Peanut allergy
Encyclopedia
Peanut allergy is a type of food allergy
Food allergy
A food allergy is an adverse immune response to a food protein. They are distinct from other adverse responses to food, such as food intolerance, pharmacological reactions, and toxin-mediated reactions....

 distinct from nut allergies. It is a type 1 hypersensitivity reaction to diet
Diet (nutrition)
In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management...

ary substances from peanut
Peanut
The peanut, or groundnut , is a species in the legume or "bean" family , so it is not a nut. The peanut was probably first cultivated in the valleys of Peru. It is an annual herbaceous plant growing tall...

s causing an overreaction of the immune system which in a small percentage of people may lead to severe physical symptoms. It is estimated to affect 0.4-0.6% of the population. In England, an estimated 4,000 people are newly diagnosed with peanut allergy per year (11 per day); 25,700 having been diagnosed with peanut allergy by a clinician at some point in their lives.

The most severe allergies in general can result in anaphylaxis
Anaphylaxis
Anaphylaxis is defined as "a serious allergic reaction that is rapid in onset and may cause death". It typically results in a number of symptoms including throat swelling, an itchy rash, and low blood pressure...

, an emergency situation requiring immediate attention and treatment with epinephrine
Epinephrine
Epinephrine is a hormone and a neurotransmitter. It increases heart rate, constricts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system. In chemical terms, adrenaline is one of a group of monoamines called the catecholamines...

.

It is usually treated with an exclusion diet
Dieting
Dieting is the practice of eating food in a regulated fashion to achieve or maintain a controlled weight. In most cases dieting is used in combination with physical exercise to lose weight in those who are overweight or obese. Some athletes, however, follow a diet to gain weight...

 and vigilant avoidance of foods that may contain whole peanuts or peanut particles and/or oils.

Symptoms

Symptoms of peanut allergy are related to the action of Immunoglobulin E (IgE
IGE
IGE was one of the largest services company buying and selling virtual currencies and accounts for MMORPG. During its peak time, it had offices in Los Angeles, China , and headquarters & customer service centre in Hong Kong. IGE was one of the main monopoly in virtual economy services, also known...

) and other anaphylatoxin
Anaphylatoxin
Anaphylatoxins, or anaphylotoxins, are fragments that are produced as part of the activation of the complement system.. Complement components C3, C4 and C5 are large glycoproteins that have important functions in the immune response and host defense...

s, which act to release histamine
Histamine
Histamine is an organic nitrogen compound involved in local immune responses as well as regulating physiological function in the gut and acting as a neurotransmitter. Histamine triggers the inflammatory response. As part of an immune response to foreign pathogens, histamine is produced by...

 and other mediator substances from mast cell
Mast cell
A mast cell is a resident cell of several types of tissues and contains many granules rich in histamine and heparin...

s (degranulation). In addition to other effects, histamine induces vasodilation
Vasodilation
Vasodilation refers to the widening of blood vessels resulting from relaxation of smooth muscle cells within the vessel walls, particularly in the large arteries, smaller arterioles and large veins. The process is essentially the opposite of vasoconstriction, or the narrowing of blood vessels. When...

 of arterioles and constriction of bronchioles in the lungs, also known as bronchospasm
Bronchospasm
Bronchospasm or a bronchial spasm is a sudden constriction of the muscles in the walls of the bronchioles. It is caused by the release of substances from mast cells or basophils under the influence of anaphylatoxins...

 (constriction of the airways).

Symptoms can include the following:
  • vomiting
    Vomiting
    Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...

  • diarrhea
    Diarrhea
    Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...

  • urticaria
    Urticaria
    Urticaria is a kind of skin rash notable for pale red, raised, itchy bumps. Hives is frequently caused by allergic reactions; however, there are many non-allergic causes...

     (hives)
  • angioedema
    Angioedema
    Angioedema or Quincke's edema is the rapid swelling of the dermis, subcutaneous tissue, mucosa and submucosal tissues. It is very similar to urticaria, but urticaria, commonly known as hives, occurs in the upper dermis...

     (swelling of the lips, face, throat and skin)
  • acute abdominal pain
    Abdominal pain
    Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem...

  • exacerbation of atopic eczema
    Eczema
    Eczema is a form of dermatitis, or inflammation of the epidermis . In England, an estimated 5.7 million or about one in every nine people have been diagnosed with the disease by a clinician at some point in their lives.The term eczema is broadly applied to a range of persistent skin conditions...

