Published online November 1, 2007
PEDIATRICS Vol. 120 Supplement November 2007, pp. S117-S118 (doi:10.1542/peds.2007-0846BB)
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ALLERGY


Accidental Ingestions in Children With Peanut Allergy

Karla L. Davis, MD and Cecilia P. Mikita, MD

Washington, DC

ABSTRACT

Yu JA, Kagan R, Verreault N, et al. J Allergy Clin Immunol. 2006;118:466–472

PURPOSE OF THE STUDY. To determine the current frequency of accidental exposures occurring in peanut-allergic children and identify factors associated with exposure.

STUDY POPULATION. Children 4 years of age and older, who were diagnosed with peanut allergy at the Montreal Children's Hospital Allergy Clinic (Quebec, Canada) between January 2000 and February 2005.

METHODS. Parents of children with peanut allergy completed questionnaires about accidental exposure to peanut occurring over the preceding year. Details of the accidental exposure requested included age of the child, quantity and type of food ingested, location of ingestion, allergic symptoms, onset and duration of reaction, and treatment administered. Medical charts were reviewed to confirm eligibility criteria, demographic information, atopic history, family history, details of the initial and most severe accidental reaction, number of previous accidental reactions, and previous use of epinephrine.

RESULTS. A total of 252 (57.7%) of 437 parents of children with peanut allergy completed a questionnaire. Chart review allowed comparison between participants and nonparticipants. Of participants, 62% were boys and the mean age was 8.1 years. The mean age at diagnosis was 2 years. There were 35 accidental exposures among 29 children over a period of 244 patient-years (annual incidence rate: 14.3%). Reactions were mild (15), moderate (16), and severe (4). Of the 20 children with reactions that were moderate to severe, only 4 received epinephrine. Eighty percent of children attended schools that prohibit peanut; only 1 accidental exposure occurred at school. Neither univariate nor multivariate logistic regression analyses identified any clinically important associations with inadvertent exposure to peanut.

CONCLUSIONS. Children with peanut allergy residing in Quebec had an annual incidence rate of accidental exposure to peanut of 14.3%. This finding is substantially lower than previously reported incidence rates. Predictors of accidental exposure could not be identified.

REVIEWER COMMENTS. In this study, only 1 of 35 accidental exposures occurred in school. Coupled with the lower incidence of accidental exposures reported in this study, these data may suggest that enhanced education about and awareness of peanut allergy in the public sector have been effective. The majority of accidental exposures occurred at the patient's home (14) or the home of a friend or relative (12), which underscores the critical importance of education of the family, friends, and caregivers of children with peanut allergy.