Scientific Study

Background: Allergic reactions to meals consumed outside the home are common, can be severe and sometimes fatal. Objective: To quantify the risk reduction potentially achieved by increasing an individual's threshold sensitivity to peanut (such as via immunotherapy) in scenarios of peanut exposure through shared kitchen materials in a restaurant setting. Methods: Three versions of popular peanut-containing sauces were selected to represent common ingredients used in Asian cooking. Different combinations of utensils, equipment, sauces and test conditions were prepared by a professional chef, with or without common cleaning procedures to represent normal daily practice. Residue amounts of peanut-containing material on kitchen equipment and utensils were measured and used for quantitative risk assessment to model the risk reduction associated with increasing an individual's threshold. Results: Shared utensils had mean residue amounts of 23-1519 mg peanut protein (no cleaning), and 3-82 mg peanut protein (after water rinse). Shared woks and pans had up to 20 mg peanut protein after rinsing. Individuals who reach a threshold of 300 mg peanut protein have a predicted relative risk reduction of 94.9 to >99.99% with brief cleaning. With no cleaning, relative risk reductions were 63.5 to 91.1% for individuals with a baseline threshold ≤100 mg peanut protein who reach a threshold of 300 mg peanut protein, increasing to 91 to 99.7% when reaching a threshold value of 1000 mg peanut protein. Conclusion: In all shared kitchen material scenarios that we studied, achieving an eliciting dose of 300 or 1000 mg peanut protein appears clinically relevant for the peanut-allergic population.