atopic disease associated • Ageat time of initial reactionr • Symptoms reported • Treatment of initial reaction • Peanut allergic children with asthma

  23. TREATMENT OF INITIAL REACTION • NONE: 207 35.5% • ANTIHISTAMINIC: 149 25.6% • EPINEPHRINE: 26 4.47% • HOSPITALISATION (asthma): 4 0.69% • E.R.(no treatment) : 1 0.17%

  24. CHILDREN WITH PEANUT ALLERGY • Other reported allergies • Other food allergies reported • Other atopic disease associated • Ageat time of initial reactionr • Symptoms reported • Treatment of initial reaction • Peanut allergic children with asthma

  25. PEANUT ALLERGY WITH ASTHMA (293) CLINICAL MANIFESTATIONS: ANAPHYLAXIS: 90 HIVES: 84 ANGIOEDEMA: 16 PRURITIS: 8 VOMITING: 7 ASTHMA: 3 RHINITIS: 1

  26. ANAPHYLAXIS DEFINITION: HIVES OR ANGIOEDEMA WITH ASTHMA OR WITH VOMITING (or other G-I symptoms) (COMBINATION OF ANY TWO)

  27. ANAPHYLAXISSYMPTOMS REPORTED • HIVES + VOMITING + ANGIOEDEMA (eyelids, tongue or throat): 27 • HIVES + ASTHMA, OR COUGH OR DIFFICULTY BREATHING: 26 • HIVES + NAUSEA OR VOMITING: 11

  28. ANAPHYLAXIS SYMPTOMS REPORTED (cont'd) • HIVES + ASTHMA + DIFFICULTY SWALLOWING OR HOARSENESS: 6 • ABDOMINAL PAIN. + ASTHMA: 2 • VOMITING + SNEEZING: 1

  29. ANAPHYLAXISSYMPTOMS REPORTED (cont'd) • ANGIOEDEMA (lips) + ASTHMA • ANGIOEDEMA (eyelids) + ASTHMA • ANGIOEDEMA (eyelids) + ASTHMA + RHINORRHEA (runny nose) • RHINORRHEA, SNEEZING + ASTHMA, etc.

  30. PEANUT ALLERGIC CHILDREN WITH ASTHMA TO CONSIDER: ALLERGY TO ANIMALS IN THESE CHILDREN In 234 subjects: Positive skin test to cats: 22 to dogs: 18 Cat in the home in 21 Dog in the home in 29 Cat and dog in the home in 11

  31. REACTION OCCURING FOLLOWING CONTACT ONLY (no ingestion) • HIVES AND PRURITIS: 18

  32. SYMPTOMS REPORTED TO THE ODOR OF PEANUT • DISLIKE: 48 • NAUSEA: 7 • PRURITIS: 2

  33. ALLERGY TESTS OBSERVATION CHILDREN WITH A POSITIVE SKIN TEST TO PEANUT NEVER HAVING EATEN PEANUT : 38 NEVER HAVING REACTED TO PEANUT: 58

  34. FOLLOW-UP PATIENTS: 86 Seen only once: 73 Seen twice: 11 Seen three times: 5 Seen > 3 times: 1

  35. ACCIDENTAL INGESTION 9 subjects INTENSITY OF REACTION COMPARED TO INITIAL REACTION: worse: 2 identical : 7

  36. PATIENTS WHO HAVE LOST THEIR ALLERGY TO PEANUT 22 (ongoing study)

  37. CONCLUSION INCIDENCE • Seemingly as reported in the medical literature. • Less in adults, which possibly indicates spontaneous outgrowing of the allergy or the allergy simply not reported. • Slight increase in the last few years of study.

  38. CONCLUSION (cont'd)re children • Family history of allergy very evident • Many associated allergies, including to other foods. • More than 40% have asthma. • Initial reaction reported at a very early age, most between 6 and 30 months. • Hives (urticaria) in more than 60% of cases.

  39. CONCLUSION (cont'd)re children • Anaphylaxis reported in less than 20% of cases. • More than 50% of reactions did not require treatment or only antihistamines. • Asthmatic children allergic to peanut more suspectible to anaphylaxis.

  40. CONCLUSION (cont'd)re children • Environmental control important in asthmatic children allergic to peanut. • Accidental ingestion little reported and subsequent reactions not necessarily more severe. • A certain number of children have outgrown their peanut allergy.

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