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

2. 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

3. 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.

4. 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

5. Mechanism

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

7. 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This recommendation was withdrawn in 2000 due to lack of research support.

8. 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 (2001): Print.

9. 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

10. 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

11. 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:
Copyright restrictions may apply.

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

13. 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.

14. 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

15. 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.

16. 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),

17. 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
( ) 3

18. 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 )
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

19. 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.

20. environment into consideration socioeconomic class differences
Large sample size
Administer questionnaires
(March )
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

21. 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)

22. Research Keywords – Peanut allergy AND Pregnancy PubMed – 41 articles
CAB Abstract – 26 articles
Learn Early About Peanut Allergy (LEAP)

23. References
Otsu, K., & Dreskin, S. C. (2011, October 14). Peanut allergy: an evolving  clinical challenge. Retrieved from  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),   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),   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),   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),   
Vadas, P., et al. "Detection of Peanut Allergens in Breast Milk of Lactating Women." JAMA : the journal of the American
Medical Association ( 2001): Print.

24. Thank you