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Will peanut allergy soon be treatable?

Will peanut allergy soon be treatable?

NEW ORLEANS – Two studies presented at the 2010 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) examine the use of oral immunotherapy in peanut allergic children and continue to add hope that a treatment may be on the horizon.

Both were completed by researchers at Duke University and the University of Arkansas for Medical Sciences. In one, peanut allergic children were randomized to receive either the peanut oral immunotherapy or a placebo. The subjects went through initial escalation, build-up and maintenance dosing. This was then followed by an oral food challenge.

Twenty-three children reached the oral food challenge, 15 had received the oral immunotherapy and eight had received the placebo. During the oral food challenge, the median cumulative dose of peanut tolerated was only 315 mg for the placebo group compared to 5,000 mg (~15 peanuts) for the oral immunotherapy group. In addition, the oral immunotherapy group saw median titrated skin tests decrease from baseline to the oral food challenge.

Median peanut IgE and IgG4 levels were also measured. IgE levels did not change from baseline to the oral food challenge in either group, while IgG4 levels increased from baseline to the oral food challenge in the treatment group.

“We are encouraged by the results of this first blinded, placebo controlled study for oral peanut immunotherapy. The differences in the treatment and placebo group are significant and help guide us to the next studies,” said A. Wesley Burks, MD, FAAAAI, one of the study authors.

In the other study, the researchers looked to identify whether subjects who received the oral immunotherapy could safely ingest peanut after stopping the treatment.

Twelve peanut allergic children who completed all phases of oral immunotherapy, along with meeting certain clinical and laboratory criteria, participated in a final oral food challenge 4 weeks after they stopped receiving the oral immunotherapy. The amount of time the children received the oral immunotherapy ranged between 32 and 61 months.

Nine of the 12 subjects passed this final oral food challenge and now have peanut in their diets.

“We are now trying to identify characteristics in those subjects who were able to stop the therapy to better understand who might be a good candidate for this treatment,” commented Burks.

Over the course of the treatment, peanut IgE levels decreased from the baseline with IgG4 levels increasing. Titrated skin prick tests also decreased from the baseline. These immunologic changes support the development of tolerance.

The AAAAI ( represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has nearly 6,500 members in the United States, Canada and 60 other countries. If you believe you may have a food allergy, consult with an allergist/immunologist. To find one in your area, visit

Editor’s notes:

  • These studies were presented during the 2010 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) on February 26-March 2 in New Orleans. However, they do not necessarily reflect the policies or the opinions of the AAAAI.
  • A link to all abstracts presented at the Annual Meeting is available at


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Living With Nut Allergies

Living With Nut Allergies

The incidence of nut allergy is on the increase in Western societies, as is the attention it receives from the public and from the media, yet little research has been carried out on the impact of living with the condition. 

A University of Leicester, UK, research project is now to look at the views and experiences of children and their families living with nut allergy, which accounts for the majority of severe food-related allergic reactions. 

Peanut allergy, which currently affects around 1 per cent of children, is the most common food trigger of anaphylaxis. 

Funded by MAARA (Midlands Asthma and Allergy Research Association), Dr Emma Pitchforth, of the University`s Department of Health Sciences, is carrying out a qualitative study involving interviews with children and their parents. 

Depending on the age of the child, they may be interviewed separately or with their parents. 

The two-year research project is being carried out with colleagues Dr David Luyt and Dr Emilia Wawrzkowicz, consultant paediatricians involved in the management of childhood allergies. 

From these investigations, the team hope to understand better the impact on family and everyday life of living with these allergies. 

They will be looking at sources of information and strategies families use to cope. 

The interviews will be audio-recorded (with permission) and the resulting transcriptions will help the researchers to identify recurring themes. All data is anonymous and confidential. 

Dr Pitchforth commented: "First allergic reactions to nuts usually develop in children at a young age and do not resolve as they get older. This means that for those affected nut allergy is a permanent, potentially life-threatening condition. 

"Clinical management of nut allergy typically involves educating children and their families to avoid all products containing nuts. They need to learn to recognise early signs of allergic reaction and to administer self-injectable epinephrine when they need to. 

"The number of deaths resulting from nut allergy is extremely low, but it is a risk and patients are told to avoid all types of nuts and their traces, and to carry an `Epi-pen` at all times, in case they suffer an anaphylactic shock." 

