Mercy Children’s Hospital study: Children with asthma often have undiagnosed peanut allergy

17 May

More children seem to have peanut allergies. Ross Brenneman wrote in the Education Week article, How Peanuts Became Public Health Enemy #1:

Researchers aren’t sure why, but over the past several years, the number of children reported to have allergies has doubled, to 5 percent of children in the United States. Yet at the same time, in schools and elsewhere, allergies have drawn what some see as an oversized amount of attention. A new paper out of Princeton University explores why that may have happened.

Allergy attacks are awful. I’ve been there plenty of times. Eyes swollen shut, coughing, hacking, sneezing—and that’s just garden-variety pollen. But severe allergic reactions, also known as anaphylaxia, can cause death, even for the constantly vigilant. That’s why the U.S. House of Representatives voted unanimously last week in favor of a bill that would incentivize states, through a pre-existing grant program, to make sure their schools have a supply of epinephrine (usually an EpiPen) on hand, as well as staff members trained in using it…

One percent. That’s it. One estimate pegs it closer to 1.4 percent for children, but only .6 percent for adults. Either way, it’s small. Not all of those affected are seriously allergic, either. One percent isn’t nothing, but it’s not the kind of number that would suggest a strong cultural reaction, either.
Why, then, have peanut allergies become such a well-known public health menace? Maybe it’s partly from the mystery surrounding all allergies; scientists don’t know why allergies exist and why some people grow out of them. It’s also not clear how much an allergy attack may be exacerbated by asthma; the two often go hand in hand….
http://blogs.edweek.org/edweek/rulesforengagement/2013/08/how_peanuts_became_public_health_enemy_number_one.html?intc=es

Kids With Food Allergies has some excellent resources.
http://www.kidswithfoodallergies.org/resourcespre.php?id=62&title=Peanut_allergy_avoidance_list&gclid=CJTC7sfLuLICFWdxQgodxHcAJQ

Science Daily reported in Many children with asthma have reaction to peanuts, but do not know it:

A new study has shown that many children who have asthma have a sensitivity to peanuts, but did not know it. Conducted by researchers in the U.S., the study specifically looked at pediatric asthma patients at a pediatric pulmonary clinic.

The study will be presented at the ATS 2015 International Conference.

“Many of the respiratory symptoms of peanut allergy can mirror those of an asthma attack, and vice versa. Examples of those symptoms include shortness of breath, wheezing and coughing,” said study lead author Robert Cohn, MD, MBA. “This study aimed to evaluate the proportion of asthmatic children who also demonstrated a sensitivity to peanuts.”

For the study, the researchers looked at 1,517 children from the pediatric pulmonary clinic at Mercy Children’s Hospital in Toledo, Ohio. They determined if the children’s charts had a documented peanut allergy and if they had undergone a blood test for antibodies demonstrating a potential reaction to peanuts, known as IgE. Children were considered positive if they had a documented history of peanut allergy or a specific IgE blood test that showed a level higher than normal.

What they found was that of the 1,517 charts that were reviewed, 163, or about 11%, had a documented history of peanut allergy. Nearly 44% (665) had specific IgE testing at some point to test for peanut allergy. Out of that group, 148, or approximately 22%, had a positive test to peanut sensitivity. However, more than half of these children and their families did not suspect there was any sensitivity to peanuts. The prevalence of positive tests varied across age groups but the prevalence of known peanut allergy was strikingly similar across age groups…

Citation:

Many children with asthma have reaction to peanuts, but do not know it

Date: May 17, 2015

Source: American Thoracic Society (ATS)

Summary:

In recent years and months, peanut allergies in children have been in the news frequently, as scientists reveal new insights into why more and more children are developing them and what can be done to avoid them. However, until now, few have studied the connection between peanut allergy and childhood asthma.
http://www.sciencedaily.com/releases/2015/05/150517143400.htm

Here is the press release:

Public Release: 17-May-2015 Many children with asthma have reaction to peanuts, but do not know it

American Thoracic Society

ATS 2015, DENVER – In recent years and months, peanut allergies in children have been in the news frequently, as scientists reveal new insights into why more and more children are developing them and what can be done to avoid them. However, until now, few have studied the connection between peanut allergy and childhood asthma.
A new study has shown that many children who have asthma have a sensitivity to peanuts, but did not know it. Conducted by researchers in the U.S., the study specifically looked at pediatric asthma patients at a pediatric pulmonary clinic.

The study will be presented at the ATS 2015 International Conference.

“Many of the respiratory symptoms of peanut allergy can mirror those of an asthma attack, and vice versa. Examples of those symptoms include shortness of breath, wheezing and coughing,” said study lead author Robert Cohn, MD, MBA. “This study aimed to evaluate the proportion of asthmatic children who also demonstrated a sensitivity to peanuts.”

