is there conclusive research of outgrowing PA?

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I am looking for conclusive studies that prove (or disprove) that children may "outgrow" a peanut allergy.

Today I met with my son's school principal and health tech, and the health tech insists that since the time my son was rast tested in 2000 there is new thoughts on weather it is possible to outgrow a peanut allergy.

On Jun 9, 2005

shannon, the last I read (which would have been here), your PA child has a 20% chance of outgrowing the allergy if they have not had an anaphylactic reaction. That's why I never even bother to enter discussions about the possibility of my son outgrowing his allergy - to me, until I read something different, it's not going to happen for us.

I understand you need the *definitive* study.

Try [url="http://www.allergicliving.com"]www.allergicliving.com[/url] and see if there is anything in their first issue (it's a magazine and website). I know there was an article about the vaccine and there is an article about the 10 top food allergens, but I haven't had an opportunity to read any of it yet.

I have a volunteer tea to go to this afternoon, but I'll try to check in later and see if anyone else has been able to help you find the information you need - and current information.

Is it possible to perhaps e-mail FAAN and ask them what they think now (although I usually don't agree with FAAN and don't find them always up-to-date - sorry, that's simply my opinion). And also, despite the fact that you're American, you could also e-mail Anaphylaxis Canada and ask them the same thing.

Also trying to think of the website for Calgary Allergy (something like cadvision) which might have up-to-date studies.

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

On Jun 9, 2005

thanks for your post, my son has had two anaphilactic reactions and one minor skin reaction. I really do not enter into these discussions either but this health tech is very persistant, she isists that since the letter that I have from an allergist dated 2000, that here have been great advances in research. I know she is full of it, but need to be able to give them documentation.

On Jun 9, 2005

shannon, curious, do you not enter into the outgrowing discussions because your child has had anaphylactic reactions and you've read about the 20% chance if you haven't had one?

Let me see what I can find later for you. There has to be something out there somewhere (and it's probably on here somewhere, I just can't think where - I have a witch of a migraine to-day and yet have to go out regardless).

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

On Jun 9, 2005

I do not discuss my son growing out of his PA, because I have never seen real evidence that it happens, and everything that I do know about PA says that it is very rare. I will not take that risk with my child's life. My understanding is that PA usually gets worse over time and not better.

On Jun 9, 2005

carefulmom's allergist told her that there was a new study out that showed that some children have a 50% chance of outgrowing peanut allergies. I am sorry that I don't know how to link. She discusses it on a post on Nov. 11, 2004 called "Interesting information from allergist today" on the main discussion board. Perhaps this is the study that was being referenced. carefulmom might know how to get a copy of the study since she is a physician.

On Jun 9, 2005

Here's a news article on it...

[url="http://uumor.pair.com/nutalle2/peanutallergy/Forum8/HTML/000768.html"]http://uumor.pair.com/nutalle2/peanutallergy/Forum8/HTML/000768.html[/url]

On Jun 12, 2005

shannon, hadn't forgotten about this.

Will this line from the link that nutternomore provided be enough:-

But for some kids, peanut allergies may not last a lifetime. New research shows while most children won't outgrow them, about 20 percent will.

I think, if it was me, I would like to have more than one article in hand.

Again, do have to ask, what does FAAN or Anaphylaxis Canada have to say about the percentage chance of outgrowing?

Let us know if you need more material - I'm willing to spend time finding it here on the board and elsewhere for you.

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

On Jan 31, 2006

I have no reasearch, just personal experience. My son was a 4+ and outgrew it last fall. Also a boy at church outgrew it as well. They were both allergic. Documented by sp testing, RAST and reactions. Good Luck!! Alicia

On Jan 31, 2006

Quote:

Originally posted by csc: [b]shannon, the last I read (which would have been here), your PA child has a 20% chance of outgrowing the allergy if they have not had an anaphylactic reaction. [/b]

another way to interpret this is that children who do outgrow their PA may be individuals who had "minor PA", who never would have had an anaphylactic reaction anyway... just an idea

On Jan 31, 2006

DD has grown INTO her PA at 18+ yrs. She has not had a severe reaction, and her Dr. isn't overly concerned about things like 'may contains', but if she's not anaphylactic, does she have any chance of outgrowing this again? I'm getting confused.

On Apr 8, 2006

I was talking about this to David's allergist. He said even though there is a chance of outgrowing PA, there are also cases in which those who have outgrown have re-developed PA.

On Apr 8, 2006

Why don't you do the RAST test just to see? I think your health tech is going on having heard this in the news -- NPR had something on it after Desforges' death. I had people say to me that they heard that it can be outgrown. I geuss I am in the denial stage where a nutritionist enraged me by googling one academic article and telling me that my son would NOT outgrow it --- in any case --- a little bit of knowledge --- makes for alot of know-it-alls. If it were me, I might satisfy them by redoing the RAST (not skin prick) test. You don't have to, of course. Or, you could back up the unlikelihood of outgrowing with a doctor's letter stating there is no reason to retest.

