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Food Allergy Case Study for Pediatricians – Explanation to Question 6

The parents want to know if Jack will outgrow his food allergy. Which is the most appropriate statement?

Explanation to Question 6

Peanut, tree nut, shellfish, and fish allergy are often lifelong. For example, less than 10% of patients develop tolerance to tree nuts and, at most, 20% of patients outgrow peanut allergy. There is also a risk of recurrence of allergy, especially among patients who fail to regularly ingest the offending allergen after resolution of their allergy. For example, recurrence of peanut allergy occurs in roughly 8% of patients who experienced resolution. Patients should continue to carry epinephrine until they have demonstrated ongoing tolerance to the offending allergen.

Most children will develop tolerance to milk, egg, soy, and wheat allergy. For example, over 75% of patients will develop tolerance to egg by 7 years of age. Similarly, a majority of children with milk allergy will develop tolerance by 5 years of age.

There is evidence to suggest that regular ingestion of cooked egg in baked products by egg-allergic children or ingestion of extensively heated milk by milk-allergic children may increase the development of tolerance. However, absent an oral challenge, there is no defined method to identify egg/milk-allergic children able to safely consume baked egg/heated milk products . Therefore, strict avoidance of the food allergen is advised until the child has consulted with an allergist.

The correct answer is B, most cases of peanut allergy persist into adulthood but there is a small chance that Jack will develop tolerance.

1. Wood RA. The natural history of food allergy. Pediatrics 2003; 111:1631-37.
2. Savage JH, Matsui EC, Skripak JM, Wood RA. The natural history of egg allergy. J Allergy Clin Immuno 2007; 120:1413-17.
3. Skripak JM, Wood RA. Peanut and tree nut allergy in childhood. Pediatr Allergy Immunol 2008; 19:368–73.
4. Nowak-Wegrzyn A, Bloom KA, Sicherer SH, et al. Tolerance to extensively heated milk in children with cow’s milk allergy. J Allergy Clin Immunol 2008; 122:342-7.
5. Lemon-Mule H, Sampson H., Sicherer SH, et al. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol 2008; 122:977-83.


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