Fleischer DM, Conover-Walker MK, Christie L, Burks AW, Wood RA. J Allergy Clin Immunol. 2004;114:1195–1201
Purpose of the Study.
To determine the rate of peanut allergy recurrence, identify risk factors for recurrent peanut allergy, and develop specific recommendations for the treatment of patients with resolved peanut allergy.
Children >4 years old with prior diagnosis of peanut allergy who had undergone and passed an oral peanut challenge.
Children were evaluated by using questionnaires, skin tests, and peanut-specific IgE levels. Patients were invited to undergo a double-blind, placebo-controlled food challenge (DBPCFC) unless the history of a possible recurrence reaction was so convincing that a challenge would be potentially dangerous.
Sixty-eight patients were evaluated. Forty-seven patients continued to tolerate peanut, of whom 34 ingested concentrated peanut products at least once per month and 13 ate peanut infrequently or in limited amounts but passed a DBPCFC. The status of 18 patients was indeterminate because they ate peanut infrequently or in limited amounts and declined to have a DBPCFC. After excluding 12 patients originally diagnosed with peanut allergy based solely on a positive skin-prick test or peanut-specific IgE level, 3 of 15 patients who consumed peanut infrequently or in limited amounts had recurrences, compared with no recurrences in the 23 patients who ate peanut frequently (P = .025). The recurrence rate was 7.9 (95% confidence interval: 1.7%, 21.4%).
Children who outgrow peanut allergy are at risk for recurrence, and this risk is significantly higher for patients who continue largely to avoid peanut after resolution of their allergy. It is recommended that patients eat peanut frequently and carry epinephrine indefinitely until they have demonstrated ongoing peanut tolerance.
Recent studies reported that up to 20% of peanut-allergic children may outgrow this condition, giving hope to many patients. Follow-up of the children who passed an oral peanut challenge showed that some children experienced acute allergic reactions to peanut some time after having passed a challenge. Children avoiding peanut were more likely to have recurrence of their peanut allergy than those ingesting peanut on a regular basis. The possibility of recurrence of peanut allergy and importance of regular dietary peanut intake should be discussed with patients and their parents when considering oral peanut challenges. It should be noted that recurrence has been reported solely for peanut and fish allergy, whereas recurrence of other food allergies such as those to cow’s milk, egg, soy, or wheat have not been described in the literature.