Common Food Sensitivities, Allergens, and Intolerances PEANUT ALLERGY Wen Hsin Fan  Pui Yin Wong Thaoly Nguyen

Objective Define food sensitivity, intolerance, and allergy Common food and symptoms of food allergy Mechanism of Food allergy Diagnosis and treatment Recommendation from American Academy of Pediatrics Study agrees with the Recommendation Study against the Recommendation Strengths and weaknesses Conclusion

Definition Food sensitivity: Food intolerance: Food allergy: undesirable response caused by psychological dislike towards certain foods rather than to the foods themselves. Food intolerance: as an inability to digest and absorb a component of specific food proteins cause by an enzyme defect. Food allergy: the involvement of immunological responses which characterized by immunoglobulin E (lgE) antibodies to food proteins.

Food allergy Common food allergens: Symptoms: Cows’ milk, Peanuts, Tree nuts, Egg white, Wheat, Fish, Soy beans. Symptoms: Skin: hives, angioedema Respiratory tract: wheezing, repetitive cough, shortness of breath, voice change. Gastrointestinal tract: vomiting, diarrhea

Mechanism

Diagnosis and Treatment Immunoglobulin E (lgE) Skin prick test Treatment: Immunotherapy (OIT), oral Immunotherapy (SLIT), sublingual Immunotherapy (ECIT), epicutabeous

American Academy of Pediatric Recommendation Women with atopic diseases or have a family history (FH) of atopic symptoms should avoid the consumptions of dietary peanuts during pregnancy and lactation, and to avoid feeding peanuts to a child until age 3. However, the prevalence of peanut allergy in children doubled after the recommendation was initiated. This recommendation was withdrawn in 2000 due to lack of research support.

Support the recommendations Vadas, P., et al. "Detection of Peanut Allergens in Breast Milk of Lactating Women." JAMA : the journal of the American Medical Association 285.13 (2001): 1746-8. Print.

Detection of Peanut Allergen in Breast Milk of lactating Women Objective To investigate the ability of maternal dietary peanut protein to pass into breast milk during lactation. Participant 23 healthy, lactating women aged 21-35

Detection of Peanut Allergen in Breast Milk of lactating Women Methods Subjects are told to avoid legumes 24 hrs. prior breast milk collection Fasting overnight Obtained breast milk at time 0 hr. Ingested 50g peanut Breast milk is collected at 1,2,3,4,6,8,12 hr. Result 11/23 had detectable peanut protein in breast milk 48% of total participant

Figure 1. Time Course of Appearance of Peanut Protein in Breast Milk Subjects ingested 50 g of peanuts. Vadas, P. et al. JAMA 2001;285:1746-1748 Copyright restrictions may apply.

Detection of Peanut Allergen in Breast Milk of lactating Women Identified Peanut Protein Ara h 1 (66kd) Ara h 2 (17kd)

Conclusion Peanut allergen could be presented in breast milk Detection of Peanut Allergen in Breast Milk of lactating Women Conclusion Peanut allergen could be presented in breast milk Maternal peanut consumption may predispose at-risk children to develop sensitization.

Pros Cons Small sample size No statistic method to analysis the data Detail explanation on the method Collect a baseline data before peanut consumption Using graph & picture to present their result Small sample size No statistic method to analysis the data Pros Cons

Against the recommendations Objectives: To determine the prevalence of PA among Israel and UK Jewish children. Evaluate the relationship of PA to infant and maternal peanut consumptions.

Du Toit, G. , Katz, Y. , Sasieni, P. , Mesher, D. , Maleki, S. J Du Toit, G., Katz, Y., Sasieni, P., Mesher, D., Maleki, S. J., Fisher, H. R., et al. (2008). Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. The Journal of Allergy and Clinical Immunology, 122(5), 984-991.

1 2 3 2 1 3 Methods: Questionnaire determined prevalence of PA (FAQ) Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy Methods: Questionnaire determined prevalence of PA (FAQ) 2nd questionnaire assessed peanut consumption & weaning (FFQ) -Pupils -Parents 1 -Postal -Telephone 2 Validated against diagnostic criteria 3 Mother of Jewish infants ages 4-24 months 1 Explained the information 2 Compared & Completed (2004-2005) 3

UK vs. Israel 1.85% (73/3943) 0.17% (8/4657) Adjusted RR= 9.8 Primary school children 0.17% (8/4657) Adjusted RR= 9.8 (CI 3.1-30.5) P < .001 9 months of age 10% 9 months of age 69% Monthly consumptions of PN in 1st year of life (8 - 14months ) = 0.0g Monthly consumptions of PN in 1st year of life (8 - 14months )= 7.1g Median level of consumption/month=0 consumption/month = 8 breastfeeding (PN) Pregnancy P < .001 P=.004 P=.06

Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy Conclusions Peanuts introduced earlier and is eaten more frequently and in larger qualities in Israel than UK. Jewish children in the UK have a prevalence of PA that is 10X higher than Jewish children in Israel. This findings raise the question of whether avoidance will actually prevent the development of PA in infants or early introduction of PN.

environment into consideration socioeconomic class differences Large sample size Administer questionnaires (March 2004-2005) Tested for the amount of peanut protein contents Definition of PA Limited recall bias Allergy testing Did not take external environment into consideration Did not further expand on socioeconomic class differences Some children with peanut allergy were not assessed clinically Obtaining FA questionnaire PROS CONS

CONCLUSION The lack of understanding about the mechanism of PA and the available evidence does not support the accordance of peanuts during maternal exposure and the delayed introduction of peanuts in the diets of children. With FA diseases or symptoms should avoid the consumptions of peanut products. ( HIGHER CHANCE OF GETTING PA)

Research Keywords – Peanut allergy AND Pregnancy PubMed – 41 articles CAB Abstract – 26 articles Learn Early About Peanut Allergy (LEAP) http://www.leapstudy.co.uk/index.html

References Otsu, K., & Dreskin, S. C. (2011, October 14). Peanut allergy: an evolving  clinical challenge. Retrieved from  http://www.discoverymedicine.com/Kanao-Otsu/2011/10/14/peanut-allergy-an-evolving-clinical-challenge/  DesRoches, A., Infante-Rivard, C., Paradis, L., Paradis, J., & Haddad, E.  (2010). Peanut allergy: Is maternal transmission of antigens during  pregnancy and breastfeeding a risk factor? Journal of Investigational  Allergology & Clinical Immunology : Official Organ of the International  Association of Asthmology (INTERASMA) and Sociedad Latinoamericana De  Alergia e Inmunologia, 20(4), 289-294.  Du Toit, G., Katz, Y., Sasieni, P., Mesher, D., Maleki, S. J., Fisher, H.  R., et al. (2008). Early consumption of peanuts in infancy is associated  with a low prevalence of peanut allergy. The Journal of Allergy and  Clinical Immunology, 122(5), 984-991.  Sicherer, S. H., Wood, R. A., Stablein, D., Lindblad, R., Burks, A. W.,  Liu, A. H., et al. (2010). Maternal consumption of peanut during pregnancy  is associated with peanut sensitization in atopic infants. The Journal of  Allergy and Clinical Immunology, 126(6), 1191-1197.  Thompson, R. L., Miles, L. M., Lunn, J., Devereux, G., Dearman, R. J.,  Strid, J., et al. (2010). Peanut sensitisation and allergy: Influence of  early life exposure to peanuts. The British Journal of Nutrition, 103(9),  1278-1286.  Vadas, P., et al. "Detection of Peanut Allergens in Breast Milk of Lactating Women." JAMA : the journal of the American Medical Association 285.13 ( 2001): 1746-8. Print.

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