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Accidental ingestions in children with peanut allergy.

https://arctichealth.org/en/permalink/ahliterature168012
Source
J Allergy Clin Immunol. 2006 Aug;118(2):466-72
Publication Type
Article
Date
Aug-2006
Author
Joyce W Yu
Rhoda Kagan
Nina Verreault
Nathalie Nicolas
Lawrence Joseph
Yvan St Pierre
Ann Clarke
Author Affiliation
Division of Pediatric Allergy and Clinical Immunology, McGill University Health Centre, 1650 Cedar Avenue L10-413, Montreal, Quebec, Canada.
Source
J Allergy Clin Immunol. 2006 Aug;118(2):466-72
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Child
Child, Preschool
Environmental Exposure
Female
Humans
Immunoglobulin E - blood
Male
Peanut Hypersensitivity - epidemiology
Quebec - epidemiology
Questionnaires
Abstract
Accidental exposure to peanut has been reported to occur frequently. Total avoidance of peanut is difficult because of its widespread use, manufacturing and labeling errors, utensil contamination, and label misinterpretation.
Given the apparent increased awareness of peanut allergy by both consumers and food manufacturers, we aimed to determine the current frequency of accidental exposures occurring in peanut allergic children in Quebec and to identify factors associated with exposure.
The parents of children with peanut allergy diagnosed at the Montreal Children's Hospital completed questionnaires about accidental exposure to peanut occurring over the period of the preceding year. Logistic regression was used to identify associated factors.
Of 252 children, 62% were boys, with a mean age of 8.1 years (SD, 2.9). The mean age at diagnosis was 2.0 years (SD, 2.1). Thirty-five accidental exposures occurred in 29 children over a period of 244 patient-years, yielding an annual incidence rate of 14.3% (95% CI, 10.0% to 19.9%). Fifteen reactions were mild, 16 moderate, and 4 severe. Of 20 reactions that were moderate to severe, only 4 received epinephrine. Eighty percent of children attended schools prohibiting peanut, and only 1 accidental exposure occurred at school. No associated factors were identified.
Accidental exposure to peanut occurs at a lower frequency than previously reported, but most reactions are managed inappropriately.
Enhanced awareness, access to safer environments, and good food manufacturing practices may have contributed to a lower incidence of inadvertent peanut exposure, but a further reduction and better education on allergy management are desirable.
PubMed ID
16890773 View in PubMed
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Establishing the diagnosis of peanut allergy in children never exposed to peanut or with an uncertain history: a cross-Canada study.

https://arctichealth.org/en/permalink/ahliterature143759
Source
Pediatr Allergy Immunol. 2010 Sep;21(6):920-6
Publication Type
Article
Date
Sep-2010
Author
Moshe Ben-Shoshan
Rhoda Kagan
Marie-Noël Primeau
Reza Alizadehfar
Elizabeth Turnbull
Laurie Harada
Claire Dufresne
Mary Allen
Lawrence Joseph
Yvan St Pierre
Ann Clarke
Author Affiliation
Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada. daliamoshebs@gmail.com
Source
Pediatr Allergy Immunol. 2010 Sep;21(6):920-6
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Algorithms
Canada
Child
Child, Preschool
Diagnosis, Differential
Environmental Exposure
Humans
Immunoglobulin E - blood
Infant
Male
Medical History Taking
Peanut Hypersensitivity - diagnosis - epidemiology - immunology
Practice Guidelines as Topic
Skin Tests
Abstract
The diagnosis of peanut allergy (PA) can be complex especially in children never exposed to peanut or with an uncertain history. The aim of the study is to determine which diagnostic algorithms are used by Canadian allergists in such children. Children 1-17 yrs old never exposed to peanut or with an uncertain history having an allergist-confirmed diagnosis of PA were recruited from the Montreal Children's Hospital (MCH) and allergy advocacy organizations. Data on their clinical history and confirmatory testing were compared to six diagnostic algorithms: I. Skin prick test (SPT) >or=8 mm or specific IgE >or=5 kU/l or positive food challenge (+FC); II. SPT >or=8 or IgE >or=15 or +FC; III. SPT >or=13 or IgE >or=5 or +FC; IV. SPT >or=13 or IgE >or=15 or +FC; V. SPT >or=3 and IgE >or=5 or IgE >or=5 or +FC; VI. SPT >or=3 and IgE >or=15 or IgE >or=15 or +FC. Multivariate logistic regression analysis was used to identify factors associated with the use of each algorithm. Of 497 children recruited, 70% provided full data. The least stringent algorithm, algorithm I, was applied in 81.6% (95% CI, 77-85.6%) of children and the most stringent, algorithm VI, in 42.6% (95% CI, 37.2-48.1%).The factor most associated with the use of all algorithms was diagnosis made at the MCH in those never exposed to peanut. Other factors associated with the use of specific diagnostic algorithms were higher paternal education, longer disease duration, and the presence of hives, asthma, eczema, or other food allergies. Over 18% (95% CI, 14.4-23.0%) of children were diagnosed with PA without fulfilling even the least stringent diagnostic criteria.
PubMed ID
20444161 View in PubMed
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Is the prevalence of peanut allergy increasing? A 5-year follow-up study in children in Montreal.

