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Dealing With a Nut Allergy May Take More Than Just Saying No

WebMD Health News

Jan. 18, 2001 -- Nuts may seem to be harmless little things, but for one in every 100 Americans, eating even one can be life threatening. Now British researchers have developed a simple plan that can help reduce potentially fatal allergic reactions to peanuts and other nuts.

Nut allergies are fairly common and they also are poorly controlled, according to Pamela W. Ewan, MD, and A.T. Clark, MD, from the department of allergy and clinical immunology at Addenbrooke's Hospital in the U.K. Their study on the subject is published in this week's issue of the British medical journal The Lancet.

Rather than suggesting to "just avoid nuts," Ewan suggests people with allergies to nuts should be treated in allergy centers. "[Nut allergy] reactions can be severe," Ewan tells WebMD. "Our plan provides greater security and safety for patients."

A management strategy for dealing with allergic reactions is important, Ewan explains, because most of the people who die of nut allergy knew they were allergic and were trying to avoid nuts without any help. Experts estimate that one out of every three emergency room visits for an allergic reaction to a substance may be due to peanuts or even a single nut.

Ewan and Clark's plan includes a thorough patient consultation with an allergy specialist about the importance of avoiding nuts. The briefing should include advice about eating out and traveling abroad. Patients also should receive information about various medications to take in case of accidentally eating a nut.

In their study, close to 600 patients received the recommended counseling and drugs to use in case of an allergic reaction, with detailed instructions on how to use the medications. They also received a written treatment plan describing in lay terms what constitutes mild, moderate, and severe reactions. For the younger patients, specially trained community pediatric nurses visited the school or nursery and explained prevention, recognition, and management of reactions.

After completion of the two-year study, only 15% of the patients had additional allergic reactions to nuts, and most of these reactions were mild. All patients except one were able to successfully treat themselves.

But an editorial commentary published in the same journal points out that the study may not be without its flaws. "Studies reported since Ewan and Clark's protocol was introduced ... suggest that it is premature to adopt the protocol in its current form," writes David J. Hill, MD, of the department of allergy at the Royal Children's Hospital in Victoria, Australia.

Still, the more information the better. As a father of a child with a severe peanut allergy, Christopher Papkee has received various treatment opinions for his child over the last five years, ranging from the drug epinephrine to "watch and wait." But being safe, not sorry, is his credo. "You only need one bad reaction," he tells WebMD. "Those first few minutes are critical."

Papkee developed a web site and now works full time training and educating pediatricians, allergists, and consumers about the subject.

In addition to counseling and drugs for a nut allergy, Ewan suggests trying to avoid the development of the allergy completely. If you have an allergic child, Ewan suggests that very strong reasons exist for delaying the introduction of peanuts and nuts. "[A nut allergy] can have terrible consequences, so if there's any way of avoiding it, it would be sensible to do so."

Papkee agrees. "It's all about survival, staying safe and being prepared."

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