A new, widely publicized study released at the American Thoracic Society’s 2015 annual meeting reveals many children with asthma may also have sensitivity to peanuts, and not know it. However, some allergists are concerned the research could lead to unnecessary peanut allergy testing, misdiagnosis, anxiety and inappropriate dietary restrictions.
Lead study author Robert Cohn, MD, from Mercy Children’s Hospital in Toledo, Ohio, suggested that children with asthma “might benefit from a test for peanut sensitivity, especially when control of wheezing and coughing is difficult to achieve.” Sensitivity means having a positive peanut allergy test but no medical history of peanut allergy symptoms.
Soon after the study was announced, the American College of Allergy, Asthma & Immunology (ACAAI) issued a press release emphasizing that children with asthma do not need to undergo routine testing for peanut allergy. The American Academy of Allergy, Asthma & Immunology (AAAAI) also issued a media alert on the topic.
A diagnosis of peanut allergy begins with a medical history of acute symptoms, such as hives, coughing or vomiting, within minutes to two hours of the ingestion of peanuts, says M. Razi Rafeeq, MD, a Toledo-based board-certified allergist and volunteer with Allergy & Asthma Network’s Anaphylaxis Community Experts (ACE) program.
“Without such a history, peanut allergy testing is not indicated,” Dr. Rafeeq says.
Chronic, poorly controlled asthma is not a sign of hidden peanut sensitization or allergy, says Matthew Greenhawt, MD, assistant professor at University of Michigan Health System’s Division of Allergy and Clinical Immunology.
Further, positive allergy blood tests (or skin tests) alone are insufficient in making a diagnosis of food allergy, Dr. Greenhawt adds. “There is no practical value to testing when a child is not showing any signs of possible peanut allergy.”
Approximately one-third of food-allergic children develop asthma, and asthma in food-allergic children is a risk factor for more severe reactions. However, these risks are not associated with children with poorly controlled asthma who do not have a known food allergy, Dr. Greenhawt says.
The study evaluated 1,516 children from the pediatric pulmonary clinic at Mercy Children’s Hospital. Almost 10 percent (148) had previously undergone IgE blood tests that revealed sensitivity to peanuts. While more than half of the children with positive tests and their families did not suspect any sensitivity to peanuts, researchers suggested it could be a factor in the children’s asthma.
“Many of the respiratory symptoms of peanut allergy can mirror those of an asthma attack, and vice versa,” Dr. Cohn says. “The study aimed to evaluate the proportion of children with asthma who also demonstrated a sensitivity to peanuts.”