On Apr 8, 2006

Our allergist says it can be outgrown but the children that are the ones outgrowing it are the children that showed a allergy with testing when the testing was mainly being done for other allergens & they had not have a known reaction & the IgE were rather low to start with. I think in those cases it is likely higher.... I find when talking to other non-allergic people that have heard such wonderful stories they don't always realize that Some have never had a reaction while other have a long reaction history & the degree/level of the allergy is different...Its not so black & white.

On Apr 9, 2006

Hi Shannon,

I don't know if you are still looking for info. on studies about outgrowing PA, but below are the abstracts from a few scientific papers. I have the pdf files of the complete papers (for most of them) and I'd be happy to send them to you.

Some points that may be relevant for your situation are: A history of anaphylaxis makes it very unlikely that one would outgrow the allergy, although not impossible. In one study, 3 patients with initial anaphylaxis reactions outgrew the allergy (this is in contrast to another study which found no one with previous anaphlaxis passing the food challenge)

Generally, those who outgrew had lower RAST levels (at time of challenge) than those who did not.

Unless you were participating in a clinical trial, I think allergists don't perform a food challenge unless your peanut-specific IgE levels (from RAST) were really low (under 5). So, maybe you should have your child retested, just so you can say the number is so high (I'm assuming it'd be high with the history of anaphylaxis) that there is no way you can even safely test if the PA has been outgrown.

The 50% chance of outgrowing refers to those with peanut-specific IgE levels of 5 or less.

I used to hang on to the hope that my son would outgrew his PA because his RAST number was under 2 when he was first diagnosed (one of the reasons I read all those papers!) But sadly, his numbers went up considerably at his most recent test, so I don't expect him to outgrow it anymore.

Good luck!

J Allergy Clin Immunol. 2001 Feb;107(2):367-74. The natural history of peanut allergy.

Skolnick HS, Conover-Walker MK, Koerner CB, Sampson HA, Burks W, Wood RA.

Department of Pediatrics, Johns Hopkins University, Baltimore, Md, USA.

BACKGROUND: It has traditionally been assumed that peanut allergy is rarely outgrown. OBJECTIVE: The goal of this study was to determine the number of children with peanut allergy who become tolerant of peanut. METHODS: Patients aged 4 to 20 years with a diagnosis of peanut allergy were evaluated by questionnaire, skin testing, and a quantitative antibody fluorescent-enzyme immunoassay. Patients who had been reaction free in the past year and had a peanut IgE (PN-IgE) level less than 20 kilounits of antibody per liter (kU(A)/L) were offered an open or double-blind, placebo-controlled peanut challenge. RESULTS: A total of 223 patients were evaluated, and of those, 85 (PN-IgE < 0.35-20.4 kU(A)/L [median 1.42 kU(A)/L]) participated in an oral peanut challenge. Forty-eight (21.5%) patients had negative challenge results and were believed to have outgrown their peanut allergy (aged 4-17.5 years [median 6 years]; PN-IgE < 0.35-20.4 kU(A)/L [median 0.69 kU(A)/L]). Thirty-seven failed the challenge (aged 4-13 years [median 6.5 years]; RAST < 0.35-18.2 kU(A)/L [median 2.06 kU(A)/L]). Forty-one patients with PN-IgE levels less than 20 kU(A)/L declined to undergo challenge, and 97 were not eligible for challenge because their PN-IgE levels were greater than 20 kU(A)/L or they had had a recent reaction. Sixty-seven percent of patients with PN-IgE levels less than 2 kU(A)/L and 61% with levels less than 5 kU(A)/L had negative challenge results. Of those who underwent challenge, PN-IgE levels for those who passed versus those who failed were different at the time of challenge (P = .009), but not at the time of diagnosis (P = .25). CONCLUSION: This study demonstrates that peanut allergy is outgrown in about 21.5% of patients. Patients with low PN-IgE levels should be offered a peanut challenge in a medical setting to demonstrate whether they can now tolerate peanuts.

Ann Allergy Asthma Immunol. 2000 Dec;85(6 Pt 1):473-6. Resolution of childhood peanut allergy.

Spergel JM, Beausoleil JL, Pawlowski NA.

Division of Immunologic and Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.

