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Resolution of peanut allergy: case-control studyScience commentary: Why do some children grow out of peanut allergy?

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7140.1271 (Published 25 April 1998) Cite this as: BMJ 1998;316:1271

Abstract

Objectives: To determine whether there are any differences between children who remain mildly or moderately allergic to peanut and children with similar histories but a negative reaction on challenge with peanut.

Design: Case-controls matched for age and sex.

Setting: Children's day wards in two teaching hospitals.

Intervention: Open food challenge with peanut.

Subjects: 15 children with resolved peanut allergy (resolvers) and 15 with persistent allergy (persisters).

Main outcome measure: Reaction on challenge with peanut, serum total and peanut specific IgE concentrations.

Results: The groups had a similar median age at first reaction to peanut (11 months, range 5-38) and similar symptoms. Allergy to other foods was less common in resolvers (2/15) than persisters (9/15) (P=0.02). On skin prick testing with peanut all 13 resolvers tested but only 3/14 persisters had a weal of <6 mm (P<0.0001). Total and peanut specific IgE concentrations did not differ much between the groups.

Conclusion: Appropriately trained clinicians must be prepared to challenge preschool children with peanut as some will be tolerant despite a history of reactions to peanut and a positive skin prick test with peanut. Preschool children whose apparent peanut allergy is refuted by food challenge show allergy to other foods less often than those in whom peanut allergy persists. The size of weal on skin prick testing to peanut predicts reactivity but not severity on peanut challenge.

Key messages

  • Peanut allergy rarely resolves in older children and adults

  • Skin prick testing with peanut has a high negative predictive value, but some people with positive skin tests do not react to peanut challenge

  • Some preschool children with a convincing history of reaction to peanut may become tolerant of peanut. Such children have fewer other manifestations of atopy than children whose peanut allergy persists

  • Paediatricians must be prepared to undertake peanut challenges or refer children to units that will undertake such challenges

Footnotes

    • Accepted 21 January 1998

    Resolution of peanut allergy: case-control study

    1. Jonathan O'B Hourihane (J.Hourihane{at}ich.ucl.ac.uk), lecturera,
    2. Stephen A Roberts, consultant paediatricianb,
    3. John O Warner, professora
    1. a Child Health, University of Southampton, Southampton SO16 6YD
    2. b South Manchester University Hospitals, Withington Hospital, Manchester M20 2LR
    3. BMJ
    1. Correspondence to: Dr J O'B Hourihane, Institute of Child Health, London WC1N 3EH
    • Accepted 21 January 1998

    Abstract

    Objectives: To determine whether there are any differences between children who remain mildly or moderately allergic to peanut and children with similar histories but a negative reaction on challenge with peanut.

    Design: Case-controls matched for age and sex.

    Setting: Children's day wards in two teaching hospitals.

    Intervention: Open food challenge with peanut.

    Subjects: 15 children with resolved peanut allergy (resolvers) and 15 with persistent allergy (persisters).

    Main outcome measure: Reaction on challenge with peanut, serum total and peanut specific IgE concentrations.

    Results: The groups had a similar median age at first reaction to peanut (11 months, range 5-38) and similar symptoms. Allergy to other foods was less common in resolvers (2/15) than persisters (9/15) (P=0.02). On skin prick testing with peanut all 13 resolvers tested but only 3/14 persisters had a weal of <6 mm (P<0.0001). Total and peanut specific IgE concentrations did not differ much between the groups.

    Conclusion: Appropriately trained clinicians must be prepared to challenge preschool children with peanut as some will be tolerant despite a history of reactions to peanut and a positive skin prick test with peanut. Preschool children whose apparent peanut allergy is refuted by food challenge show allergy to other foods less often than those in whom peanut allergy persists. The size of weal on skin prick testing to peanut predicts reactivity but not severity on peanut challenge.

    Key messages

    • Peanut allergy rarely resolves in older children and adults

    • Skin prick testing with peanut has a high negative predictive value, but some people with positive skin tests do not react to peanut challenge

    • Some preschool children with a convincing history of reaction to peanut may become tolerant of peanut. Such children have fewer other manifestations of atopy than children whose peanut allergy persists

    • Paediatricians must be prepared to undertake peanut challenges or refer children to units that will undertake such challenges

    Footnotes

      • Accepted 21 January 1998

      Science commentary: Why do some children grow out of peanut allergy?

      1. Abi Berger, science editor
      1. a Child Health, University of Southampton, Southampton SO16 6YD
      2. b South Manchester University Hospitals, Withington Hospital, Manchester M20 2LR
      3. BMJ
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