For the study, the researchers looked at 1,517 children from the pediatric pulmonary clinic at Mercy Children’s Hospital in Toledo, Ohio. They determined if the children’s charts had a documented peanut allergy and if they had undergone a blood test for antibodies demonstrating a potential reaction to peanuts, known as IgE. Children were considered positive if they had a documented history of peanut allergy or a specific IgE blood test that showed a level higher than normal.

What they found was that of the 1,517 charts that were reviewed, 163, or about 11%, had a documented history of peanut allergy. Nearly 44% (665) had specific IgE testing at some point to test for peanut allergy. Out of that group, 148, or approximately 22%, had a positive test to peanut sensitivity. However, more than half of these children and their families did not suspect there was any sensitivity to peanuts. The prevalence of positive tests varied across age groups but the prevalence of known peanut allergy was strikingly similar across age groups.
“This study demonstrates children with asthma might benefit from a test for peanut sensitivity, especially when control of wheezing and coughing is difficult to achieve. If a physician is having this problem, or if a parent notices it in his or her asthmatic child, they should consider testing, even if they believe their child is not sensitive to peanuts,” said Dr. Cohn. “There should be continued investigation to learn more about the connection between asthmatic children and peanut sensitivity.”
###
* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.
Abstract 61468
Prevalence of Peanut Sensitivity Among Children with Asthma
Type: Scientific Abstract
Category:01.21 – Pediatric Epidemiology: Risk Factors, Outcomes and Management (PEDS)
Authors: R.C. Cohn, A. Al-Yazji; Mercy Children’s Hospital/University of Toledo – Toledo, OH/US

Abstract Body
Introduction: The prevalence of childhood asthma in the US is increasing. Coexistence of peanut allergy with asthma could be a risk factor for increased morbidity and mortality. Also some asthma medications should be avoided in children with peanut allergy. Few studies are available assessing the relationship between peanut allergy and asthma. In this study we set out to determine the prevalence of peanut sensitivity among children with asthma who were active patients in a large pediatric pulmonary clinic.
Methods: All charts of children who carried the diagnosis of asthma and who were actively seen in the pediatric pulmonary clinic at Mercy Children’s Hospital in Toledo, Ohio were retrospectively reviewed for documented peanut allergy and the presence or absence of peanut IgE testing. Children were considered positive if they had a documented history of peanut allergy or a specific IgE blood test >0.35 ku/l. Children who had a positive test and who did not report a peanut allergy before testing were labeled as”unsuspected”. Data were analyzed collectively and by age groups.

Results: 1517 charts of children diagnosed with asthma were reviewed; 163 (10.7%) had a documented h/o peanut allergy. 665 patients of the 1517 (43.8%) had specific IgE testing at some point. Of the 665, 148 (22.3%) had a positive test to peanut. 53% of these children and their families did not suspect peanut sensitivity. The prevalence of positive tests varied across age distributions but the prevalence of known peanut allergy was strikingly similar across age groups.

Conclusion: In this select group of asthma patients the prevalence of peanut sensitivity was high. Many children/families did not suspect a peanut sensitivity. We speculate that children with asthma might benefit from peanut sensitivity screening especially when control is difficult to achieve.
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Media Contact
Nathaniel Dunford
ndunford@thoracic.org

@atscommunity
http://www.thoracic.org

A physical examination is important for children to make sure that there are no health problems. The University of Arizona Department of Pediatrics has an excellent article which describes Pediatric History and Physical Examination http://www.peds.arizona.edu/medstudents/Physicalexamination.asp The article goes on to describe how the physical examination is conducted and what observations and tests are part of the examination. The Cincinnati Children’s Hospital describes the Process of the Physical Examination http://www.cincinnatichildrens.org/health/p/exam/
If children have allergies, parents must work with their schools to prepare a allergy health plan. See, Journal of American Medical Association study: Consumption of nuts by pregnant woman may reduce nut allergies in their children https://drwilda.com/tag/peanut-allergy/

Resources:

Micheal Borella’s Chicago-Kent Law Review article, Food Allergies In Public Schools: Toward A Model Code
http://www.cklawreview.com/wp-content/uploads/vol85no2/Borella.pdf

USDA’s Accomodating Children With Special Dietary Needs
http://www.k12.wa.us/ChildNutrition/pubdocs/SpecialDietaryNeeds.PDF

Child and Teen Checkup Fact Sheet
http://www.health.state.mn.us/divs/fh/mch/ctc/factsheets.html

Video: What to Expect From A Child’s Physical Exam
http://on.aol.com/video/what-to-expect-from-a-childs-physical-exam-325661948

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