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Alana Sherman
NTD 600-91
Dr. Gilboy
April 16, 2017

Peanut Allergy Research Paper

Peanut allergies have become an increasing public health concern affecting

approximately 2% of the population (Fleischer, 2007). Peanuts are one of the most

common food allergies among the pediatric population and are ranked as one of the top

eight food allergies in America (Fleischer, 2007). Peanut allergies are the leading cause

of fatal food-allergy induced reactions, warranting the need for increased research,

treatment, and management strategies. According to Sicherer et al., prevalence of peanut

allergies have more than tripled from the years 1997-2008 (Sicherer et al., 2010). With

peanuts comprising a large proportion of the Westernized diet, children with a peanut-

allergy are at increased risk for exposure and accidental ingestion. Peanuts and peanut

derivatives are hidden in various foods such as: curry sauce, chili, Asian-style dipping

sauces, baked goods, candy, and vegetarian food products (FARE, 2010). In fact, peanuts

are used as an ingredient in body-care products, make-up, and even dog food (FARE,

2010). Children with peanut allergies have to follow highly-restrictive diets to avoid

accidental ingestion and exposure, leading to high stress levels and impaired quality of

life among both the child and family.

Children with a peanut allergy generally present a reaction by the age of three,

with the most common reaction signs and symptoms including: hives, angioedema, and

difficulty breathing (Dyer et al., 2015). In a randomized cross-sectional survey of 40,000

US households, 2% of parents reported their child had a peanut allergy which accounts
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for 24.8% of all parent-reported food allergies. Over 50% of reported cases involved

severe reactions, such as anaphylaxis. The survey also found that children between the

ages of 11-17 were at the highest risk for suffering a severe allergic reaction to peanuts as

compared to children between the ages of 0-2 years. Dyer et al. reported that 76.0%

children in the study were formerly diagnosed with a peanut-allergy by their physician.

Skin tests were found to be the most common form of diagnostic testing employed,

accounting for 50.3% of cases. 44.8% of diagnoses were confirmed via a blood test, and

20.0% of diagnoses were confirmed via an Oral Food Challenge (OFC) (Dyer et al.,

2015). Diagnoses were found to be less likely in children of low socioeconomic status

whose parents make less than 50,000 per year due to limited healthcare access (Dyer et

al., 2015).

The most common signs and symptoms of a peanut-allergy include: hives, skin

rash, redness around the eyes, itchiness around the mouth and ears, nausea and vomiting,

diarrhea, gastrointestinal upset, runny nose, and sneezing (FARE, 2016). Severe reactions

typically involve: lip, tongue, and throat swelling; difficulty swallowing and breathing;

sudden drop in blood pressure; chest pain; and a weakened pulse. Parents with infants or

toddlers should watch for non-verbal signs of a reaction where the child may put their

hand in their mouth and/or pull or scratch at their tongue (FARE, 2016).
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The natural history of peanut allergies remains complex due to varying rates of

allergy persistence and resolution succeeding diagnosis. Peanut allergies were previously

thought to be lifelong, however recent studies have confirmed that 20% of children may

outgrow peanut allergies (Fleischer, 2007). Peanut-allergy resolution rates still remain

low in comparison to other food allergies (Fleischer, 2007). Allergic reactions occurring

after diagnosis can lead to life-threatening reactions, and generally are more severe in

nature as compared to the first observed reaction. Fleischer reports that 55% of children

are accidentally exposed to peanuts within five years of diagnosis, and that reaction

severity increases proportionally with age (Fleischer, 2007). Dyer et al. found the median

age for peanut-allergy resolution to be approximately 6.6 years (Dyer et al., 2015).

Risk factors increasing the likelihood for persistent or chronic peanut allergies

include: asthma, eczema, allergic rhinitis, high initial PN-IgE levels, reduced diversity in

the gut microbiome, and having an initial reaction affecting three organ systems

(Fleischer, 2007). Those with resolved peanut allergies still retain the risk of the allergy

reoccurring. For this reason, patients with resolved peanut allergies often avoid

consuming peanuts due to fear of a subsequent reaction.

A study conducted by Fleischer et al. examined the recurrence rate, predictability,

and risk factors for recurring peanut allergies through delivering a questionnaire to 96

patients who outgrew their peanut allergy. Of the 96 interviewed, 47 claimed they were

able to tolerate frequent peanut consumption, 34 consumed peanuts in a concentrated

form at least once a month, and 13 stated they did not frequently consume peanuts

(Fleischer, 2007). Only three out of the 96 patients included in the study were diagnosed

with a recurrent allergy upon testing. Those who tended to avoid peanut ingestion were at
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increased risk for recurrence as compared to those who frequently consumed peanuts

(Fleischer, 2007).