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Nut Allergy Symptoms

Nut Allergy Symptoms

Step 1 
Know the different nut families. Affected patients often have allergy symptoms in relation to particular categories of nuts. For example, an allergy to walnuts often coincides with an allergy to pecans. Other nut families include: pistachios and cashews; beechnuts and chestnuts and hazelnuts, filberts and hickory nuts. Brazil nuts, macadamia nuts and almonds don`t seem to be related to any other nuts. 

Step 2 
Be cautious of tree nuts if you have an allergy to peanuts. While people with allergies to tree nuts aren`t always allergic to peanuts, those with a peanut allergy are significantly more likely to be allergic to other types of nuts as well. Cashews, walnuts and pistachios, in particular, tend to cause similar reactions because they contain the same allergenic proteins as peanuts. 

Step 3 
Note the first symptoms of an allergic reaction. Though all allergic persons should know the signs, children especially should be warned to watch for tongue swelling, hives, tightening of the throat and vomiting after possible exposure to a tree nut or tree nut product. These symptoms can signal the beginning of a very serious systematic reaction known as anaphylaxis, which needs immediate medical attention. 

Step 4 
Pay attention to persistent itchy skin rashes, nasal congestion, diarrhoea and hives. These lesser allergy symptoms can be related to chronic exposure to the allergenic proteins in nuts but, if they occur within 2 to 4 hours of consumption, can be an indication that more severe symptoms may develop. 

Step 5 
Ask questions and read labels carefully. Many products have "hidden" nuts in them that can cause an allergic reaction. Be specifically cautious with candy, cookies and other deserts, donuts, granola bars, pesto sauces, suntan lotions, shampoos and flavoured coffees. 

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Peanut Allergies

Peanut Allergies

Prevalence of Peanut Allergies

Peanut is one of the eight most common foods to result in food allergic reactions in individuals, with studies demonstrating that peanut allergy (PA) has doubled in the last 10 years (1).  In Australia it is estimated that PA affects 2 – 3% of children by school age, with 80% of these individuals maintaining the allergy for life.  There is a geographical variation for the prevalence of PA, with it being relatively common in Australia, UK, France, Switzerland and USA (1).  In Israel, it is the fourth most common allergen in infants less than two years of age.  Peanut allergy is rarely seen in Italy and Singapore (1). 

Food and Allergens

Peanuts belong to the botanical family, Fabaceae or Leguminosae and are classified as legumes (1).  Other legumes include Beans (soya, runner, French, GoA, haricot, butter, faba, limer); Peas (chickpea, pigeon pea, pea), Lupin, lentils, tamarind, guar, acacia, traganth gum, fenugreek, liquiorice (1).  The cross reactivity between peanut and these other legumes being relatively rare (1).  
Peanut is 26% protein and contains nine known allergens, Ara h 1- 9. Everyone with a peanut allergy will be sensitized to Ara h 2, which is the allergen involved with most reactions, though it is Ara h 1 that is responsible for the most severe reactions (1).  The classification of allergens within superfamilies tends to dictate the cross-reactivity between legumes, seeds, and tree nuts rather than their botanical classification (1).  This cross reactivity between soya protein and other legumes and peanuts is immunological in nature and probably due to the epitopes on the soya protein being homologous to those found within peanut protein (1).  This link does not necessarily translate into clinical cross reactivity (1).  Studies in children have found there is a cross-reactivity of 0.8% – 3% for children having allergies to both peanut and soy bean (1).  This cross-reactivity also exists between peanut and tree nut and is related to the epitope homology rather than the botanical classification (1).  People with peanut allergy are at greater risk (one in five) of having a tree nut allergy (1).

Many allergens are affected by heat treatments and processing, which may alter the allergens potency.  Frying and boiling peanuts has been shown to significantly reduce the amount of Ara h 1 (1).  Roasting peanuts has been found to increase Ara h 1 and Ara h 2 allergens ability to bind to the IgE antibodies 90 fold, resulting in them being more allergenic (1).  In refining peanut oils, virtually all the protein is removed, reducing the oils allergenicity (1). 

Diagnosis of Peanut Allergies

Skin prick test (SPT), along with the measurement of IgE levels in the blood and a detailed clinical history are keys to investigating peanut allergy (1).  In children SPT has been shown to have an excellent negative predictivity and specificity for peanut allergy diagnosis (1). 


