Paeds Vivas · allergy-and-immunology
Peanut, tree-nut and seed allergy — branching viva
Structured oral on IgE-mediated nut and seed allergy: anaphylaxis first-line therapy, the LEAP prevention evidence, component-resolved diagnostics versus sensitisation, and oral immunotherapy shared decision-making.
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Examiner: This child has peanut allergy and asthma. How will you frame the consultation for the family? [3]
Strong answer: I would confirm the diagnosis is challenge-confirmed or based on a clear history with supportive testing, reassure the family that the plan is built around keeping her safe rather than only restricting her, and signal that we will address three things: whether she will outgrow it, whether all nuts must be avoided, and whether immunotherapy is appropriate. I would also note that her asthma must be well controlled, because asthma is the strongest risk factor for fatal food anaphylaxis. [3]
References6ShowHide
- [1]Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med, 2015.PMID 25705822
- [3]Peters RL, Allen KJ, Dharmage SC, et al. Natural history of peanut allergy and predictors of resolution in the first 4 years of life. J Allergy Clin Immunol, 2015.PMID 25725989
- [6]Vickery BP, Vereda A, Casale TB, et al. AR101 Oral Immunotherapy for Peanut Allergy. N Engl J Med, 2018.PMID 30449234
- [7]Jones SM, Kim EH, Nadeau KC, et al. Efficacy and safety of oral immunotherapy in children aged 1-3 years with peanut allergy. Lancet, 2022.PMID 35065784
- [12]Shaker MS, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations. J Allergy Clin Immunol, 2020.PMID 32001253
- [14]Santos AF, et al. EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy, 2023.PMID 37815205