Registered Dietitians (RDs) play a critical role in providing nutrition therapy to

both children with peanut allergies and their caregivers. According to the Academy of

Nutrition and Dietetics, RDs should follow the Nutrition Care Process (NCP) when

treating children and adults with peanut allergies (Collins, 2016). RDs should monitor

patients with a diagnosed peanut allergy for nutrient deficiencies, malnutrition, or over-

restriction of the diet. Furthermore, RDs should confirm the diagnosis via a

comprehensive diet history to ensure the child is consuming an adequate diet and

following recommendations to avoid accidental ingestion. With the increased risk of

malnutrition, stunted growth, and nutrition deficiency among children with peanut

allergies, patients should undergo thorough physical, clinical, and biochemical

assessments to ensure proper nutrition status, growth, and development (Collins, 2016).

Intervention strategies for peanut allergies should ideally begin prior to the

allergy’s onset. Pregnant and breastfeeding mothers are advised to avoid restricting

allergenic foods from their diet unless the mother or infant develops an allergy (Collins,

2016). The American Academy of Pediatrics (AAP) recommends introducing allergenic

foods to a child after a variety of solid foods have already been successfully introduced

and tolerated by the child. Peanuts should be served via thinned peanut butter rather than

the whole nut (Collins, 2016). The “Addendum Guidelines for the Prevention of

Peanut Allergy in the United States” align with the Academy’s guidelines for early-infant

feeding practices, recommending that foods containing peanuts be introduced as early as

4-6 months of age (Habich, 2017). Children should undergo skin prick testing (SPT) and
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evaluation for peanut-specific immunoglobulin E (peanut sIge) prior to introduction.

Furthermore, children suffering from eczema ranging from mild to moderate in severity

should be introduced to peanut-containing food at around six months of age to prevent

and reduce risk for developing a peanut-allergy (Habich, 2017). High risk children

should consult with their allergist prior to allergen introduction (Collins, 2016).

Children with established diagnoses of peanut-allergies should seek education and

counseling via an RD. RDs should primarily focus counseling sessions on “increasing

self-efficacy, self-advocacy, and reducing fear” for both child, parents, and caregivers

(Collins, 2016)). It is important to provide nutrient-dense substitutions for the food

allergen to prevent stunted growth and nutritional deficiencies. Teaching menu and label

reading to identify the presence of peanuts in a food is a critical component of nutrition

education to prevent accidental exposure/ingestion (Collins, 2016).

Peanut allergic reactions can be treated via the use of antihistamines or

epinephrine injection administration. However, recent research has explored alternative

treatment options to prevent, manage, and treat food allergies. Sublingual immunotherapy

(SLIT) involves providing individuals with diluted amounts of the allergen delivered

under the tongue with the goal of desensitizing the patient to the allergen through

repeated dosages increasing in amount as time progresses (Fleischer et al., 2012).

Fleischer et al. examined the clinical efficacy and safety of sublingual immunotherapy in

a randomized, double-blind, placebo controlled trial on 40 subjects with established

peanut allergies. At follow-up, the median successfully consumed dose (SCD) of peanuts

increased from 3.5 to 496mg (Fleischer et al., 2012). Furthermore, 63.1% of administered

doses were symptom free (Fleischer et al., 2012). Other therapies such as oral
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immunotherapy (OIT) have shown promising results patients in increasing allergen

tolerance (Collins, 2016), Emerging therapies and treatment approaches present exciting

research opportunities to ultimately prevent peanut-allergy onset and increase resolution

rates.
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References

Collins, S. C. (2016). Practice Paper of the Academy of Nutrition and Dietetics: Role of

the Registered Dietitian Nutritionist in the Diagnosis and Management of Food Allergies.

Journal of the Academy of Nutrition and Dietetics, 116(10), 1621-1631.

doi:10.1016/j.jand.2016.07.018

Dyer, A. A., Rivkina, V., Perumal, D., Smeltzer, B. M., Smith, B. M., & Gupta, R. S.

(2015). Epidemiology of childhood peanut allergy. Allergy and Asthma Proceedings,

36(1), 58-64. doi:10.2500/aap.2015.36.3819

Food Allergy Research and Education (FARE): Peanut Allergy. (2016). Retrieved April

16, 2017, from https://www.foodallergy.org/allergens/peanut-allergy

Fleischer, D. M. (2007). The natural history of peanut and tree nut allergy. Current

Allergy and Asthma Reports, 7(3), 175-181. doi:10.1007/s11882-007-0018-y

Fleischer, D., Wood, R., Jones, S., Sicherer, S., Liu, A., Stablein, D., . . . Burks, A.

(2012). Sublingual Immunotherapy for Peanut Allergy: A Randomized, Double-Blind,

Placebo-Controlled Multicenter Trial (CoFAR). Journal of Allergy and Clinical

Immunology, 129(2). doi:10.1016/j.jaci.2011.12.739

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Habich, M. M. (2017). Introduction to the Addendum Guidelines for the Prevention of

Peanut Allergy in the United States. Journal of Pediatric Nursing, 32, 88.

doi:10.1016/j.pedn.2016.12.007

Sicherer, S. H., Muñoz-Furlong, A., Godbold, J. H., & Sampson, H. A. (2010). US

prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up.

Journal of Allergy and Clinical Immunology, 125(6), 1322-1326.

doi:10.1016/j.jaci.2010.03.029