The safe and effective management of peanut allergy is the total dietary avoidance of peanuts and all peanut containing foods and drink.  Because of the cross-reactivity of 1 in 5 between peanuts and tree nuts, all tree nuts should also be avoided (1).

At present peanut allergy cannot be treated, with one in five outgrowing this allergy.  Currently underway are clinical trials using immunotherapy, herbal remedies, and epitope alteration (1).  However, the use of desensitization and other treatments presently used in day-to-day clinical practice is a long way off (1).  

Becoming an accomplished food label reader is a key to the management of this allergy. It is important to learn how to read labels as peanut can be listed in various ways peanuts; nuts; ground nuts; earth nuts; monkey nuts; arachis oil; Arachis hypogaea; ground nut oil; peanut oil; peanut flour; peanut butter. 
In accordance with Australian food labelling law, ingredients in foods that may cause severe allergic reactions, such as peanuts, tree nuts (e.g. cashews, almonds, walnuts), shellfish, tinned fish, milk, eggs, sesame and soy beans and their products, must be declared on the label however small the amount (2).  Many food manufacturers use the statement may contain traces, indicating the potential risk of unknown contamination and hence this product should be avoided.  

There is also the possibility that ingredients derived from these foods, may not be clearly identified on the label.  For example soy might be listed as textured vegetable protein? (2).  Fortunately there are a number of food manufacturers who produce their product in nut free environments.  Some of these include Orgran; Hullabaloo; Enjoy Life, and Sweet William. 

Other forms of possible exposure are through human contact and cooking and eating utensils.  Young adults and adolescents are at risk of fatality due to delayed use of adrenalin injection during anaphylaxis (1).  The allergen, Ara h 1 remains in saliva for up to one hour after ingestion (1).  One ml of saliva contains 1110 mg of Ara h 1, indicating the high potential risk of exposure through personal contact and the use of eating utensils.  It is paramount to wash hands and clean cooking utensils and surfaces with soap and water; rather antibacterial washes as these do not remove the allergen (1). 

Table:  Foods which may contain nuts

Food Types Examples
Spreads Peanut Butter, Other Nut Butters
Snacks Peanut Snacks, Trail Mix, Rice Crackers, Chocolate Covered Peanuts, Cereal Bars
Cakes & Biscuits Cookies, Brownies
Ice Creams Nut Toppings
Vegetarian Meals Nut Roast, Veggie Burgers
Sauces Satay Sauce, Salad Dressings (may contain refined peanut oil)
Breakfast Cereals Anything with Crunchy Nut, or Honey Nut, Muesli and other Fruit & Nut Cereals
Meals Out

Indonesian, Malaysian, Thai & Chinese meals often contain peanuts:

Indian Food may also contain peanuts, although other nuts are more likely

by Julie Albrecht Consultant Dietitian-Nutritionist  A.P.D. 

1.     Tanya Wright and Rosan Meyer., Dietary Management of Milk and Eggs -Food Hypersensitivity: diagnosing and managing food allergies and intolerances ? edited by Isabel Skypala, Carina Venter; Wiley and Blackwell 2009, Part 2, p 117- 128. 
2.    Consumer Information: Information for Allergy Suffers: Food Standards Australia New Zealand, April 2010.


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Precautions for Living With Peanut Allergy or Tree Nut Allergy

Precautions for Living With Peanut Allergy or Tree Nut Allergy

If allergy testing shows that someone has a peanut or tree nut allergy, a doctor will provide guidelines on what to do. 
The only real way to treat a nut allergy is to avoid peanuts and tree nuts.  Avoiding nuts means more than just not eating them. It also means not eating any foods that might contain tree nuts or peanuts as ingredients. The best way to be sure a food is nut free is to read the label. Check the ingredients list first. 

After checking the ingredients list, look on the label for phrases like these: 
"may contain nuts" 
"produced on shared equipment with nuts or peanuts" 
"produced in a facility that also processes nuts" 

People who are allergic to nuts also have to avoid foods with these statements on the label. Although these foods might not use nut ingredients, the warnings are there to let people know the food may contain traces of nuts. That can happen through something called "cross-contamination," when nuts get into a food product because it is made or served in a place that uses nuts in other foods. Some of the highest-risk foods for people with peanut or tree nut allergy include:
Biscuits and baked goods Even if baked goods don`t contain nut ingredients, it is possible that they came into contact with peanut or tree nuts through cross-contamination. Unless you know exactly what went into a food and where it was made, it`s safest to avoid store-bought or bakery cookies and other baked goods. 

