peanut allergies

[DrDeth]

I did some research on peanut allergies for another thread, and thought it could be of more interest here.

Actually, food allergies were somewhat common a couple gens ago, but the symptoms were not as severe and the foods were less common- shellfish is a common allergen.

1-4% of Americans have a peanut or tree nut allergy.
http://www.jacionline.org/article/S0.../abstract?cc=y
http://www.jacionline.org/article/S0...575-0/abstract

“Allergy to peanuts and tree nuts (TNs) is the leading cause of fatal allergic reactions in the United States, and the prevalence appears to be increasing.”

Causes could be application of peanut oil to skin during early years or soy-milk formulae.

http://www.nejm.org/doi/full/10.1056...articleResults

“It is likely that children with allergy to cow’s milk or with eczema are at increased risk for food allergies, and soy consumption in infancy is increased in response to these atopic disorders…In contrast, analysis of data on creams applied to the infant’s skin revealed that 84 percent of the children who were allergic to peanuts and 91 percent of those with a positive peanut-challenge test had been exposed to creams containing peanut oil during the first six months of life …The apparent recent increase in the prevalence of peanut allergy has been difficult to explain, although it parallels an overall increase in allergic diseases of childhood.5 We found that, in a cohort of preschool children, peanut allergy proved by double-blind, placebo-controlled food challenge had important associations, which persisted after adjustment for other factors, with a family history of peanut allergy, consumption of soy by the infant, early onset of eczema, other rashes with oozing and crusting, and exposure to topical preparations containing peanut oil.”

Apparently it could be that kids get rashes, rashes are treated with salve with peanut oil, this leads to allergy?

https://www.sciencenews.org/blog/foo...peanut-allergy
But note again- only about 1% of kids really have a significant peanut allergy.

[Bill_Door]

I’d like to point out that soy milk formula usage and kids getting rashes that require treatment with topical creams are also indicators of children with allergies, so the lesson may be “Kids with allergies to one thing are likely to get allergies to another.” Useful information, but hardly a game changer.

[Broomstick]

I would also like to point out (again) that “tree nuts” and “peanuts” are not the same thing. PEANUTS ARE NOT NUTS, THEY ARE LEGUMES.

And put me down for “kids that are allergic to one thing are also likely to be allergic to multiple things.” I offer myself as exhibit A.

[iljitsch]

I understand that you can treat allergies by building up exposure over time. But apparently most people go the other route and try to avoid exposure. That would make sense for mild allergies, but if it’s really bad and potentially life-threatening, why not do something about it rather than live in fear?

[DrDeth]

@Broomstick

I would also like to point out (again) that “tree nuts” and “peanuts” are not the same thing. PEANUTS ARE NOT NUTS, THEY ARE LEGUMES.

And put me down for “kids that are allergic to one thing are also likely to be allergic to multiple things.” I offer myself as exhibit A.

The first study lumped the two together, apparently the mechanism is similar. But yes, not the same thing.

[Broomstick]

They shouldn’t lump them together. Frankly, that makes me question the study as a whole.

Too often it’s assumed, even by medical personnel, that they’re all the same thing. They are not. Being allergic to tree nuts does not automatically mean one is allergic to peanuts and vice versa. Indeed, someone allergic to peanuts is more likely to be allergic to other legumes than to tree nuts. Many people allergic to tree nuts are not allergic to peanuts. Many people allergic to one particular tree nut are not allergic to other tree nuts. And yes, some are allergic to both.

[DSeid]

@Broomstick

… someone allergic to peanuts is more likely to be allergic to other legumes than to tree nuts. …

Okay, cite please.

Been in practice about 27 years and cannot recall too many peanut allergy kids allergic to other legumes.

