A report on Anaphylaxic Food Allergies

March 12, 2006 at 8:25 am (Blog & Websites)

by Laura Duke

Common food allergies in children are milk, eggs, soy, wheat and peanuts. A recent survey in the United States suggests that 0.7 % of children are allergic to peanuts. Sensitivity to many other foods, especially milk, eggs, and soy tend to resolve with age, whereas allergy to peanuts and tree nuts often begins in infancy but fails to improve with age. For the reasons that are still unclear, peanut allergy is associated with fatal anaphylaxis more than any other food.

Food allergies usually occur in individuals who also have other manifestations of allergic disease such as hay fever, asthma, and eczema. People with these allergic disorders have greater tendency to develop sensitivities to food. Since allergies tend to be inherited, family members are often allergic as well although not necessarily with the same allergies. Although allergies to specific foods are not inherited per se, the tendency to be allergic to food in general is genetic. Some recent studies now suggest the possibility of genetic transmission of peanut allergy, but the results are still inconclusive.

Peanuts were cultivated for food at least as early as 2,000 to 3,000 B.C.

The American biochemist George Washington Carver is given credit for developing the many modern uses of peanuts.

In 1989, Bock and Atkins showed that peanut allergy in childhood usually persists into adulthood.

In the United States there is up to two to five-million Americans are affected by peanut allergy. Approximately three million Americans, including both children and adults suffer from peanut and nut allergies.

Dr. Hugh Sampson, a prominent investigator in the field of food allergy is in the process of developing a vaccine for people that have peanut allergies.  Dr. Hugh Sampson is with the New York’s Mount Sinai School of Medicine, has observed an increase of 55% in the number of peanut-allergic patients, both children and adults.

Peanuts are vegetables and nuts are fruits. Peanuts (botanical name Arachia hypogea) are actually members of the legume family which includes lentils, soybeans, peas, black-eye peas, chick peas, lima beans, kidney beans, green beans, and garbanzo beans. There are many hidden sources of peanuts artificial nuts can be peanuts that have been deflavored and reflavored with another nut. Mandelonas are peanuts soaked in almond flavoring. Arachis oil is peanut oil. It is advised that peanut allergic patients avoid chocolate candies unless they are absolutely certain there is no risk of cross-contamination during manufacturing process. African, Chinese, Inonesain, Mexican, Thai, and Vietnamese dishes often contain peanuts, or are contaminated with peanuts during preparation of other types of meals. Foods sold in bakeries and ice cream shops are often in contact with peanuts too. Many brands of sunflower seeds are produced on equipment shared with peanuts. Alternative nut butters (such as cashew butter) are often produced on equipment used to process peanut butter and thus present a risk. Cold pressed, expelled and extruded peanut oil can produce allergic reactions. Avoid “Food Additive 322.? Also avoid: beer nuts, ground nuts, and mixed nuts. “Nu-Nuts? flavored nuts, chili, egg rolls, hydrolyzed plant protein, hydrolyzed vegetable protein, marzipan, and nougat.

You can be allergic to multiple foods, including foods in the same family, but this is usually a result of separate allergies and not a common cross reacting allergy. If you are allergic to peanuts, you should also avoid tree nuts unless allergy testing is negative or unless you have previously tolerated tree nuts.

Thirty-five percent of peanut-allergic people are also allergic to tree nuts, but only ten percent of peanut-allergic people are allergic to legumes.

In 1997, a case reported was published in the New England Journal of Medicine of a live and kidney transplant recipient who developed a new peanut allergy. His donor organs apparently came from a man who had died from peanut anaphylaxis after eating satay sauce containing peanuts. The recipient had no prior history of peanut or food allergy. Three months after his transplant, the patient developed a skin rash and swelling of his throat after eating peanuts. The transfer of peanut allergy to the recipient most likely was the result of the transfer of white blood cells contained in the donor liver called B cells which produce peanut-specific IgE. Similar transfer of peanut allergy with bone marrow transplantation has been reported. Because transplant recipients take drugs to suppress their normal immune response to allow survival of the donated organ, cells of the donor immune system are not destroyed by the recipient. This allows cells of the immune system such as B cells which produce peanut-specific IgE contained in the bone marrow, to survive, and these transplanted cells will perpetuate the peanut allergy in the transplant recipient.  Organ transplant recipients should be warned of the possibility of their developing allergic reactions if their organ donor has a history of food allergies.