Ice cream Unfortunately, cross-contamination is common in ice creameries because of shared scoops. It`s also a possibility in soft-serve ice cream, custard, or yogurt places because the same dispensing machine is often used for lots of different flavours. Instead, do as you would for candy: Buy tubs of ice cream at the supermarket and be sure they`re made by a large manufacturer and the labels indicate they`re safe. 

Asian, African, and other cuisine African and Asian (especially Thai and Indian) foods often contain peanuts or tree nuts. Mexican and Mediterranean foods may also use nuts, so the risk of cross-contamination is high with these foods. 

Sauces. Many cooks use peanuts or peanut butter to thicken chilli and other sauces. 

Always proceed with caution even if you are used to eating a particular food. Even if you`ve eaten a food in the past, manufacturers sometimes change their processes for example, switching suppliers to a company that uses shared equipment. And two foods that seem the same might also have differences in their manufacturing. 

Here are some other precautions you can take:
Be on the watch for cross-contamination that can happen on kitchen surfaces and utensils everything from knives and cutting boards to the toaster. Make sure the knife another family member used to make peanut butter sandwiches is not used to butter your bread and that nut breads are not toasted in the same toaster you use. You may decide to make your home entirely nut-free. 

Avoid cooked foods you didn`t make yourself anything with an unknown list of ingredients. 

Tell everyone who handles the food you eat, from relatives to restaurant wait staff, that you have a nut allergy. If the manager or owner of a restaurant is uncomfortable about your request for peanut- or nut-free food preparation, don`t eat there. 

Make school lunches and snacks at home where you can control the preparation. 

Be sure your school knows about your allergy and has an action plan in place for you. 

Keep rescue medications (such as epinephrine) accessible at all times not in your locker, but in a pocket, purse, or book bag that`s with you. Seconds count during an episode of anaphylaxis. 
Feedback from Fiona, mother of 2 children with allergies. 

" Hi Kylie.  My 6 year old daughter is anaphylactic to peanuts. Basically I don`t buy food in packets and I bake alot. The dangers are that people unfamiliar with what anaphylaxis really means think that people with allergies need to consume the item to be affected – which is not the case. Now that my daughter is at school I am completely reliant on all parents at the school to follow the school rules to maintain a `nut free` school. If a child has nuts at school and come into contact with my daughter the consequence could be dire." 

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Seed Allergies

Seed Allergies

Prevalence of Seed Allergies  

Hypersensitivity reactions to seeds, including sunflower seeds, cottonseed and linseed have been noted since the early 1900’s (1).  Sesame allergy was first identified in the 1950’s. The increases in the consumption of sesame seeds and its products have seen an increase in the degree of the reactions, particularly in children. In Australia sesame seed allergy is more common than tree nut allergy in infants  (0.42%) and is the fourth most prevalent food allergy in this age group (1).  

Seed allergies also have geographical variation.  In Israel, sesame seed allergy is the major cause of immediate IgE allergy and the third most common cause of IgE mediated food allergy.  It is the second highest cause of anaphylaxis behind cows’ milk in infants under 2 years of age (1).  In contrast to this, mustard seed is a major allergen in children in France, with an estimated prevalence of 1.1% in children and 0.84% in adults (1). 

Foods and Allergens

Seeds come from plants with different botanical classifications (1).  The allergens in seeds are spread amongst many different superfamilies, with researchers continuing to discover new allergens within seeds (1).   Many oils are cold pressed and contain traces of protein highlighting their potential allergenicity.

Diagnosis of Seed Allergies

Clinician’s and researchers have found skin prick test and specific Ig E test difficult to interpret with respect to the diagnosis of seed allergies, hence a detailed clinical history is paramount to the diagnosis (1).  


At present the only effective and proven management of any seed allergy is the total avoidance of the offending allergen (1).  At present there appears to be no evidence, which support the avoidance of all seeds, only those known to trigger the allergic reaction (1). 

by Julie Albrecht Consultant Dietitian-Nutritionist  A.P.D. 

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