Food and Drug Reactions and Anaphylaxis
Relevance of casual contact with peanut butter in children with peanut allergy,☆☆

https://doi.org/10.1067/mai.2003.1486Get rights and content

Abstract

Background: Casual skin contact or inhalation of peanut butter fumes is reported and feared to cause allergic reactions in highly sensitive children with peanut allergy but has not been systematically studied. Objective: We sought to determine the clinical relevance of exposure to peanut butter by means of inhalation and skin contact in children with peanut allergy. Methods: Children with significant peanut allergy (recent peanut-specific IgE antibody concentration >50 kIU/L or evidence of peanut-specific IgE antibody and one of the following: clinical anaphylaxis, a reported inhalation-contact reaction, or positive double-blind, placebo-controlled oral challenge result to peanut) underwent double-blind, placebo-controlled, randomized exposures to peanut butter by means of contact with intact skin (0.2 mL pressed flat for 1 minute) and inhalation (surface area of 6.3 square inches 12 inches from the face for 10 minutes). Placebo challenges were performed by using soy butter mixed with histamine (contact), and scent was masked with soy butter, tuna, and mint (inhalation). Results: Thirty children underwent the challenges (median age, 7.7 years; median peanut IgE level, >100 kIU/L; 13 with prior history of contact and 11 with inhalation reactions). None experienced a systemic or respiratory reaction. Erythema (3 subjects), pruritus without erythema (5 subjects), and wheal-and-flare reactions (2 subjects) developed only at the site of skin contact with peanut butter. From this number of participants, it can be stated with 96% confidence that at least 90% of highly sensitive children with peanut allergy would not experience a systemic-respiratory reaction from casual exposure to peanut butter. Conclusions: Casual exposure to peanut butter is unlikely to elicit significant allergic reactions. The results cannot be generalized to larger exposures or to contact with peanut in other forms (flour and roasted peanuts). (J Allergy Clin Immunol 2003;112:180-2.)

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.

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