There are reports in the medical literature of people experiencing allergic reactions merely from smelling the odor of foods they are allergic to. Cooking fumes, in particular, have been cited as triggers of asthma attacks and runny-nose symptoms.

Manufacturers are required to list ingredients on labels, especially highly allergenic foods such as peanut. Careful reading of labels is obviously helpful and important but sometimes not enough.

Air Carriers Access Act of 1986 which guaranteed access to airlines for the disabled, prompted the department to issue a recommendation in August of 1998, that all airlines provide, on request, a three-row peanut-free buffer zone for a passenger with a medically documented peanut allergy. A number of airlines subsequently announced peanut-free flights for peanut-allergic passengers on their request. Policies are subject to change so it is always wise to contact your airline before making reservations. The social and legal aspects of this question are very similar to those related to airline peanut exposure. Some preschools and schools have, in fact, banned peanuts from the classrooms and cafeterias. This is depended in large part of the number of students affected in the school and community, the efforts of the parents to be heard, and the willingness of the school system and community to make accommodations. Hand washing before and after eating greatly decreases the cross-contamination problem. The nurse can use a special light which shows the spots children have missed after hand washing. This helps not only the issue of food allergies, but reinforces good hygiene as well.

The Medic-Alert bracelet is a metal tag engraved with an individual’s name and vital information in case of emergency, usually the diagnosis a list of allergies and brief instructions. The tag can be worn as a bracelet around the wrist or on a chain around the neck.

Peanuts are one of the main causes of food allergies and together with tree-nut allergies, are the leading cause of fatal and near-fatal food anaphylaxis.

The incidence of peanut allergy has increased to 55% over the past 20 years.

Most people do not outgrow peanut allergies. The symptoms of allergic reactions are itching, hives, severe headache, swelling of face, throat, tongue, abdominal pain, vomiting and diarrhea, difficulty breathing, wheezing, dizziness, loss of consciousness and shock. The entire body is shutting down. The lungs, heart, and kidneys.

Anaphylaxis is a systemic reaction that can lead to cardiovascular collapse and death. It requires immediate treatment with epinephrine. Since there is no cure as yet for peanut allergy, strict avoidance is the key to management.

Accidental ingestion’s and cross-contamination are a fact of life. Twenty-five percent of peanut-allergic patients have had accidental ingestions and reactions in the preceding year.

Be prepared to deal with accidental ingestion’s or cross-contamination with peanuts wile eating and traveling outside of your home. Peanut allergic individual should have epinephrine with him/her at all times. A rapid-acting antihistamine such as Benadryl should be kept as well. Epinephrine is the only drug that will treat anaphylaxis. It is better to over treat with epinephrine rather than to under treat. You should create a written action plan with your physician and file it with a medical office at the workplace or nurse’s office in school. Reading labels and ingredient list are crucial in protecting yourself from an anaphylaxis reaction. Be aware of the problem of hidden allergens, cross-contamination, and indirect exposures. When eating outside the home, inform people of your allergy; especially food servers, restaurant staff, school cafeteria staff, airline staff, and so forth.

Peanut oil may not b e safe if it has been contaminated through cooking or if it is crude, cold pressed, or unrefined.

Peanut allergy is caused by a specific Immunologic response to peanut protein. Peanut allergy is usually genetically determined and inherited. Peanut allergy is more common in an individual who has other allergic diseases, such as hay fever, asthma, or eczema, and is more common in close relatives such as siblings, parents, and other relatives who have allergic disease. Parents with allergic diseases will have children at higher risk of developing allergic disease, including food allergy.  Potentially allergic infants should be breast-fed for the first six months to minimize exposure and sensitization to food proteins. Ideally, the maternal diet should not contain highly allergenic food such as peanuts, tree nuts, and seafood.

The highly allergenic food, such as peanuts, tree nuts, and seafood should be withheld from the potentially allergic child’s diet until age three years. In general, this appears to be the general age at which the child’s immune system and gastrointestinal tract is able to handle and process these highly allergenic foods.

Knowledge of the molecular structure of the peanut allergens may enable the development of novel vaccines to treat a peanut allergy. Advanced biotechnological techniques may lead to new strains of genetically engineered peanuts that do not cause allergic reactions. Until then, education, increasing public awareness and prevention remain the principal approaches to this increasingly common and deadly problem.


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