Scientific Study
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Products: Peanuts
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Long-term prospective observational study of patients with peanut and nut allergy after participation in a management plan in England.
Authors: Ewan PW, Clark AT
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- Journals: Lancet
- Pages: 111-115.
- Volume: 357
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BACKGROUND: Peanut and nut allergy is common and the most frequent cause of severe or fatal reactions to foods. Current advice is poor--doctors give an epinephrine injector to patients; without training or advice on nut avoidance--so that further reactions are common and deaths occur. We devised and assessed a management programme providing advice on nut avoidance and emergency medication. METHODS: Unselected referrals with confirmed peanut or tree-nut allergy were recruited. Severity of nut allergy was graded 1-5 and emergency medication allocated accordingly: oral antihistamine with or without inhaled or injected epinephrine. Patients; parents; and school staff received verbal and written advice on nut avoidance as well as training in recognition and self-treatment of reactions; with a written treatment plan. At follow-up (more than 13610 patient months) retraining was given and details of further reactions obtained. FINDINGS: 88 (15%) of 567 patients had a follow-up reaction of reduced severity. 62 of 88 were mild (grades 1-3; mainly cutaneous) and 49 patients used oral antihistamine; six inhaled adrenaline; and ten took no treatment. 12 of 12 patients with a moderate follow-up reaction improved after inhaled epinephrine. Only three (0.5%) of 567 patients; aged 27-40 years; had a severe follow-up reaction (involving dyspnoea) compared with 12% initially. Only one of 567 changed from a mild index reaction to a severe follow-up reaction. Patients with a moderate/severe (grade 4-5) reaction were older (median 18 years vs 9 years; p=0.03) and nine of 26 received injected epinephrine which was always effective. 85% of patients had no further reactions. Severity was related to the amount of nut eaten. INTERPRETATION: Self-treatment was effective (inhaled epinephrine for early laryngeal oedema and an epinephrine injector for severe reactions) but provision of this treatment; including who should carry epinephrine; required assessment of allergy severity. Our management plan was effective; and our results indicate that patients should be referred to specialist allergy centres for advice on nut avoidance.