11:16am Monday 14 October 2019

U-M allergist: News on asthma and peanut allergies in kids could lead to misdiagnosis, unnecessary testing

ANN ARBOR, Mich. —  University of Michigan allergist Matthew Greenhawt has raised concerns about highly-publicized research findings suggesting that children with asthma are prone to peanut allergy.

Authors of an abstract promoted during the American Thoracic Society’s annual meeting May 17 suggest that children who have poorly controlled asthma may be more likely to have a peanut sensitization, and that parents should consider having kids with asthma tested for possible peanut allergy. The early findings have made national and international news in recent days, including coverage by NBC, Time Magazine and other high-profile outlets.

“Such testing could potentially lead to misdiagnosis, and represents an unnecessary and unjustified use of resources,” says Greenhawt, M.D., M.B.A., M.Sc., of the U-M Division of Allergy and Clinical Immunology and C.S. Mott Children’s Hospital in a statement representing the American College of Allergy, Asthma, and Immunology (ACAAI).

Dr. Matthew Greenhawt

Dr. Matthew Greenhawt

“While many of the children in the abstract are peanut sensitive on testing, it raises a question of relevance as to why testing was performed. There is no evidence that diagnosing peanut sensitization better controls chronic asthma. Chronic asthma is not a manifestation of peanut sensitization or allergy. There is no practical value to testing in this situation because these children are not showing any signs of possible peanut allergy.”

Greenhawt is an assistant professor in the Division of Allergy and Clinical Immunology at U-M, member of U-M’s Child Health Evaluation and Research and Evaluation Unit in the Department of Pediatrics and member of the U-M Institute for Healthcare Policy and Innovation. 

Greenhawt offered additional points regarding this abstract and the use of food allergy testing in patients with asthma, so that these abstract findings are not misinterpreted:

• A food allergy results in specific, acute symptoms (e.g., hives, wheezing, cough, vomiting, etc.), developing within approximately 2 hours of ingestion of a suspected allergen.   Without such history, testing is not indicated.   
• Chronic, poorly controlled asthma is not an indication of a “hidden” food allergy.  Food allergen testing was not indicated in any of these patients. 
• Positive allergy blood tests (or skin tests) alone are insufficient to make a diagnosis of food allergy.  Many more individuals test positive than will have actual food allergy.  Testing for the presence of sensitization to a food is of no value, and cannot be interpreted when positive if the patient does not develop symptoms after eating that particular food. 
• While approximately 1/3 of food allergic children develop asthma, and asthma in a food allergic child is a risk factor for more severe reactions, these risks are not associated with the asthmatic child under poor control, without a presumption of a known food allergy. Existing food allergy guidelines do not indicate testing in this situation. However, such children may benefit from inhalant allergen testing to better their asthma control.

Peanut allergy affects approximately 1-1.5 percent of people in the U.S., and can be associated with severe reactions, which require emergency treatment with epinephrine.  If symptoms develop within two hours after eating peanuts, an individual should be referred to a board certified allergist/immunologist for further assessment and possible testing.

Additional Information:

For more information about asthma treatment, including the Children’s Asthma Wellness Program at C.S. Mott Children’s Hospital that specializes in complex or difficult to control asthma, visit www.mottchildren.org/asthma.

Media alert on this topic on the American Academy of Allergy Asthma and Immunology website.

About ACAAI: The ACAAI is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. The College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research.

Originally published by the ACAAI: http://college.acaai.org/Pages/ATSrebuttal.aspx

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