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Child Peanut
Allergies
Presentation by: Alana Sherman
NTD 600-91
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Epidemiology
 Increasing public health concern
 Affects approximately 2% of population
 One of the most common pediatric food allergies
 Ranked as one of the top 8 food allergies in America

 Leading cause of food-allergy related death

(anaphylaxis)
 Reactions range from mild to moderate to severe
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Consequences
 Poor quality of life
 Limited ability to participate in activities
 Constant fear of reaction or accidental exposure

 High economic burden

 Medical costs amount to ~$4,184 per child with a food
allergy (Gupta et al., 2013)

 Psychological consequences
 Increased anxiety for both child and family
 Increased stress levels

 Limited ability to participate in activities

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Signs and Symptoms
 Minor  Severe
 Hives  Swelling of the lips,
 Skin rash tongue, throat
 Redness around the eyes  Difficulty swallowing
 Itchiness around mouth  Trouble breathing
and/or ears  Drop in blood pressure
 Nausea/Vomiting/Diarrhe  Chest pain
a  Weakened pulse
 Abdominal pain
 Runny nose
 Sneezing
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Natural History

 Children generally present an allergic reaction by the

age 3

 Children between ages of 11-17 at highest risk of

suffering severe allergic reaction compared to children
between ages of 0-2

 Subsequent reactions generally more severe than

initial reaction

 20% of children estimated to outgrow the allergy

 6.6 years estimated as median age of resolution (Dyer et
al., 2015)
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Risk Factors for Persistent or
Chronic Peanut Allergies
 Asthma

 Eczema

 Allergic rhinitis

 High initial PN-IgE levels

 Reduced microbiome diversity

 Initial reaction affecting three organ systems

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Current Guidelines and
Recommendations
 Infant Feeding Practices:
 Introduce peanuts around 4-6 months after solid foods have successfully
been introduced and tolerated
 Children with eczema should be introduced at ~6 months of age
 Skin prick testing and peanut-sIgE testing advised prior to introduction

 Pregnant/breastfeeding mothers:
 Encouraged to consume diet as normal
 Allergen-containing foods safe to eat as long as mother/infant do not have or
develop allergy

 RDNs should monitor patients for:

 Malnutrition
 Nutrient deficiencies
 Stunted growth
 Proper food-safety techniques
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Potential Treatment Options

 Oral Immunotherapy (OIT)

 Administer small dose of allergen to promote
desensitization/increased tolerance
 Further research warranted to determine safety and
efficacy

 Sublingual Immunotherapy (SLIT)

 Administer small dose of diluted allergen under the tongue
 Involves repeated dosages increasing in amount as time
progresses
 Slower than OIT
 Promotes desensitization
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References
 Collins, S. C. (2016). Practice Paper of the Academy of Nutrition and Dietetics: Role of the Registered
Dietitian Nutritionist in the Diagnosis and Management of Food Allergies. Journal of the Academy of
Nutrition and Dietetics, 116(10), 1621-1631. doi:10.1016/j.jand.2016.07.018

 Dyer, A. A., Rivkina, V., Perumal, D., Smeltzer, B. M., Smith, B. M., & Gupta, R. S. (2015). Epidemiology of
childhood peanut allergy. Allergy and Asthma Proceedings, 36(1), 58-64. doi:10.2500/aap.2015.36.3819

 Food Allergy Research and Education (FARE): Peanut Allergy. (2016). Retrieved April 16, 2017, from
https://www.foodallergy.org/allergens/peanut-allergy

 Gupta, R., Holdford, D., Bilaver, L., Dyer, A., Holl, J. L., & Meltzer, D. (2013). The Economic Impact of
Childhood Food Allergy in the United States. JAMA Pediatrics, 167(11), 1026.
doi:10.1001/jamapediatrics.2013.2376

 Fleischer, D. M. (2007). The natural history of peanut and tree nut allergy. Current Allergy and Asthma
Reports, 7(3), 175-181. doi:10.1007/s11882-007-0018-y

 Fleischer, D., Wood, R., Jones, S., Sicherer, S., Liu, A., Stablein, D., . . . Burks, A. (2012). Sublingual
Immunotherapy for Peanut Allergy: A Randomized, Double-Blind, Placebo-Controlled Multicenter Trial
(CoFAR). Journal of Allergy and Clinical Immunology, 129(2). doi:10.1016/j.jaci.2011.12.739

 Habich, M. M. (2017). Introduction to the Addendum Guidelines for the Prevention of Peanut Allergy in the
United States. Journal of Pediatric Nursing, 32, 88. doi:10.1016/j.pedn.2016.12.007

 Sicherer, S. H., Muñoz-Furlong, A., Godbold, J. H., & Sampson, H. A. (2010). US prevalence of self-reported
peanut, tree nut, and sesame allergy: 11-year follow-up. Journal of Allergy and Clinical Immunology,
125(6), 1322-1326. doi:10.1016/j.jaci.2010.03.029