Reviews and feature articlesPeanut allergy: Emerging concepts and approaches for an apparent epidemic
Section snippets
Clinical insights regarding the epidemic of peanut allergy
Peanut allergy is being described as “epidemic” only in certain countries, an observation that may provide clues toward etiology and prevention. When considering breathlessness as a reported symptom of a reaction to food from among 15 countries, peanut was identified as the most common food only for the United States.16 The estimated rate of peanut allergy in France is 0.3% to 0.75%17; in Denmark it is 0.2% to 0.4%18; and in a cross-sectional study from Israel, peanut allergy diagnosed by
Present and future diagnostic strategies/natural course
The clinician may be faced with diagnosing peanut allergy in several diverse circumstances: a patient who had an apparent reaction to peanut (clinical history), a child who has not ingested peanut but was tested for peanut IgE because of other food allergies or atopic disease (no ingestion history), or a previously diagnosed child who may have outgrown the allergy. Serum peanut-specific IgE or skin prick tests (SPTs) are primary modalities to determine sensitization and have a major role in
Clinical observations that affect management
The general treatment for a patient diagnosed with peanut allergy is to avoid the food and have an emergency plan in place to treat an allergic reaction/anaphylaxis. The plan typically includes prescription of self-injectable epinephrine83; resources for families are available through the Food Allergy & Anaphylaxis Network (www.foodallergy.org) and similar organizations in several other countries. However, the noted severity of peanut allergy, the young age of children affected, and the
Insights from molecular and immunologic characterization
As noted in this article's Table E2 in the Online Repository at www.jacionline.org, the International Union of Immunological Societies Nomenclature Sub-committee recognizes 8 allergenic proteins in peanuts, although Ara h 3 and Ara h 4 are nearly identical isoforms and Ara h 6 is highly homologous to Ara h 2.103, 104 The 3 major allergens, Ara h 1-3, are comprised of a vicilin, conglutin, and glycinin seed storage proteins, respectively.104 Two of the 8 identified peanut allergens are not
Future therapeutic options
Currently, the only proven therapy for the treatment of peanut allergy, and food allergy in general, is strict avoidance of the peanut-containing foods and education of patients to recognize and treat allergic reactions caused by accidental exposure.23 Attempts at standard subcutaneous immunotherapy have been abandoned because of overwhelming adverse reactions and marginal efficacy.121 As indicated in Table II, immunotherapeutic approaches have more recently focused on 2 main strategies:
Conclusion
Peanut allergy appears to be increasing, and we are just beginning to recognize potential genetic, environmental, and immunologic influences on the development and progression of the disease. Recent studies have refined our understanding of the natural course of peanut allergy and have provided insights for improved diagnosis, management, and patient education. Molecular characterization and clinical-epidemiologic studies continue to increase our understanding of risk factors and present
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(Supported by an unrestricted educational grant from Genentech, Inc. and Novartis Pharmaceuticals Corporation)
Section editors: Donald Y. M. Leung, MD, PhD, and Dennis K. Ledford, MD
Disclosure of potential conflict of interest: H. A. Sampson has consulting interests with Allertein and the Food Allergy Initiative; owns stock in Allertein; has patent licensing arrangements with Allertein, Mount Sinai, and other universities; has received grant support from the National Institutes of Health and the Food Allergy Initiative; and served as an expert witness in peanut allergy litigation 3 to 4 years ago. S. H. Sicherer has declared that he has no conflict of interest.