Wednesday, July 31, 2013

The Seriousness of Peanut Allergies

Here is a sad article about a 13 year old girl with peanut allergy who dies after ingesting a snack that contained peanuts in it.  She died despite spitting out the snack right after tasting it and despite benadryl and multiple doses of epipen injection.

Food allergies have become more prevalent in this generation and as this article demonstrates, allergies to certain foods, especially peanuts, can be extremely serious.  

Thankfully, none of my kids currently have any serious food allergies but it is wise to be aware of the potential.

Dr Joann Lin, board certified in both Adult and Pediatric Allergy and Immunology and General Pediatrics shares some important facts:
  1. Peanut allergy is separate from Tree nut allergies because peanuts are legumes and do not grow from trees.  People can be allergic to only peanuts, only tree nuts, or both.
  2. There is high cross reactivity amongst tree nuts so it usually recommended that if you are allergic to one tree nut, avoid all tree nuts.
  3. The likelihood of outgrowing a peanut or tree nut allergy is only about 20%.
  4. Peanut and tree nut allergies can be acquired suddenly in adulthood.
  5. It is recommended that an epinephrine autoinjector should be carried at all times.  They now come in 2-packs.  It is recommended that the packs stay together because the first injection might not work, or the reaction is persistent, and you might need the second one.
  6. There are currently three types of epinephrine autoinjectors in the market: Epipen, AuviQ (provides audio instructions), and generic epinephrine autoinjector.  Each device works differently.  Physicians should "dispense as written" and train patients with the appropriate trainer because at time of emergency, people are usually in panic mode and don't have time to read the instructions.
  7. If epinephrine autoinjector is used, seek immediate medical attention. The autoinjector basically "buys you time" to get to a doctor.  There is a risk of a persistent allergic reaction and the epinephrine does wear off in a few minutes.  Epinephrine is basically adrenaline so the biggest side effect would be a little jitteriness.
  8. Any organ system can be affected with a severe allergic reaction. Skin = hives and swelling of lips, face, tongue, throat, Lungs = wheezing, cough, asthma attack, GI = vomiting, diarrhea, stomach cramping, Cardiovascular = headache, fainting, weakened pulses.
  9. Use epinephrine autoinjector when there is more than a little rash - ie rapidly progressing rash, if you're not sure, or other organ systems are affected; Liquid Benadryl orally works the fastest, but it still takes 15-20 minutes for it to work. No one will ever fault you for using the epinephrine "too early."
  10. Most at-risk population for bad reaction and possible death - preteens/ teens/ young adults.  Because they have "forgotten" how severe the reaction was and may forget to ask about foods, because they are now becoming more independent and doing sleepovers, and because they "want to be like" everyone else
  11. Most peanut allergic individuals tolerate products cooked in peanut oil (think Chick fil a) because it is highly refined. Peanut oils that are cold-pressed, expelled, or extruded, however, still have the peanut allergen.     
  12. Currently there is no cure for peanut or tree nut allergy.  Oral desensitization is mainly done in academic centers; it is still dangerous and should be discussed with your allergist.  
  13. Great resource: Food Allergy Research and Education:

Dr Joann Lin has a private practice in Texas.  You can read more about her and her office here.