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May 20, 2015

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Media Alert: AAAAI Adverse Reactions to Foods Committee Responds to Calls for Asthmatic Patients to be Indiscriminately Tested for Peanut Allergies

Misconceptions Over Asthma and Peanut Allergy Study Released at 2015 ATS Meeting Need Clarification


Milwaukee, WI -- A new study highlighted during the American Thoracic Society’s Annual Meeting is receiving considerable media attention regarding an association between chronic asthma and peanut sensitization. The study's authors suggest children who have poorly controlled asthma are more likely to be peanut sensitized, and that such patients may benefit from testing for possible peanut allergy.

The study unfortunately has a misguided premise and conclusion.

A recommendation to test asthmatic patients for peanut allergy will potentially lead to misdiagnosis, and an unnecessary use of resources. Testing for food allergy in the absence of clear symptoms of an acute allergic reaction is never recommended. Despite a high rate of peanut sensitization in this study, there is no relevance to the study’s finding since diagnosing peanut sensitization does not improve asthma control. False positive tests may result in unnecessary avoidance of peanut, which has recently been associated with an increased risk of peanut allergy in certain ages. Peanut allergy needs to be carefully differentiated from asymptomatic sensitization by a food challenge, which was not done in this study. Chronic asthma is not a manifestation of peanut sensitization or allergy, and hence there was no practical value to testing these children since they exhibited no signs of having possible peanut allergy.

The following additional information should help to clarify points of potential misinformation regarding this study and highlight the appropriate role of food allergy testing in patients with asthma:
• Food allergy results in specific, acute symptoms (e.g., hives, wheezing, cough, vomiting, etc.) which develop within approximately 2 hours of ingestion of a suspected allergen. Food allergy is a clinical diagnosis characterized by a history of reactions to the food; food allergy testing without clinical history is associated with a false positive rate greater than 50%. In the absence of such a history, testing is not indicated.
• Poorly controlled asthma is not an indication for testing to diagnose a “hidden” food allergy. In this study, allergen testing was not indicated in any of these patients.
•  Food allergy cannot be diagnosed based on the presence of sensitization (positive allergy tests) alone. Such tests cannot be interpreted without a further context of a possible reaction to the food. Moreover, rates of sensitization far exceed the number of individuals that have actual food allergy.
• Though approximately 1/3 of food allergic children develop asthma, and asthma in a food allergic child is a risk factor for severe reactions, there is no role for food testing in patients with chronic asthma. Existing food allergy guidelines strongly indicate testing is not warranted in situations as highlighted in this study.  However, such children may benefit from inhalant allergen testing to better their asthma control.

There is need to additionally clarify another erroneous report that followed release of this study, regarding the risk of possible food allergen content in asthma medication:
• Peanut allergic patients are generally not allergic to soy, and are not advised to avoid soy; the clinical cross reactivity rate between peanut and soy allergy is very low.
• Certain inhalers (Atrovent and Combivent) prescribed for COPD contain soy lecithin, a fatty derivative of soy.  Soy lecithin contains negligible protein and is not considered to be an allergen for soy allergic individuals. Atrovent and Combivent can be used safely for soy allergic patients, and is not contraindicated for peanut allergic patients.
 
Peanut allergy affects approximately 1-1.5% of the population. Individuals developing symptoms concerning for peanut allergy should be referred to a board certified allergist/immunologist for further assessment.

In 2012 the ABIM Foundation launched Choosing Wisely® with a goal of advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures. As such, Choosing Wisely advocates against diagnostic tests such as immunoglobulin G (lgG) testing or an indiscriminate battery of immunoglobulin E (lgE) tests, in the evaluation of allergy. Allergist/Immunologists know appropriate diagnosis and treatment of allergies requires specific IgE testing (either skin or blood tests) based on the patient’s clinical history. The use of other tests or methods to diagnose allergies is unproven and can lead to inappropriate diagnosis and treatment. Appropriate diagnosis and treatment is both cost effective and essential for optimal patient care.

More information on asthma and Choosing Wisely is available at the AAAAI website.

The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has more than 6,800 members in the United States, Canada and 72 other countries. The AAAAI’s Find an Allergist/Immunologist service is a trusted resource to help you find a specialist close to home.

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