General paediatricians and the case of resolving peanut allergy

Abstract

Children with peanut allergy are almost always advised to avoid nuts for life. There have been recent reports from academic centres that in some cases the allergy might resolve and thus these dietary restrictions can be lifted. To evaluate resolution of peanut allergy in a selected group of children in a general paediatric setting. Children 4-16 yr old with a clear history of an allergic reaction to peanuts who had not had any reaction in the previous 2 yr were eligible. Specific immunoglobulin E (IgE) or skin prick test (SPT) at the time of diagnosis was sought. A SPT and specific IgE was then done and if this was <or= 8 mm and <or= 17.5 kU[A]/l respectively, a double-blind placebo-controlled food challenge was undertaken. A negative challenge consisted of tolerance to a cumulative dose of 15.8 g peanuts followed by an open challenge. From the 82 case notes reviewed 54 children were eligible to participate. Twenty-nine agreed to participate and underwent SPT (29) and specific IgE (28). Of these children eight were eligible for food challenge. Four challenges were negative and four positive. Peanut allergy may resolve in approximately 15% of selected children attending an allergy clinic run by general paediatricians in a district general hospital. Food challenge constitutes the appropriate way of removing the burden that comes with a diagnosis of peanut allergy and enables dietary restriction to cease.