Peanut allergy: Burden of illness

Background: Peanut allergy affects 1% to 4.5% of children, with the potential for severe reactions. The peanut allergy burden impacts families, communities, and societies. Objective: To provide an update on the peanut allergy burden of illness and diagnostic pitfalls. Methods: A narrative review of the literature that described the role of food allergy testing for the evaluation of clinical allergy or eczema, consequences of peanut allergy diagnosis, quality of life, and emerging peanut immunotherapies. Results: Peanut allergy is considered persistent in the majority of those diagnosed with it; however, fatal anaphylaxis is rare. There is an absence of evidence to support food allergy screening in children with eczema, apart from those with immediate food reactions. Allergist-directed education may enhance the quality of life for patients and families living with peanut allergy. Appropriate pricing, availability, and use of epinephrine autoinjectors may reduce peanut allergy burden of illness. Peanut oral immunotherapy may decrease anxiety but, on balance, may cause more episodes of peanut anaphylaxis than it prevents. Conclusion: The personal, family, community, and societal burden of peanut allergy is significant but can be reduced by preventing overdiagnosis. Patient education should be anchored in the appropriate risk perspective. Longer-term data are needed to better understand how peanut immunotherapy products can be leveraged to improve patients' quality of life.