https://arctichealth.org/en/permalink/ahliterature151661
Source
J Allergy Clin Immunol. 2009 Apr;123(4):783-8
Publication Type
Article
Date
Apr-2009
Author
Moshe Ben-Shoshan
Rhoda S Kagan
Reza Alizadehfar
Lawrence Joseph
Elizabeth Turnbull
Yvan St Pierre
Ann E Clarke
Author Affiliation
Department of Pediatrics, Division of Clinical Immunology/Allergy and Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada.
Source
J Allergy Clin Immunol. 2009 Apr;123(4):783-8
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Arachis hypogaea - immunology
Canada - epidemiology
Child
Cross-Sectional Studies
Female
Follow-Up Studies
Humans
Immunoglobulin E - blood
Male
Peanut Hypersensitivity - epidemiology
Prevalence
Abstract
Studies suggest that peanut allergy prevalence might be increasing, but these results have not yet been substantiated.
We conducted a follow-up study to determine whether peanut allergy prevalence in Montreal is increasing.
Questionnaires regarding peanut ingestion were administered to parents of children in randomly selected kindergarten through grade 3 classrooms between December 2000 and September 2002 and between October 2005 and December 2007. Respondents were stratified as (1) peanut tolerant, (2) never/rarely ingest peanut, (3) convincing history of peanut allergy, or (4) uncertain history of peanut allergy. Children in group 3 with positive skin prick test responses were considered to have peanut allergy. Children in groups 2 and 4 with positive skin prick test responses had peanut-specific IgE levels measured, and if the value was less than 15 kU/L, an oral peanut challenge was performed. Multiple imputation was used to generate prevalence estimates that incorporated respondents providing incomplete data and nonrespondents.
Of 8,039 children surveyed in 2005-2007, 64.2% of parents responded. Among those providing complete data, the prevalence was 1.63% (95% CI, 1.30% to 2.02%) in 2005-2007 versus 1.50% (95% CI, 1.16% to 1.92%) in 2000-2002. After adjustment for missing data, the prevalence was 1.62% (95% credible interval, 1.31% to 1.98%) versus 1.34% (95% credible interval, 1.08% to 1.64%), respectively. The differences between the prevalences in 2005-2007 and 2000-2002 were 0.13% (95% credible interval, -0.38% to 0.63%) among those providing complete data and 0.28% (95% credible interval, -0.15% to 0.70%) after adjustment for missing data.
This is the first North American study to document temporal trends in peanut allergy prevalence by corroborating history with confirmatory tests. The results suggest a stable prevalence, but wide CIs preclude definitive conclusions.
PubMed ID
19348918 View in PubMed
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Prevalence of peanut allergy in primary-school children in Montreal, Canada.

https://arctichealth.org/en/permalink/ahliterature182536
Source
J Allergy Clin Immunol. 2003 Dec;112(6):1223-8
Publication Type
Article
Date
Dec-2003
Author
Rhoda S Kagan
Lawrence Joseph
Claire Dufresne
Katherine Gray-Donald
Elizabeth Turnbull
Yvan St Pierre
Ann E Clarke
Author Affiliation
Department of Pediatrics, McGill University Health Care Centre, Montreal, Quebec, Canada.
Source
J Allergy Clin Immunol. 2003 Dec;112(6):1223-8
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Arachis hypogaea - immunology
Canada - epidemiology
Child
Child, Preschool
Double-Blind Method
Humans
Immunoglobulin E - blood - immunology
Peanut Hypersensitivity - epidemiology
Prevalence
Questionnaires
Schools
Skin Tests
Abstract
Peanut allergy is receiving increasing attention. Only one study has estimated the prevalence in North America, but it did not corroborate history with diagnostic testing.
We estimated the prevalence of peanut allergy in Montreal by administering questionnaires regarding peanut ingestion to children in kindergarten through grade 3 in randomly selected schools.
Respondents were stratified as follows: (1). peanut tolerant, (2). never-rarely ingest peanut, (3). convincing history of peanut allergy, and (4). uncertain history of peanut allergy. Groups 2, 3, and 4 underwent peanut skin prick tests (SPTs), and if the responses were positive in groups 2 or 4, measurement of peanut-specific IgE were undertaken. Children in group 3 with a positive SPT response were considered allergic to peanut without further testing. Children in groups 2 and 4 with peanut-specific IgE levels of less than 15 kU/L underwent oral peanut challenges.
Of the 7768 children surveyed, 4339 responded, 94.6% in group 1. The prevalence of peanut allergy was 1.50% (95% CI, 1.16%-1.92%). When multiple imputation was used to incorporate data on those responding to the questionnaire but withdrawing before testing, the estimated prevalence increased to 1.76% (95% CI, 1.38%-2.21%). When data regarding the peanut allergy status of nonresponders (as declared to the school before the study) were also incorporated, the estimated prevalence was 1.34% (95% CI, 1.08%-1.64%).
Our prevalence study is the first in North America to corroborate history with confirmatory testing and the largest worldwide to incorporate these techniques. We have shown that, even with conservative assumptions, prevalence exceeds 1.0%.
PubMed ID
14657887 View in PubMed
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