From one expert source (Food Allergy Research and Education - FARE):

If you are allergic to peanuts, you do not have a greater chance of being allergic to another legume (including soy) than you would to any other food. … Based on recent studies, an estimated 25-40 percent of people who have peanut allergy also are allergic to tree nuts.2 In addition, peanuts and tree nuts often come into contact with one another during manufacturing and serving processes. For these reasons, allergists usually tell their patients with peanut allergy to avoid tree nuts as well. …

Of note is the fact that our delay of intentional peanut exposure in the West of the last several decades may have contributed to the rise in severe peanut allergy. In Israel peanut exposure occurs earlyin large amounts and they have ten times less peanut allergy than matched western groups do.

We demonstrate that Jewish children in the UK have a prevalence of PA that is 10-fold higher than that of Jewish children in Israel. This difference is not accounted for by differences in atopy, social class, genetic background, or peanut allergenicity. Israeli infants consume peanut in high quantities in the first year of life, whereas UK infants avoid peanuts. These findings raise the question of whether early introduction of peanut during infancy, rather than avoidance, will prevent the development of PA.

Theoretically complete avoidance would work but in the real world that does not occur - repeat unidentified small exposures does. OTOH large early exposures may trigger a supresser response.

There is work at controlled small exposure to desensitize. The issue is doing it safely.

[picunurse]

“Tree Nuts” is sort of a garbage can term. If it’s crunchy, it’s a nut, but not really.

Almonds are also not nuts, they’re seeds. They are more closely related to apricots than any nut.
My husband developed a severe almond allergy. It’s so bad he has to have a shot of epi if he touches one. I had a bottle almond extract in the cupboard. He picked it up to throw it away, and went down for the count. After three hospitalizations, he’s learned his lesson.
He can eat all other nuts and peanuts.

[Broomstick]

@DSeid

Okay, cite please.

I’ve been told over and over these past few decades that being allergic to one item makes it more likely for you to be allergic to similar and related items. Peanuts are legumes, so being allergic to them would logically make you more likely to have problems with other legumes.

As noted, “tree nuts”, just like “nuts”, is a garbage term of unrelated items with superficial resemblance to each other.

Been in practice about 27 years and cannot recall too many peanut allergy kids allergic to other legumes.

Well, my niece (allergic to peanuts and soy) and I (allergic to peanuts, lentils, and green peas) are probably not your patients.

In addition, peanuts and tree nuts often come into contact with one another during manufacturing and serving processes. For these reasons, allergists usually tell their patients with peanut allergy to avoid tree nuts as well.

That’s a problem of contamination, not multiple allergies. But hey, it’s OK for doctors to tell their patients they’re allergic to both rather than explaining what’s actually the concern. The misinformation is for their own good, right?

Yes, I do have to avoid foods possibly contaminated with allergens but I’d rather know the actual truth so I can continue to eat foods that are safe. It’s takes a little more effort to find safe tree nuts but it is possible to do this. Other nuts is not the only food potentially contaminated with peanuts, either, but if you don’t make that understood there could be a dangerous situation.

I can understand telling a small child a simplified version of facts, but adults should be fully informed, be they parents of an allergic child or an allergic adult. Some doctors are good that this. Others are idiots.

There is work at controlled small exposure to desensitize. The issue is doing it safely.

The other issue I have is that all of this work is concentrated solely in children. We adults with food allergies can just go hang.

[DSeid]

Honestly Broomstick many people hear “avoid all nuts” and translate into “allergic to” as a mental shorthand. Running gag in my household is based on that mussels cause me to get major pease-let-me-die migraines … early on my wife and I went to a restaraunt with one of those Chef’s Choice degustations and were asked in advance if either of us had any food allergies. I tried to answer that I wasn’t allergic but that I could not eat anything with mussels and my wife told me in no uncertain terms that a normal person would just say they are allergic to mussels. Even the-smartest-man-I-know, a good friend, an MD-PhD from med school, shorthands his true celiac disease as “gluten allergy” which he very well knows is not really what is the case. (The silly-ac boy.)

