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The typical route to diagnose peanut allergy begins with a physical examination and detailed medical history.8,9 The next step may include testing, such as specific IgE blood testing or skin-prick testing, that is used to support the diagnosis of peanut allergy and determine whether an oral food challenge should be considered.8-12 These key diagnostic tools are essential for arriving at an accurate diagnosis.9 Making an accurate diagnosis when evaluating a patient with a possible peanut allergy is important to avoid unnecessary dietary restrictions and prevent life-threatening anaphylactic reactions.9
Identifying individuals with peanut allergy is important, as these patients are at risk for severe reactions.1-3 As allergy to peanut is usually lifelong and accounts for most of the food-induced severe and fatal allergic reactions, the diagnosis of peanut allergy carries with it considerable significance medically and emotionally, as well as psychosocially and financially on patients and their families.8,13
Children with peanut allergy may be re-evaluated at regular intervals to determine whether they have achieved tolerance to peanut.5
The evaluation for a patient with a possible food allergy begins with a thorough history and physical exam. If the clinical history suggests an IgE-mediated food allergy, specific IgE tests are needed to help confirm the diagnosis.11
When a patient asks, “Do I have a peanut allergy?,” it’s tempting to get a “yes” or “no” answer and leave it at that. But what if there was a way to uncover even more information about an allergic sensitization, such as the specific protein that’s triggering your patient’s reaction?
If you have a patient sensitized to peanut, specific IgE blood testing for peanut components can help assess the risk of reaction severity, from mild and localized to severe, including the risk of anaphylaxis, or potentially no clinical reaction at all.16
So instead of just answering the question, “Am I allergic to peanuts?,” you can determine the exact proteins that trigger a reaction, and the risk of reaction severity and cross-reaction associated with that protein. Testing with allergen components can also help determine whether an oral food challenge (OFC) test is recommended. An OFC test can be used to confirm a food allergy or determine whether a patient has outgrown a food allergy.
By detecting sensitization with peanut component testing, you can create a personalized management plan for your patient.
Food allergy, including peanut allergy, can have a dramatic effect on quality of life.14 Many studies have detailed the negative effect of food allergy on health-related quality of life (HRQoL), as well as the financial and emotional toll a food allergy takes.12 Identified issues include feeling different because of the diet, worrying about foods, the presence of physical and emotional distress, increased responsibility, effect on social activities (social restrictions, school, travel, and restaurants), anxiety, stress, bullying, and having to consistently exercise greater caution.12
It is important for healthcare providers to educate patients on reading and interpreting food labels, as peanut can be an ingredient in many foods.15 A high level of patient education is needed to maintain safety when it comes to allergen avoidance.12
Possible hidden sources of peanut exposure include: 8
Nonfood sources containing peanut may include ant baits, bird feed, mouse traps, pet food, cosmetics, sunscreens, craft materials, medications, vitamins, mushroom-growing medium, and stuffing in toys.8
Co-sensitization to tree nuts and seeds are also common in peanut allergy patients.8
Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.i,ii Diagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.iii,iv
i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.
ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331
iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.
iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238
Avoidance is the key to peanut allergy treatment and management, but it can be difficult to achieve as peanuts may be hidden in foods.17 Manifestations of peanut allergy may be life-threatening and require an aggressive approach to risk-factor modification and management, with emphasis on prevention and the use of injectable epinephrine.8
Management of peanut allergy is based mainly on:
1. Educating patients and their families to avoid peanuts and peanut-containing products.
2. Awareness of early signs of an allergic reaction resulting from exposure to peanut.
3. Education on the proper use of an epinephrine auto-injection kit.8
Practice parameters have been developed to help guide the management and treatment of patients with food allergies, including peanut.