American College of Allergy, Asthma & Immunology Annual Scientific Meeting

American College of Allergy, Asthma & Immunology Annual Scientific Meeting

Source:

Kteish R, et al. P111. Presented at: ACAAI Annual Scientific Meeting; Nov. 4-8, 2021; New Orleans (hybrid meeting).

Disclosures: The authors report no relevant financial disclosures.
November 07, 2021
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Peanut allergy persists in most young adults

Source:

Kteish R, et al. P111. Presented at: ACAAI Annual Scientific Meeting; Nov. 4-8, 2021; New Orleans (hybrid meeting).

Disclosures: The authors report no relevant financial disclosures.
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Most patients diagnosed with peanut allergy as children remained significantly sensitized in adulthood, whereas only around 10% lost their peanut allergy, according to results of a retrospective chart review.

“We used to tell our patients they would have the peanut allergy for life, although now we think many should be re-evaluated,” Rima Rachid, MD, director of the Allergen Immunotherapy Program at Boston Children's Hospital, told Healio. “Unexpectedly, we also found that a history of allergic reaction was associated with elevated peanut allergy markers. Surprisingly, however, a history of eczema or male sex was very strongly associated with elevated markers. This could suggest that controlling or preventing eczema early on in infancy might have long-term effect on the development or persistence of peanut allergy.”

Peanuts
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The researchers conducted this study because little is known about the long-term follow-up of patients with peanut allergy.

“It is not clear how many develop allergic reactions over an extended period of time, such as from childhood into adulthood, and how many of these reactions are serious,” Veronica Kalwajtys, BS, clinical research assistant at Boston Children's Hospital, told Healio. “Additionally, factors affecting peanut allergy resolution require further investigation.”

Rima Rachid, MD
Rima Rachid

In a poster presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting, researchers reviewed the medical information of 524 peanut-allergic patients (48.9% women) who had at least one visit in adulthood at the Allergy Program at Boston Children's Hospital from 1998 to 2020.

Of the cohort, 86% were diagnosed with peanut allergy in childhood. However, it is likely that a greater percentage were diagnosed in childhood, but it was not clearly documented, according to the researchers.

Overall, 61.1% of the cohort had a history of a peanut allergic reaction and 26.3% had a history of anaphylaxis.  The worst reactions experienced by patients were mostly grade 1 (29%) or grade 2 (23.3%).

Of all patients, 10.9% underwent a food challenge test, of which 84.2% passed. The majority of patients who did not undergo a food challenge (58.2%) had an elevated IgE and/or skin prick test within 4 years of their most recent allergy clinic visit. However, 31% of those who did not undergo a food challenge did not have recent high peanut allergy markers or a history of grade 2 or higher peanut allergic reaction.

Researchers found that male sex (P = .001), history of peanut allergic reaction (P = .004) and eczema (P <. 001) were significantly associated with a high value of peanut-specific IgE or skin prick test at 18 years or older.

Peanut allergy resolution was documented in 11.3% of patients. Peanut allergy resolution appeared more likely in patients without asthma (OR = 2.1; 95% CI, 1.1-3.9) and who did not have a history of a confirmed peanut allergic reaction (OR = 3.1; 95% CI, 1.5-6.3) but less likely among males (OR = 0.5; 95% CI, 0.3-0.9).

“The exact rate of resolution of peanut allergy over time is not clear. Some patients did not undergo food challenges, although they could have been eligible as they neither had recent high peanut allergy lab values nor a history of allergic reaction to peanut grade 2 or higher. This implies that further discussion with patients and their families about peanut allergy testing results and identification of reasons for not undergoing food challenges is recommended, as many of these patients may have lost their allergy,” Rayan Kteish, MD, resident physician at Nassau Health Care Corporation in East Meadow, New York, told Healio.