Journal List > Asia Pac Allergy > v.10(1) > 1142168

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

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.

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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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