  • asthma
    Asthma
    Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...

  • anaphylactic shock
    Anaphylaxis
    Anaphylaxis is defined as "a serious allergic reaction that is rapid in onset and may cause death". It typically results in a number of symptoms including throat swelling, an itchy rash, and low blood pressure...



The British Dietetic Association
British Dietetic Association
The British Dietetic Association is a professional association and trade union for dieticians in the United Kingdom. It was founded in 1936 and became a certified union in 1982; it is affiliated to the Trades Union Congress and the Scottish Trades Union Congress.The BDA was established in 1936...

 warns that: "If untreated, anaphylactic shock can result in death due to obstruction of the upper or lower airway (bronchospasm
Bronchospasm
Bronchospasm or a bronchial spasm is a sudden constriction of the muscles in the walls of the bronchioles. It is caused by the release of substances from mast cells or basophils under the influence of anaphylatoxins...

) or hypotension
Hypotension
In physiology and medicine, hypotension is abnormally low blood pressure, especially in the arteries of the systemic circulation. It is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is the...

 and heart failure. This happens within minutes to hours of eating the peanuts. The first symptoms may include sneezing and a tingling sensation on the lips, tongue and throat followed by pallor
Pallor
Pallor is a reduced amount of oxyhaemoglobin in skin or mucous membrane, a pale color which can be caused by illness, emotional shock or stress, stimulant use, lack of exposure to sunlight, anaemia or genetics....

, feeling unwell, warm and light headed. Severe reactions may return after an apparent resolution of 1–6 hours. Asthmatics with peanut sensitivity are more likely to develop life threatening reactions".

Causes

The exact cause of someone developing a peanut allergy is unknown. A 2003 study found no link to maternal exposure to peanuts during pregnancy or during breast-feeding, though the data show a linkage to the amount of time a child is breastfed. The same study indicated that exposure to soy milk or soy products was correlated with peanut allergies. However, an analysis of a larger group in Australia found no linkage to consumption of soy milk, and that the appearance of linkage is likely due to preference to using soy milk among families with known milk allergies. It's possible that exposure to peanut oils in lotions may be implicated with development of the allergy. Another hypothesis for the increase in peanut allergies (and other immune and auto-immune disorders) in recent decades is the hygiene hypothesis
Hygiene hypothesis
In medicine, the Hygiene Hypothesis states that a lack of early childhood exposure to infectious agents, symbiotic microorganisms , and parasites increases susceptibility to allergic diseases by suppressing natural development of the immune system...

.
Comparative studies have found that delaying introduction of peanut products significantly increases the risks of development of peanut allergies, and the American Association of Pediatrics, in response to ongoing studies that showed no reduction in risk of atopic disease, rescinded their recommendation to delay exposure to peanuts along with other foods. They also found no reason to avoid peanuts during pregnancy or while breastfeeding. A study conducted jointly in Israel and United Kingdom in 8600 children noted a nearly 10 fold increase in incidence of peanut allergy among U.K. children compared to Israeli children. It was found that Israeli children were given peanut at a much younger age than those in the U.K. following recommendation of pediatricians in the U.K. Pediatric Associations in Britain and Australia recommend delaying introduction until age 3 and have not changed their recommendations .

Prevalence

The Asthma and Allergy Foundation of America
Asthma and Allergy Foundation of America
The Asthma and Allergy Foundation of America is a non-profit organization dedicated to finding a cure for and controlling asthma, food allergies, nasal allergies and other allergic diseases. AAFA's mission is also to educate the public about these diseases...

 estimates that peanut allergy is one of the most common causes of food-related death. However, there is an increasing body of medical opinion that, while there definitely are food sensitivities, the dramatic uptick in frequency of nut allergies and more particularly the measures taken in response to the threat show elements of mass psychogenic illness
Mass Psychogenic Illness
Mass psychogenic illness , also called mass sociogenic illness, is “the rapid spread of illness signs and symptoms affecting members of a cohesive group, originating from a nervous system disturbance involving excitation, loss or alteration of function, whereby physical complaints that are...

