Peanut allergy: an increasing health risk for children

Matthew, age 24 months, is brought into the clinic by his frantic mother. She reports Matthew started wheezing and broke out in a blotchy skin rash within 5 minutes of eating a cracker with peanut butter. Matthew has a history of mild, intermittent asthma treated with nebulized albuterol, which the mother administered without improvement in the child's breathing pattern. He also has a history of moderate atopic dermatitis and a prior milk intolerance that he has since outgrown. No other food allergies are noted in his history, and the mother believes this is the first time Matthew has eaten peanut butter. It has been approximately fi hour since he ingested the peanut butter. Matthew's vital signs are temperature 98.6 degrees F, pulse 90, and respirations 60 with audible wheezing and repetitive cough. His blood pressure is 80/60. His face and chest are flushed with urticaria, and some swelling is noted around his mouth.