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Peanut Inhalant Challenge in Peanut-Allergic Children and Adolescents
Bente Krane Kvenshagen1, Espen Kolsrud2, Martin Sørensen3
1BestHelse Nordstrand, Oslo, Norway.
Insights
Airborne peanut exposure poses a low risk for allergic reactions in children and adolescents. This study found few objective reactions during a peanut inhalation challenge, offering reassurance for proximity to peanuts.
Area of Science:
- Allergy and Immunology
- Pediatric Allergy
- Environmental Exposure
Background:
- Uncertainty exists regarding allergic reactions from airborne peanut exposure.
- Previous small studies suggest a low risk, necessitating further investigation.
- This study addresses the need for more evidence on peanut allergy risks.
Purpose of the Study:
- To assess the risk of allergic reactions during a standardized peanut inhalation challenge.
- To evaluate reactions in a large cohort of children and adolescents with peanut allergy.
- To provide data on the safety of proximity to peanuts.
Main Methods:
- Recruited 323 children/adolescents (5-18 years) with probable peanut allergy.
- Conducted a standardized open peanut inhalation challenge followed by observation.
- Classified allergic responses as subjective or objective, monitoring spirometry and physical exams.
Main Results:
- 15.5% experienced possible allergic reactions; only 3.1% had objective reactions.
- A low incidence of medical treatment (1.2%) and no severe adverse events or hospitalizations occurred.
- The study demonstrated a low risk of significant allergic reactions from airborne peanut exposure.
Conclusions:
- Airborne peanut exposure presents a low risk of significant allergic reactions.
- Findings suggest safety for individuals with peanut allergy in proximity to peanut consumption.
- Reassurance is provided to patients, caregivers, and healthcare professionals.
Introduction:
The risk of allergic reactions due to airborne exposure to peanuts remains uncertain. Although a few small studies indicate that this risk is low, further evidence is needed. We aimed to assess the risk of allergic reactions during a standardized, open peanut inhalation challenge in a large cohort of peanut-allergic children and adolescents.
Methods:
Patients aged 5-18 years with probable peanut allergy were recruited to undergo a standardized inhalation challenge. Inclusion criteria were either having a history of allergic reaction involving more than one organ system and having Ara h 2 >2.0 kU/L or having no known exposure and Ara h 2 >5.0 kU/L. Participants were exposed to an open bag of peanuts positioned 30 cm from the nose for 10 min, followed by a 20-min observation period. Spirometry and physical examination were performed before and after the challenge. Data were collected on age at index allergic reaction to peanuts when available, atopic comorbidities, specific IgE levels for peanut and Ara h 2, and family history. Allergic responses were classified as subjective or objective. Objective reactions were defined as visible or measurable signs, including urticaria, erythema, rhinitis, conjunctivitis, angioedema, or respiratory symptoms (e.g., stridor, wheezing, or ≥12% reduction in forced expiratory volume in 1 s from baseline). Subjective reactions were defined as symptoms other than those defined as objective.
Results:
A total of 323 children and adolescents with probable peanut allergy completed the inhalation challenge. Fifty participants (15.5%) showed possible allergic reactions during or after exposure, of whom 10 (3.1%) exhibited objective reactions. Only four (1.2%) participants received medical treatment. No severe adverse events occurred, and no participants required hospitalization.
Conclusion:
The findings indicate that the risk of significant allergic reactions from airborne peanut exposure is low. These results may offer reassurance to patients, caregivers, and healthcare professionals regarding the safety of being in proximity to others consuming peanuts.
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