, hysterical reactions grossly out of proportion to the level of danger:http://well.blogs.nytimes.com/2008/12/15/are-nut-bans-promoting-hysteria/ "Dr. Christakis points out that about 3.3 million Americans are allergic to nuts, and even more — 6.9 million — are allergic to seafood. But of 30 million hospitalizations each year, just 2,000 are due to food allergies, and about 150 people die annually from serious allergic food reactions. That’s the same number of people killed by bee stings and lightning strikes combined. About 10,000 children are hospitalized annually with traumatic brain injuries from sports, 2,000 children drown each year, and about 1,300 die in gun accidents, he writes." Media sensationalism has also been blamed.

Prevalence among adults and children is similar—around 1%—but at least one study shows it to be on the rise in children in the United States. The number of young children affected doubled between 1997 and 2002. 25% of children with a peanut allergy outgrow it. In America, about 10 people per year die from peanut allergies.

One study has shown that peanut allergies also correlate with race; in particular, Native Americans are less prone to be allergic to peanuts.

Routes of Exposure

While the most obvious and dangerous route for an allergic individual is unintentional ingestion, some reactions are possible through external exposure. However some of these are controversial, exaggerated, or have been discredited through empirical testing. Common beliefs are that anaphylaxis can be triggered by touching peanuts or products, smelling the odor of peanuts, and simple proximity to peanut products. Many of these beliefs have resulted in controversial bans on all peanut products from entire facilities such as schools and medical facilities. Harvard pediatrician Dr. Michael C. Young notes in his book The Peanut Allergy Answer Book that while such secondary contact might pose a risk to an allergic individual, the occurrence of a reaction is rare and limited to minor symptoms. Some reactions have been noted to be psychogenic in nature, the result of conditioning and belief rather than a true chemical reaction. Blinded, placebo-controlled studies
Placebo-controlled studies
A Placebo-controlled study is a way of testing a medical therapy in which, in addition to a group of subjects that receives the treatment to be evaluated, a separate control group receives a sham "placebo" treatment which is specifically designed to have no real effect...

 by Sicherer et al. were unable to produce any reactions using the odor of peanut butter or its mere proximity. That said, some activities such as cooking or large-scale shelling or crushing of peanuts (such as in a farming or factory production environment) can cause particles to become airborne, and can have respiratory effects to allergic individuals who are nearby. Similarly, residue on surfaces has been known to cause minor skin rashes, though not anaphylaxis.

Treatments

Currently there is no confirmed treatment to prevent or cure allergic reactions to peanuts; however some children have been recently participating in a method of treating the allergy to peanuts. This method consists of feeding the children minuscule peanut traces which gradually become larger and larger in order to desensitize the immune system to the peanut allergens. Strict avoidance of peanuts is the only way to avoid an allergic reaction. Children and adults are advised to carry epinephrine injectors to treat anaphylaxis.

In order to diagnose allergies one must be prepared to first tell their doctor about their symptoms. These symptoms should include any time intervals between the ingestion of the product and the time that the symptoms began. A person should also include the exact type of symptoms and any other history of the symptoms that may have also occurred from this same product. The time interval from the person's last reaction will also be helpful to the doctor to determine the specific allergy or medical issue. One of the first and easiest ways a doctor is able to diagnose the food allergy is by means of something called a Food Challenge. During this challenge, the patient will be asked to eliminate the peanut allergen completely from their diet for a time span from 10 to 14 days from start to finish. This type of elimination food challenge time span if for the IgE mediated allergy. There will be a time span as long as 8 weeks for the reaction called the cell mediated allergic reaction. By running these Food Challenges, doctors are able to determine whether or not the suspicion of the peanut allergy is accurate. The doctor will look at the results after the given time and if the symptoms have not changed, even after the peanuts have been eliminated completely for such a long period of time, that the allergy is probably not the likely cause. If the symptoms go away after the challenge then the allergy is probably the cause of the symptoms.

While several companies have developed promising drugs to counteract peanut allergies, trials have been mired in legal battles.

Injected peanut desensitization

An early and successful trial of injecting escalating doses of peanut allergen was conducted in 1996. However, one participant died seconds later from laryngospasm
Laryngospasm
In medicine, laryngospasm is an uncontrolled/involuntary muscular contraction of the laryngeal cords. The condition typically lasts less than 60 seconds, and causes a partial blocking of breathing in, while breathing out remains easier. It may be triggered when the vocal cords or the area of the...

 due to a pharmacy error in calculating the dose. The tragic incident itself abruptly ended one of the only studies on injected allergen desensitization to peanut allergies.

