An evaluation of the sensitivity of subjects with peanut allergy to very low doses of peanut protein: A randomized, double-blind, placebo-controlled food challenge study

doi:10.1016/S0091-6749(97)70161-1

Journal of Allergy and Clinical Immunology

Volume 100, Issue 5, November 1997, Pages 596-600

https://doi.org/10.1016/S0091-6749(97)70161-1 Get rights and content

Abstract

Background: The minimum dose of food protein to which subjects with food allergy have reacted in double-blind, placebo-controlled food challenges is between 50 and 100 mg. However, subjects with peanut allergy often report severe reactions after minimal contact with peanuts, even through intact skin. Objective: We sought to determine whether adults previously proven by challenge to be allergic to peanut react to very low doses of peanut protein. Methods: We used a randomized, double-blind, placebo-controlled food challenge of 14 subjects allergic to peanuts with doses of peanut ranging from 10 μg to 50 mg, administered in the form of a commercially available peanut flour. Results: One subject had a systemic reaction to 5 mg of peanut protein, and two subjects had mild objective reactions to 2 mg and 50 mg of peanut protein, respectively. Five subjects had mild subjective reactions (1 to 5 mg and 4 to 50 mg). All subjects with convincing objective reactions had short-lived subjective reactions to preceding doses, as low as 100 μg in two cases. Five subjects did not react to any dose up to 50 mg. Conclusion: Even in a group of well-characterized, highly sensitive subjects with peanut allergy, the threshold dose of peanut protein varies. As little as 100 μg of peanut protein provokes symptoms in some subjects with peanut allergy. (J Allergy Clin Immunol 1997;100:596-600.)

Section snippets

Subjects

Fourteen adult subjects (2 men and 12 women), from a group of 60 subjects who participated in a previous study of the in vivo allergenicity of peanut oils, were enrolled in the study.¹² Six subjects (nos. 2, 3, 4, 8, 10, and 13) were selected for this study on the basis of having reacted to the crude peanut oil (implying high sensitivity). Two of the six subjects who reacted to crude oil also had positive reactions to peanut challenge, and four were not challenged with peanut protein after

Results

Results for each subject are shown in Table I.

. DBPCFC with peanut flour

Patient No.	Age (yr)	SPT wheal (mm)	Duration of challenge (min)	Total No. of doses (peanut and placebo)	Reaction to preceding doses	Provoking dose	Cumulative dose of peanut protein	Reaction	Clinical impression
1	26	7	115	11		Placebo	0.43 mg	Oral itching	Reaction to placebo
2	17	10	240	18	250 μg, 500 μg, 1 mg, 2 mg	5 mg	8.93 mg	Lip tingling, throat itching, anxiety	Subjective reaction to 5 mg dose
3	37	10	330	24	5 mg, 10 mg, 20 mg	50 mg	88.93 mg	Itchy throat

Discussion

Peanut allergy is the most common cause of fatal food–related allergic reactions.3, 4 Many subjects react to foods in which the initial source of peanut is not obvious, and they may occasionally have been reassured that peanuts were absent from the offending food.²¹ The implication is that the food has become adulterated with peanut during the preparation of the meal. The dose of peanut that has adulterated the meal must be low, or persons without peanut allergy would be able to detect a peanut

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Clinical study of peanut and nut allergy in 62 consecutive patients: new features and associations

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For the increasing number of consumers with food allergies in the United States, dining out may pose serious health threats. Both restaurateurs and consumers need to be vigilant to prevent food allergy reactions in restaurants, but empirical studies that explored knowledge, attitudes, and behaviors of consumers with food allergies are limited. Therefore, this research aimed to examine food allergy knowledge, attitudes and behaviors of customers with food allergies or parents or guardians with children with food allergies by conducting focus groups and a cross-sectional survey. Customers with food allergies (n = 63) and parents or guardians of children with food allergies (n = 257), who were members of a food allergy social networking website, participated in the survey. Due to the nature of the website, in which members share their dining experience and recommendations, only 2.8% of participants indicated that they have never eaten at a restaurant. The average knowledge score of participants was 24.7 out of 30 (82.3%), and they well recognized typical causes of food allergy reactions in restaurants (i.e., hidden allergens, cross-contacts, and restaurant employees’ lack of knowledge, care, and communication about food allergies). Customers with food allergies took a variety of actions to prevent food allergy reactions before or during their visits to restaurants. Depending on the types of food allergens and previous dining experiences, respondents voiced diverse concerns about different types of restaurants. Restaurateurs may benefit from recognizing and addressing these concerns to improve their service for customers with food allergies.
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^☆: From ^aUniversity Child Health, Southampton General Hospital, Southampton; and ^bthe Department of Food Science & Technology, Food Allergy Research and Resource Program, Institute of Agriculture and Natural Resources, University of Nebraska, Lincoln.

^☆☆: Reprint requests: Jonathan O'B. Hourihane, MD, Institute of Child Health, 30 Guilford St., London WC1N 1EH, England.

^★: 1/1/84498

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An evaluation of the sensitivity of subjects with peanut allergy to very low doses of peanut protein: A randomized, double-blind, placebo-controlled food challenge study☆,☆☆,★

Abstract

Section snippets

Subjects

Results

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Lancet

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Food Protection

Clinical study of peanut and nut allergy in 62 consecutive patients: new features and associations

BMJ