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A new abstract promoted during the American Thoracic Society’s annual meeting has received considerable media attention on the topic of children with asthma being prone to peanut sensitization. Sensitization means having a positive peanut test but no clear history of peanut allergy. The abstract authors suggest that children who have poorly controlled asthma may be more likely to have a peanut sensitization, and that parents should consider having kids with asthma tested for possible peanut allergy.

According to allergist Matthew Greenhawt, MD, FACAAI, “Such testing could potentially lead to misdiagnosis, and represents an unnecessary and unjustified use of resources.  While many of the children in the abstract are peanut sensitive on testing, it raises a question of relevance as to why testing was performed. There is no evidence that diagnosing peanut sensitization better controls chronic asthma. Chronic asthma is not a manifestation of peanut sensitization or allergy. There is no practical value to testing in this situation because these children are not showing any signs of possible peanut allergy.” 

Dr. Greenhawt is an assistant professor in the Division of Allergy and Clinical Immunology at the University of Michigan and member of U-M's Child Health Evaluation and Research and Evaluation Unit in the Department of Pediatrics. His commentary is on behalf of the American College of Allergy, Asthma, and Immunology (ACAAI).

Dr. Greenhawt offered additional points regarding this abstract and the use of food allergy testing in patients with asthma, so that these abstract findings are not misinterpreted:

  • A food allergy results in specific, acute symptoms (e.g., hives, wheezing, cough, vomiting, etc.), developing within approximately 2 hours of ingestion of a suspected allergen.   Without such history, testing is not indicated.   
  • Chronic, poorly controlled asthma is not an indication of a “hidden” food allergy.  Food allergen testing was not indicated in any of these patients. 
  • Positive allergy blood tests (or skin tests) alone are insufficient to make a diagnosis of food allergy.  Many more individuals test positive than will have actual food allergy.  Testing for the presence of sensitization to a food is of no value, and cannot be interpreted when positive if the patient does not develop symptoms after eating that particular food. 
  • While approximately 1/3 of food allergic children develop asthma, and asthma in a food allergic child is a risk factor for more severe reactions, these risks are not associated with the asthmatic child under poor control, without a presumption of a known food allergy. Existing food allergy guidelines do not indicate testing in this situation. However, such children may benefit from inhalant allergen testing to better their asthma control.

Peanut allergy affects approximately 1-1.5% of people in the US, and can be associated with severe reactions, which require emergency treatment with epinephrine.  If symptoms develop within 2 hours after eating peanuts, an individual should be referred to a board certified allergist/immunologist for further assessment and possible testing.  

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The ACAAI is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. The College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit Join us on Facebook, Pinterest and Twitter.

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