In any case, despite your belief based on logic and your family anecdote, the data is that a large number of people allergic to peanuts are allergic to tree nuts and many of those allergic to one tree nut are allergic to others while peanut allergic individuals being allergic to other legumes is very uncommon.

[RivkahChaya]

According to my son’s pediatrician, conditioned response (the same thing that produces the placebo response) mighty play a role in severe reactions to the presence of peanuts. A kid has an anphylactic reaction to eating peanuts, it’s a scary experience, and the kid becomes conditioned to fear peanuts, so that the smell or the, or skin exposure to the oils, can produce anaphylaxis. It’s more like a panic attack, but it’s real anaphylaxis, and just as deadly. When you hear about a child who is treated for anaphylaxis with an epipen injection, but has no follow-up, and is fine, that probably had a psychogenic component.

Kids like this could probably benefit from reconditioning or biofeedback, so they can be in the presence of the allergen, but psychological treatments can’t help the original allergy-- albeit, a daily Claritin possibly could, but sometimes it’s hard to get parents to see how what they perceive as a not-terribly-effective cold pill can “cure” a deathly allergy. Parents whose child has survived anaphylaxis are understandably frightened, and their wish to ban whatever the allergen is makes sense from their point of view. Trying to convince them not to over-react is hard.

My son had croup, and we had to call 911 when he had trouble breathing; he spent the night in the hospital. I still get panicky every time he gets a cold with a cough. For about a year after the croup, I was rushing him to the doctor every time he cleared his throat.

My husband kept telling me I was going to make our son paranoid, and I tried to listen to him, because of course, I didn’t want to do that. It was really hard. I’m so glad he doesn’t have allergies for me to worry about.

[RivkahChaya]

@DSeid

In any case, despite your belief based on logic and your family anecdote, the data is that a large number of people allergic to peanuts are allergic to tree nuts and many of those allergic to one tree nut are allergic to others while peanut allergic individuals being allergic to other legumes is very uncommon.

In my experience working in my son’s preschool, there is a connection, but it’s the kind of thing statisticians love, and makes other people’s heads spin.

People with soy allergies are likely to be allergic to peanuts, but people with peanut allergies are not likely to be allergic to other legumes.

What?

Soy allergies discovered in infancy because of allergies to soy formula, or some other soy thing served up before age one is a good indicator of a peanut allergy to come, but not having a soy allergy does not mean you won’t have a peanut allergy, because peanut allergies far outnumber soy allergies.

Now, I don’t know if that’s because soybeans and peanuts are both legumes, or because soy allergies indicate multiple food sensitivities-- after all, the main reason a child gets exposed to soy very early is a reaction to milk-based formula.

FWIW, though, I babysat a girl who was adopted, and turned out in early infancy to be both lactose intolerant and allergic to soy (this was in the 1980s before lactose-free formula was on the shelves of grocery stores). She ended up in the hospital on donor breastmilk, and then elemental formula, which her parents had to have shipped to them in cases (insurance fortunately paid for it). Elemental formula smells nasty, but babies drink it. When she was six months old, she figured out the elemental formula was awful, and so she went on a homemade formula of boiled goat’s mild, Karo syrup, water, and prescription vitamins. I think they put a tiny bit of vanilla in it too. What was interesting was that by the time she was about five, she had outgrown all her food sensitivities. She could eat tofu, and drink regular milk.

Her parents were not alarmists, and had an older child raised perfectly well on formula from the store. She really had genuine problems, but her gut matured, somehow, and she could eat anything by the time she was in school. She wasn’t premature, but she was small-for-gestational-age, and I always wondered if maybe she had a very young birthmother who perhaps didn’t take care of herself, or eat well when she was pregnant, but I have no way of knowing.

[DSeid]

The vingette first - cow’s milk protein and soy protein allergy actually are typically outgrown, many by school age. No association I know of relating to prenatal care.

