A 5-year retrospective review of children with peanut allergy in the largest paediatric hospital in Singapore

May Ping Lee; Seyed Ehsan Saffari; Wenyin Loh; Si Hui Goh; Anne Goh; Wen Chin Chiang; Kok Wee Chong

doi:10.5415/apallergy.2020.10.e6

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Lee, Saffari, Loh, Goh, Goh, Chiang, and Chong: A 5-year retrospective review of children with peanut allergy in the largest paediatric hospital in Singapore

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Asia Pac Allergy 2020;10(1):e6.

Published online: 4 January 2020

DOI: https://doi.org/10.5415/apallergy.2020.10.e6

A 5-year retrospective review of children with peanut allergy in the largest paediatric hospital in Singapore

May Ping Lee^1,^*, Seyed Ehsan Saffari², Wenyin Loh¹, Si Hui Goh¹, Anne Goh¹, Wen Chin Chiang¹, Kok Wee Chong¹

¹Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore

²Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Medical School, Singapore

^*Correspondence to May Ping Lee Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. Tel: +65-6394-7236 Fax: +65-6291-7923 E-mail: samantha.lee.mp@singhealth.com.sg

Revised 29 November 2019 Accepted 23 January 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The prevalence of peanut allergy (PA) among children has increased significantly over the past decade. Even though the prevalence of PA in Singapore is considered low, peanut is the top trigger for food-induced anaphylaxis in Singaporean children.

Objective

To describe the demographic characteristics and clinical features of children with PA.

Methods

This is a 5-year retrospective review of children diagnosed with PA based on clinical history coupled with a positive skin prick test to peanut or positive oral food challenge results.

Results

There were 269 patients (53.9% males) with a clinical diagnosis of PA. The median age at first allergic presentation for the PA group was 24 months old, with interquartile range of 13–39 months. The most common form of peanut introduced was roasted peanut. The rate of peanut anaphylaxis was 7.1%. Concomitant tree nut sensitization was found in 32.3% of this cohort, predominantly to cashew nut. Majority of them have a personal history of atopy – 75.8% with eczema, 63.6% with allergic rhinitis, and 19.7% with asthma.

Conclusion

This is the first large review of peanut-allergic children in Singapore. Prospective population-based studies are needed to establish the true prevalence and risk factors associated with the development of this potentially life-threatening condition.

Keywords: Peanut allergy, Children, Singapore, Asia

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Table 1.

Demographic and clinical characteristics of peanut allergy and peanut tolerant groups

Variable	Peanut allergy (PA) (n = 269)	Peanut tolerant (PT) (n = 59)	p value^†
Demographics
Male sex	145 (53.9)^*	37 (62.7)	0.218
Age (yr)	3.9 ± 3.2	3.7 ± 3.3	0.633
Race, Chinese	184 (68.4)	39 (66.1)	0.732
History of atopy
Rhinitis^∥	171 (63.6)	24 (40.7)	<0.01
Atopic dermatitis^∥	204 (75.8)	47 (79.7)	0.530
Asthma^¶	53 (19.7)	9 (15.3)	0.429
Drug allergy^∥	14 (5.2)	4 (6.8)	0.630
Urticaria/angioedema^∥	27 (10.1)	9 (15.3)	0.250
Tree nut sensitisation	87 (32.3)	15 (25.4)	0.299
Other food allergies^**	149 (55.4)	26 (44.1)	0.114
Investigation results
SPT wheal size (mm)	10.2 ± 5.5	5.2 ± 3.3	<0.01
IgE to peanut (kU/L)	22.8 ± 30.7	7.6 ± 19.3	<0.05

Values are presented as number (%) or mean ± standard deviation.

SPT, skin prick test.

^† Comparing the 2 groups (PA and PT); 2-sided 2 independent sample t test for continuous variables and chi-square/Fisher exact test for categorical variables.

^∥ Parental report of patient's history of rhinitis, atopic dermatitis, drug allergy and urticaria/angioedema.

^¶ Physician-diagnosed asthma.

^** Clinical diagnosis of food allergy based on clinical history and positive SPT/IgE.

Table 2.

Univariate and multivariable analysis of demographics, atopic history, and investigation parameters with peanut allergy

Variable	Unadjusted OR (95% CI)^*	p value	Adjusted OR (95% CI)^†	p value
Demographics
Male sex	0.70 (0.39–1.25)	0.228	0.68 (0.38–1.23)	0.200
Age (yr)	1.57 (0.89–2.78)	0.122	1.18 (0.64–2.18)	0.598
Race, Chinese	1.12 (0.62–2.03)	0.709	1.03 (0.56–1.88)	0.936
History of atopy
Rhinitis^‡	2.52 (1.42–4.47)	<0.01	2.39 (1.30–4.38)	<0.01
Atopic dermatitis^‡	0.82 (0.41–1.63)	0.575	0.80 (0.40–1.62)	0.541
Asthma^§	1.31 (0.61–2.81)	0.482	0.90 (0.40–2.02)	0.792
Drug allergy^‡	0.70 (0.23–2.16)	0.534	0.45 (0.14–1.46)	0.182
Urticaria/angioedema^‡	0.61 (0.27–1.36)	0.223	0.67 (0.29–1.53)	0.345
Tree nut sensitisation^∥	1.38 (0.73–2.60)	0.324	1.33 (0.70–2.54)	0.378
Other food allergies^∥	1.57 (0.89–2.76)	0.118	1.57 (0.87–2.84)	0.132
Investigation results
SPT wheal size (mm)^¶	4.68 (2.32–9.41)	<0.01	1.32 (1.20–1.45)	<0.01
IgE to peanut (kU/L)^¶	1.96 (0.63–6.11)	0.244	1.09 (1.02–1.17)	<0.05

OR, odds ratio; CI, confidence interval; SPT, skin prick test.

^* Odds ratio (OR) using univariate logistic regression analysis.

^† Odds ratio using multivariable logistic regression analysis; adjusted for age and rhinitis.

^‡ Parental report of patient's history of rhinitis, atopic dermatitis, drug allergy, and urticaria/angioedema.

^§ Physician-diagnosed asthma.

^∥ Clinical diagnosis of food allergy based on clinical history and positive SPT/IgE.

^¶ Odds ratio is reported for the risk of SPT ≥ 3 mm, and serum IgE ≥ 0.35 kU/L.

Table 3.

Clinical manifestation of children with peanut allergy (n = 269)

Clinical manifestation	No. (%)
Mucocutaneous	233 (86.6)
Eye angioedema	70 (26.0)
Lip angioedema	42 (15.6)
Urticaria	84 (31.2)
Maculopapular rash	4 (1.5)
Rash: not specified	109 (40.5)
Respiratory	215 (80.0)
Sneezing	179 (66.5)
Runny nose	65 (24.2)
Cough	16 (5.9)
Stridor/voice hoarseness	4 (1.5)
Wheeze	20 (7.4)
Dyspnoea	20 (7.4)
Gastrointestinal	51 (18.9)
Vomiting	50 (18.6)
Abdominal pain	7 (2.6)
Diarrhoea	1 (0.4)
Cardiovascular	3 (1.1)
Drowsiness/lethargy	3 (1.1)
Anaphylaxis	19 (7.1)

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