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Papers

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

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Author's reply

The letters posted so far typify the problem parents of allergic children face in trying to protect and care for them.

One father reports the results of a blood test and seeks more info about the significance of the reported levels of IgE. I do not think tests of antigen mixtures are useful. One needs to know about individual nuts to base advice on the relative risk. Having said that, nut and peanut allergic people need to avoid all nuts, unless they have eaten them safely before and they are CERTAIN that there is no possibility of confusion or mix up of one nut (a risk) for another(previously safe).

The 2nd letter is about testing before school entry. This is the time of greatest parental fear, as the child will be away from them for long periods. One cannot predict resolution of peanut allergy in any individual without a consultation,tests (skin prick and blood) and a challenge if necessary. My practice is to challenge children before school entry, if they have not had a reaction for about 2-3 years and if the reaction described was not life-threatening (see article). If the challenge is negative, dietary and lifestyle restrictions can be relaxed. If the challenge is positive, nothing has been lost. Anecdotally, families are usually reassured by the mild reaction elicited in positive challenges and with reinforcement of response strategies, feel more confident sending the child to school.

I am aware of only very few severe reponses among 1000s of formal food challenges. Nevertheless they must be done in hospital. Our paper reflects the experience of 2 of the very rare centres that frequently do such challenges. More allergists and allergy clinics need to be provided by the NHS to meet the already huge and increasing demand for advice and expertise. The BMJ's current series/book "ABC of allergy" should make a huge contribution to the advice available to the public via GPs and clinics not dealing with severe allergies every day

Competing interests: No competing interests

20 May 1998
Jonathan Hourihane
Lecturer, Immunobiology
Institute of Child health, London