TY - JOUR
T1 - Peanut allergy
T2 - Recurrence and its management
AU - Fleischer, David M.
AU - Conover-Walker, Mary Kay
AU - Christie, Lynn
AU - Burks, A. Wesley
AU - Wood, Robert A.
N1 - Funding Information:
Supported by National Institutes of Health training grant T32 AI 07007 from the National Institute of Allergy and Infectious Disease, the Eudowood Foundation for the Consumptives of Maryland, the Myra Reinhard Family Foundation, and General Clinical Research Center grants M01-RR000052 and M01-RR14288.
PY - 2004/11
Y1 - 2004/11
N2 - Although peanut allergy may recur, the frequency with which this occurs is unknown. The goals of this study were to determine the rate of peanut allergy recurrence, identify risk factors for recurrent peanut allergy, and develop specific recommendations for the treatment of patients with resolved peanut allergy. Children who outgrew peanut allergy were evaluated with questionnaires, skin tests, and peanut-specific IgE levels. Patients were invited to undergo a double-blind, placebo-controlled food challenge (DBPCFC) unless the history of a possible recurrence reaction was so convincing that a challenge would be potentially dangerous. Sixty-eight patients were evaluated. Forty-seven patients continued to tolerate peanut, of whom 34 ingested concentrated peanut products at least once per month and 13 ate peanut infrequently or in limited amounts but passed a DBPCFC. The status of 18 patients was indeterminate because they ate peanut infrequently or in limited amounts and declined to have a DBPCFC. After excluding 12 patients originally diagnosed with peanut allergy based solely on a positive skin prick test or peanut-specific IgE level, 3 of 15 patients who consumed peanut infrequently or in limited amounts had recurrences, compared with no recurrences in the 23 patients who ate peanut frequently (P =. 025). The recurrence rate was 7.9 (95% CI, 1.7% to 21.4%). Children who outgrow peanut allergy are at risk for recurrence, and this risk is significantly higher for patients who continue largely to avoid peanut after resolution of their allergy. On the basis of these findings, we now recommend that patients eat peanut frequently and carry epinephrine indefinitely until they have demonstrated ongoing peanut tolerance.
AB - Although peanut allergy may recur, the frequency with which this occurs is unknown. The goals of this study were to determine the rate of peanut allergy recurrence, identify risk factors for recurrent peanut allergy, and develop specific recommendations for the treatment of patients with resolved peanut allergy. Children who outgrew peanut allergy were evaluated with questionnaires, skin tests, and peanut-specific IgE levels. Patients were invited to undergo a double-blind, placebo-controlled food challenge (DBPCFC) unless the history of a possible recurrence reaction was so convincing that a challenge would be potentially dangerous. Sixty-eight patients were evaluated. Forty-seven patients continued to tolerate peanut, of whom 34 ingested concentrated peanut products at least once per month and 13 ate peanut infrequently or in limited amounts but passed a DBPCFC. The status of 18 patients was indeterminate because they ate peanut infrequently or in limited amounts and declined to have a DBPCFC. After excluding 12 patients originally diagnosed with peanut allergy based solely on a positive skin prick test or peanut-specific IgE level, 3 of 15 patients who consumed peanut infrequently or in limited amounts had recurrences, compared with no recurrences in the 23 patients who ate peanut frequently (P =. 025). The recurrence rate was 7.9 (95% CI, 1.7% to 21.4%). Children who outgrow peanut allergy are at risk for recurrence, and this risk is significantly higher for patients who continue largely to avoid peanut after resolution of their allergy. On the basis of these findings, we now recommend that patients eat peanut frequently and carry epinephrine indefinitely until they have demonstrated ongoing peanut tolerance.
KW - Peanut allergy
KW - RAST
KW - food challenge
KW - food hypersensitivity
KW - recurrence
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U2 - 10.1016/j.jaci.2004.08.035
DO - 10.1016/j.jaci.2004.08.035
M3 - Article
C2 - 15536431
AN - SCOPUS:7944225984
VL - 114
SP - 1195
EP - 1201
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
SN - 0091-6749
IS - 5
ER -