Nut so bad…….


I’ll apologize straight away for the groan-inducing headline.  Nut allergy is a serious subject and as allergists, we must walk a fine line between imparting the potential seriousness of a reaction and scaring parents into a fear-induced paralysis.  A recent study published in the Journal of Allergy and Clinical Immunology, the main U.S. allergy journal, shows that through planning and education, rates of reactions can be lowered considerably.

The study followed 785 kids for an average of about 5 years.  All the kids had been seen in a specialty allergy clinic , had written avoidance information and written treatment plans, and had schools which had been educated on how to deal with nut reactions.  A few important statistics stood out to me.

First, only 5% of reactions during the study period occurred in schools.  This should be reassuring to parents who worry while their children are out of their control and also warns that the majority of accidental ingestions are due to the parents or children themselves.

The annual risk of reaction was about 3%, which is considerably lower than in previous studies.  Only 10% of study period reactions occurred in very young kids, <4 years, and 90% of those reactions were mild.

Recent dogma has been that subsequent peanut reactions may be more severe than the initial reaction, but this study found that 90% of reactions were of equal or less severity than the initial reaction.  Of those that worsened, only 1 was deemed severe.

All reactions deemed moderate or worse were due to ingestion.  Contact reactions were all mild.  There were no reports of reactions from inhalation.  This should help us further tailor our avoidance recommendations.

The final take home point here is that specialty care is important in cases of nut allergy.  Allergists see more cases of nut allergy than other doctors and are specially trained to handle them.  Our job is to take the time necessary to educate families on these issues.  If you have a child with nut allergy, seeing a allergist is important.

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