I do not know of data supporting your observation but can believe it, and would suspect your second explanation as the reason why: those identified as soy allergic are a select subset of likely highly allergic kids, most commonly already allergic to cow’s milk protein (hence why soy was tried) and now allergic to soy as well, or possibly from such an allergy prone family that the parents thought going to soy right off would be protective. I agree, it would not be surprising to find that group to also have peanut allergy a fair amount of the time despite the fat that soy allergy is not over-represented among those with peanut allergy.

I’ve not heard of the bit about anaphylaxis as a conditioned response before. Wouldn’t say he’s wrong but am a bit skeptical.

[Guinastasia]

@RivkahChaya

FWIW, though, I babysat a girl who was adopted, and turned out in early infancy to be both lactose intolerant and allergic to soy (this was in the 1980s before lactose-free formula was on the shelves of grocery stores). She ended up in the hospital on donor breastmilk, and then elemental formula, which her parents had to have shipped to them in cases (insurance fortunately paid for it). Elemental formula smells nasty, but babies drink it.

My sister had that problem as an infant. You’re not kidding – that stuff reeks. (Fortunately, she also outgrew her soy allergy) But it was hella expensive – my mom was elligible for WIC to obtain it.

[Broomstick]

@DSeid

I’ve not heard of the bit about anaphylaxis as a conditioned response before. Wouldn’t say he’s wrong but am a bit skeptical.

I’m not.

The smell of pizza has always made me nauseous. Yes, I have a tomato allergy (it’s actually one of my worst - just touching a tomato plant or juice can give me a rash like poison ivy) but other tomato dishes don’t induce nausea. Pizza does. This is almost certainly because every time I was forced/induced to eat pizza as a child I would get horribly, horribly ill, including violent puking.

It didn’t take long at all to establish a link there.

So I was the weird kid who didn’t like pizza and would throw up sometimes even before I ate it.

After allergy testing - well, OK, that is why she doesn’t like pizza.

I haven’t eaten pizza probably in 40 or more years. The smell no longer makes me throw up, but I still find it quite hideous and I can’t bring myself to eat the tomato-less pizzas people have occasionally tried to make for me. Yes, it’s in my head, but it produces a pretty strong physical reaction. In my particular circumstance it’s also protective in that it makes me avoid something that is definitely unhealthy for me, so while I was happy to have it moderate no, I don’t really feel motivated to get rid of it.

Psychosomatic anaphylaxis is probably uncommon, which is no doubt a good thing, but it seems entirely plausible to me.

[DSeid]

How many trials does it typically take to get a good conditioned response? How many exposures to anaphylaxis over what time period do you think most kids get?

While I can believe it is plausibe I am skeptical that the first number is as large or greater than the second virtually ever and am very skeptical of attributing anaphylaxis that gets better after the EpiPen only to that as the go-to explanation. Of course I could be wrong.

[Broomstick]

I think it is possible to get a conditioned response with just one sufficiently traumatic event. I doubt that is typical, just possible.

[Hampshire]

My wife developed a peanut allergy that seemed to appear out of nowhere at age 28. She had eaten peanuts and peanut butter her entire life up to that point. Then suddenly out of nowhere she was having these extreme reactions and the docs said “yep, you have a peanut allergy, it happens, have no idea why.”
It started not long after our son was born invitro during which time I was giving her Progesterone in peanut oil injections once a week.
I always sort of linked the two together but I can’t find any studies confirming my theory.

[Guinastasia]

I’m allergic to penicillin, but didn’t become so until I was in my twenties. Prior to that, I had taken it before with no problem, but then when I was given a scrip for a toothache, I broke out in hives, big time. Ugh.

[Renee]

Allergies are so weird. When I was about 20, I became highly allergic to asprin and related drugs, despite taking them (occasionally) all my life. I avoided them for about a decade, then decided to try a tiny dose last year just to see. I was fine. I can take that stuff again. No idea what that was about.