Oral desensitization

A desensitization study at Duke University
Duke University
Duke University is a private research university located in Durham, North Carolina, United States. Founded by Methodists and Quakers in the present day town of Trinity in 1838, the school moved to Durham in 1892. In 1924, tobacco industrialist James B...

 was done with escalating doses of peanut protein. Eight children with known peanut allergy were given escalating doses of peanut protein in the form of a ground flour mixed into apple sauce or other food. To enter the study peanut IgE level > 7 kU/L and a positive skin prick test. The first day, they are given 0.1 mg of peanut protein, then the amount of peanut is increased gradually to 50 mg, if tolerated, over that first day. About ½ of the kids tolerated 50 mg dose by the end of the day, while the others were able to reach 12.5 mg or 25 mg. The children continued taking daily doses of peanut at home, returning to the hospital every two weeks for dose increases until they reached 300 mg peanut protein a day, or the equivalent of a single peanut. The maintenance phase follows lasted up to 18 months, depending on how much peanut protein the child tolerated. Seven children completed the study. These children were given a "food challenge" to peanut flour, exposing them to up to nearly 8 grams, or the equivalent of more than 13 peanuts. Five of the seven children tolerated the equivalent of 13 peanuts at the food challenge at the end of the study. The children’s immunologic findings were similar to those seen with other types of immunotherapy—an initial rise followed by a decline in peanut-specific IgE and IgG. They also had a rise in peanut-specific IgG4 throughout the study, which is thought to be a marker of protection in other forms of immunotherapy.

In February 2009 a successful desensitization study was announced by Addenbrooke's Hospital
Addenbrooke's Hospital
Addenbrooke's Hospital is an internationally renowned teaching hospital in Cambridge, England, with strong links to the University of Cambridge. It was founded in 1766 on Trumpington Street with £4,500 from the will of Dr John Addenbrooke, a fellow of St Catharine's College...

 in Cambridge
Cambridge
The city of Cambridge is a university town and the administrative centre of the county of Cambridgeshire, England. It lies in East Anglia about north of London. Cambridge is at the heart of the high-technology centre known as Silicon Fen – a play on Silicon Valley and the fens surrounding the...

, England. An example of the oral rush immunotherapy protocol is the administration of diluted peanut at a dose of 0.1 mg (1 mL of a 1 gram/10L solution), and escalating by 10 fold every 30 minutes. Once a maximum dose of 50 mg is reached (1 mL of a 5 gram/100 mL solution), or when systemic or local reaction occurs, the escalation is stopped. The patient is maintained on this maximum day one dose daily and the dose is escalated by a less rapid twofold increase each week, or each month, depending on tolerance or protocol used. Reactions are treated with antihistamines, and if needed anaphylactic drugs. Standard protocols are being developed by several clinical trials being conducted in the United States. Pre- and post-study serum anti-peanut IgE levels are measured, and varying doses and escalation schedules are being compared to placebo in blinded study protocols. Actual desensitization treatments are being carried out in the community using modified protocols. Success has been reported in both rapid (short duration of weeks) to slow rush protocol (spread over months) with minimal systemic reactions. The first day of the protocol often required inpatient hospital admission, or observation in a physician's office equipped with resuscitative drugs and with IV access). Frequent follow up is required during the desensitization trials to treat reactions and modify the protocol if needed. Because of the relative safety of oral rush immunotherapy, some in the medical community have questioned if desensitization is better than living with peanut allergy.

Allergen-free peanuts

On July 20, 2007, the North Carolina Agricultural and Technical State University
North Carolina Agricultural and Technical State University
North Carolina Agricultural and Technical State University is a land-grant university located in Greensboro, North Carolina, United States. It is the largest publicly funded historically black college in the state of North Carolina.NC A&T is a constituent institution of the University of North...

announced that one of its scientists, Dr. Mohamed Ahmedna, had developed a process to make allergen-free peanuts. Initial testing showed a 100 percent deactivation of peanut allergens in whole roasted kernels, and human serums from severely allergic individuals showed no reaction when exposed to the processed peanuts. Food companies have expressed an interest in licensing the process, which purportedly does not degrade the taste or quality of treated peanuts, and even results in easier processing to use as an ingredient in food products.

External links

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