BACKGROUND: Peanut allergy creates great fear in many families because it is one of the leading causes of fatal and near-fatal food-induced allergies. Earlier reports suggested that peanut allergy was life-long, but a recent study described resolution of peanut allergy in some children. OBJECTIVE: Tolerance to peanut allergy in childhood was studied. Examination of the natural history of childhood peanut allergy was explored. METHODS: A retrospective review of all children with peanut allergy seen at the Children's Hospital of Philadelphia in a 3-year period (n = 293). Children with histories of peanut allergy were challenged at the mean age [3.8 years; range 1.5 to 8 year] which was 1.8 years [range: 0.5 to 6.8 years], following their last known clinical reaction. Food allergy or tolerance was confirmed by open challenges. RESULTS: Thirty-three patients with histories of peanut allergy and a positive skin test to peanut underwent oral challenges. Not one patient (n = 5) with a history of peanut anaphylaxis developed tolerance to peanuts. In comparison, 9 of 17 patients with history of urticaria upon ingestion to peanuts developed tolerance. Also, 4 of 10 patients with flaring of their atopic dermatitis upon ingestion to peanuts developed tolerance. The 14 patients with a negative challenge to peanut had a significantly smaller wheal and flare reaction than the 19 patients with positive challenges. Tolerance to peanut was documented by a positive challenge reverting to a negative challenge in one patient. Oral challenge of 13 additional patients with positive skin tests and histories of only refusing to eat peanut resulted in 5 (39%) positive challenges. CONCLUSION: A selected group of peanut-allergic children, who do not have a history anaphylaxis to peanut, may develop tolerance to peanuts.

Pediatr Allergy Immunol. 2004 Oct;15(5):449-53. General paediatricians and the case of resolving peanut allergy.

Rangaraj S, Ramanathan V, Tuthill DP, Spear E, Hourihane JO, Alfaham M.

Department of Child Health, Llandough Hospital, Penarth, Cardiff, UK.

Children with peanut allergy are almost always advised to avoid nuts for life. There have been recent reports from academic centres that in some cases the allergy might resolve and thus these dietary restrictions can be lifted. To evaluate resolution of peanut allergy in a selected group of children in a general paediatric setting. Children 4-16 yr old with a clear history of an allergic reaction to peanuts who had not had any reaction in the previous 2 yr were eligible. Specific immunoglobulin E (IgE) or skin prick test (SPT) at the time of diagnosis was sought. A SPT and specific IgE was then done and if this was

J Allergy Clin Immunol. 2003 Jul;112(1):12-4.

The natural progression of peanut allergy: Resolution and the possibility of recurrence.

Fleischer DM, Conover-Walker MK, Christie L, Burks AW, Wood RA.

Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.

BACKGROUND: It was once thought that peanut allergy is a lifelong problem. We previously reported that about 20% of children outgrow their peanut allergy and that more than 60% of patients with a peanut-IgE level of 5 or less passed an oral challenge. OBJECTIVE: The goal of this study was to further describe the natural progression of peanut allergy by reviewing patients who have undergone oral peanut challenges since the previous study. METHODS: Patients with peanut-IgE levels of 5 or less were offered a peanut challenge. Those who passed were further evaluated by questionnaire to assess reintroduction of peanut into their diet and whether any recurrence has occurred. RESULTS: Eighty-four patients were evaluated, and 80 underwent complete analysis. Fifty-five percent with peanut-IgE levels of 5 or less and 63% with peanut-IgE levels of 2 or less passed challenges, compared to 61% and 67%, respectively, in our previous study. The 4 additional patients passed peanut challenges in this study after previously failing. Three patients with initial anaphylactic reactions and 2 patients with initial peanut-IgE levels greater than 70 passed their challenge. Follow-up of those who passed in both studies showed that the majority of patients reintroduced peanut into their diet, but that continued label reading, infrequent/limited ingestion, and aversion to peanut were all common in this population. Two patients had suspected subsequent reactions to peanut after passing their challenge. CONCLUSIONS: Patients with a history of peanut allergy and peanut-IgE levels of 5 or less have at least a 50% chance of outgrowing their allergy. Recurrence of peanut allergy may occur but appears to be uncommon.

BMJ. 1998 Apr 25;316(7140):1271-5. Resolution of peanut allergy: case-control study.

Hourihane JO, Roberts SA, Warner JO.

Child Health, University of Southampton, Southampton SO16 6YD. [email]J.Hourihane@ich.ucl.ac.uk[/email]

OBJECTIVES: To determine whether there are any differences between children who remain mildly or moderately allergic to peanut and children with similar histories but a negative reaction on challenge with peanut. DESIGN: Case-controls matched for age and sex. SETTING: Children's day wards in two teaching hospitals. INTERVENTION: Open food challenge with peanut. SUBJECTS: 15 children with resolved peanut allergy (resolvers) and 15 with persistent allergy (persisters). MAIN OUTCOME MEASURE: Reaction on challenge with peanut, serum total and peanut specific IgE concentrations. RESULTS: The groups had a similar median age at first reaction to peanut (11 months, range 5-38) and similar symptoms. Allergy to other foods was less common in resolvers (2/15) than persisters (9/15) (P=0.02). On skin prick testing with peanut all 13 resolvers tested but only 3/14 persisters had a weal of <6 mm (P<0.0001). Total and peanut specific IgE concentrations did not differ much between the groups. CONCLUSION: Appropriately trained clinicians must be prepared to challenge preschool children with peanut as some will be tolerant despite a history of reactions to peanut and a positive skin prick test with peanut. Preschool children whose apparent peanut allergy is refuted by food challenge show allergy to other foods less often than those in whom peanut allergy persists. The size of weal on skin prick testing to peanut predicts reactivity but not severity on peanut challenge.

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