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Skin Care Products a Risk Factor for Peanut Hypersensitivity

We may need to reconsider the use of certain skin care preparations in children.

People with peanut hypersensitivity live in fear of life-threatening, inadvertent exposure. Affected children are especially troubled by the social limitations, not only during Halloween and at the ice cream parlor but also in the classroom and school cafeteria. Investigators in England analyzed risk factors for peanut allergy in a large cohort of affected and unaffected children. Study subjects were identified from a public health database that included 13,971 children born during a 19-month period in 1991-1992. Information was collected by questionnaire before delivery and at 3- to 6-month intervals thereafter. Children with peanut allergy were identified, and the diagnosis was confirmed in 23 children by skin testing and double-blind, placebo-controlled food challenge. Randomly selected, unmatched control groups included 70 children with personal and maternal history of eczema and 140 unaffected children.

Peanut hypersensitivity was found to be independently associated with the consumption of soy formula, presence of a rash suggestive of atopic dermatitis, and use of skin care products containing peanut oil (91% of children with positive peanut allergy had been exposed to such creams, vs. 53% of atopic controls and 59% of healthy controls). There was no association between peanut allergy and asthma, hay fever, maternal diet, or diaper rash.

Comment: The identification of a possible association between type 1 peanut hypersensitivity and cutaneous exposure to peanut oil is intriguing. Unfortunately, specific information was not provided about the peanut oil products used by the children in this study. This association requires much more evidence before it can be accepted, including clarification about the nature of the relevant protein antigen and whether it can be eliminated from the oil. Meanwhile, avoiding such exposure is relatively simple, although it eliminates the use of a popular, commercially available, and cosmetically acceptable treatment that is one few proven to be safe and effective for children with atopic dermatitis. We welcome additional information from the pharmaceutical producers of this product.

— Elaine S. Siegfried, MD

Published in Journal Watch Dermatology March 26, 2003

Citation(s):

Lack G et al. Factors associated with the development of peanut allergy in childhood. N Engl J Med 2003 Mar 13; 348:977-85.

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