Food and Drug Reactions and AnaphylaxisRelevance of casual contact with peanut butter in children with peanut allergy☆,☆☆
Section snippets
Subjects
Children with peanut allergy were recruited through the allergy practices of the Mount Sinai School of Medicine. Inclusion criteria were designed to enrich for children with a presumed increased likelihood for a systemic reaction from casual exposure. Thus subjects were eligible to participate if they met one of the following criteria. The first criteria is peanut-specific IgE antibody concentration of greater than 50 kIU/L (Pharmacea CAP System FEIA), a level associated with definitive
Results
The characteristics of the total study group and those who experienced reactions are shown in Table I. Nineteen (63%) subjects reported a previous reaction to skin contact or inhalation (5 children [17%] had a history of both a skin contact and inhalation reaction) to peanut. In regard to the 13 previous reactions from skin contact, 3 were from being kissed by an individual who ate peanut (not intimate kissing) and the remainder from touching items with peanut or peanut butter. The exact
Discussion
Although ingestion of peanut can clearly lead to severe reactions,3 the relevance of exposure through skin contact or inhalation is less well understood. Reactions to airborne peanut protein have been reported in relation to commercial airliners, when many packets of roasted peanuts are opened simultaneously.4, 7 In such circumstances peanut dust might become airborne, and filters in these commercial airlines contain measurable amounts of peanut protein.13 The potential degree of exposure for
Acknowledgements
We thank Sylvan Wallenstein, PhD, for statistical advice; Audrey Brown for challenge preparation; the nursing staff of the General Clinical Research Unit of Mount Sinai Hospital (National Institutes of Health grant no. RR 00071); and the participants and their families.
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Supported by the Geduld Family and the Food Allergy Initiative. SHS is supported, in part, by K23 AI 01709 from the National Institutes of Health.
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Reprint requests: Scott H. Sicherer, MD, Division of Allergy/Immunology, Mount Sinai Hospital, Box 1198, One Gustave L. Levy Place, New York, New York 10029-6574.