I just got done reading an article from Omaha about a child who had a severe reaction to peanuts (http://www.ketv.com/news/30307603/detail.html#ixzz1kcSdIHui). The headline “Boys survives Delayed Reaction to Peanut” piqued my interest. I was expecting a story about a patient who had a reaction 4 or more hours after ingesting peanut. This was not the case. A child with asthma, as well as gluten and peanut allergy, had an accidental exposure to a peanut butter granola bar. According to the story, he immediately had symptoms of itchy mouth. The school called the parents and then they drove him to the hospital.  At that time “ The boy complained of a stomachache but was talking and breathing comfortably” After another thirty minutes in the ED he then developed hives and his throat was tightening. His condition then rapidly deteriorated and required very aggressive medical care. Fortunately, he recovered and is doing well.

This story raises some concerns and questions. First off, as described this was not a delayed reaction to peanut allergy. This child has a known exposure to a known allergen and “Max said he knew there was trouble when after just a penny-sized bite, his tongue started itching.” Then over the course of the next thirty plus minutes his symptoms progressed to severe anaphylaxis. Anaphylaxis is an immediate reactions to an allergen that can progress over time. This is exactly what was described in this article – the child had a known exposure to a known allergen developed symptoms immediately that progressed to more severe symptoms over the course of at least 30 minutes. This was not a delayed reaction to peanut exposure this was classic anaphylaxis.

Second, it does not appear from the article that this child ever received epinephrine for his symptoms. After he had the peanut exposure the school called his parents and he was taken to the emergency department. No where was it noted that he received epinephrine. Furthermore, according to the author of the article, “The boy complained of a stomachache but was talking and breathing comfortably. After 30 minutes in the emergency room, the child broke out in hives and his throat was tightening.” Subsequently more symptoms developed and he become very ill and came close to death. The statements as reported above, suggest that this child with a known peanut allergy and asthma may have gone as long as 30 minutes without receiving epinephrine despite progressive symptoms.

There are several lessons to be learned from this article as reported:

1) peanut allergy can be quite severe and life threatening; 2) an asthmatic with peanut allergy and known exposure to peanut and develops symptoms should be treated with epinephrine immediately; 3) delay in treatment of peanut allergic individual will result in progressive symptoms that will be more challenging to treat;  4) asthmatics with peanut allergy are at risk for more severe reactions when exposed to peanuts and 5) schools need to have good guidelines for treating asthmatic peanut allergic children who are exposed to peanuts – not just calling the parents.

Peanut allergy is a serious disease. Peanut allergy patients with asthma are at particularly increased risk for serious reactions to peanut exposure. Prompt recognition of symptoms and aggressive use of epinephrine is required to treat these patients. Are you prepared?