Peanut Related Incidents in Health. Statistics, Prevalence, and Impact

Transcription

1 Peanut Related Incidents in Health Statistics, Prevalence, and Impact Wednesday, February 23, 2005 Cmpiled fr Dr. Cllin Carrie MP - Oshawa by Truehpe Nutritinal Supprt Ltd. Tarn Fletcher Bsc. (Authr)

2 Table f Cntents Statistics... 3 Prevalence... 5 Impact... 8 Additinal Materials frm Health Canada... 9

3 Statistics It is estimated that abut 30,000 fd-induced anaphylactic events are seen in American emergency departments each year, apprx. 200 f which are fatal. Either peanuts r tree nuts cause mre than 80% f these reactins. Burks W. Peanut allergy: a grwing phenmenn. J Clin Invest Apr;111(7): Review. PMID: [PubMed - indexed fr MEDLINE] Apprximately ne third f emergency-rm visits fr anaphylaxis may be due t peanut sensitivity. Sampsn HA, H DG.: Relatinship between fd-specific IgE cncentratins and the risk f psitive fd challenges in children and adlescents. J Allergy Clin Immun 1997 Oct;100(4): Bush RK: Management f peanut allergy. Can J All & Clin Imm 1996 Nv;1(5): Immediate hypersensitivity t peanuts is a frequent cause f anaphylactic reactins and deaths in children and adults. Nelsn HS, Lahr J, Rule R, Bck A, Leung D: Treatment f anaphylactic sensitivity t peanuts by immuntherapy with injectins f aqueus peanut extract. J Allergy Clin Immunl 1997 Jun;99(6 Pt 1): Peanuts are the fd mst likely t prduce allergic and anaphylactic reactins. The majr allergen is a prtein that des nt partitin int Peanut Oil, Hydrgenated Peanut Oil, Peanut Acid, and Peanut Glycerides. [N authrs listed] Final reprt n the safety assessment f Peanut (Arachis hypgaea) Oil, Hydrgenated Peanut Oil, Peanut Acid, Peanut Glycerides, and Peanut (Arachis hypgaea) Flur. Int J Txicl. 2001;20 Suppl 2: Review. Severe allergic reactins caused by fdstuffs have been reprted in Sweden since 1993, 60 cases, five f them fatal, ccurring during the first 3-year perid. Mre than 70 % f all reactins reprted were caused by peanuts, sya beans, nuts r almnds. In nly 13% f reprted cases were the patients ver 17 years f age...with extremely severe reactins including asthma. Fucard T, Edberg U, Malmheden Yman I.: [Fatal and severe fd hypersensitivity. Peanut and sya underestimated allergens]. Lakartidningen 1997 Jul 23;94(30-31): Allergies t these fds [peanut and tree nut] are cmmn, frequently have an nset in the fist years f life, generally persist, and accunt fr severe and ptentially fatal reactins. Furthermre, the ubiquity f these fds in the diet makes avidance difficult and accidental ingestins, with reactins, cmmn. Sicherer SH, and Sampsn HA: Peanut and tree nut allergy: Current pinin in Pediatrics 2000;12: Fd anaphylaxis is nw the leading knwn cause f anaphylactic reactins treated in emergency departments in the United States. Is is estimated that there are 30,000 anaphylactic reactins t fds treated in emergency deparments and 150 t 200 deaths each year. Peanuts, tree nutes, fish, and shellfish accunt fr mst severe fd anaphylactic reactins...the mechanistic details respnsible fr symptms f fd-induced anaphylaxis are nt cmpletely understd, and in sme cases, symptms are nt seen unless the patient exercises within a few hurs f the ingesin." Sampsn HA. Anaphylaxis and emergency treatment. Pediatrics Jun;111(6 Pt 3):

4 An evaluatin f 142 bservatins f allergy t peanuts in France. The clinical features included: atpic dermatitis [eczema] (40%) angiedema (37%) asthma (14%) anaphylactic shck (6%) digestive symptms (1.4%) Mneret-Vautrin DA, Rance F, Kanny G, Olsewski A, Gueant JL, Dutau G, Guerin L:Fd allergy t peanuts in France--evaluatin f 142 bservatins.clin Exp Allergy 1998 Sep;28(9): An evaluatin f 132 bservatins f pediatric allergy t peanuts in France. f 132 pediatric cases f peanut hypersensitiviy, aged between 6 mnths and 15 years, cnfirmed by fd challenge, mre than half were diagnsed befre age three. the mst cmmn symptm was atpic dermatitis (43.1% f cases). Others were: harseness (34.8%), asthma (13.6%), anaphylaxis (6%), gastr-intestinal symptms (1.5%), and ral syndrme [ithchy muth, lips, thrat] (0.7%). all patients had psitive skin tests, with a mean wheal diameter f 8mm (range: 2 t 25mm); wheal diameter was significantly smaller in the yungest children (mean 4.5mm fr children < 1 yr f age). peanut-specific IgE cncentratin was < 0.75 IU/ml in 16 cases (14.3%), the mean fr the entire grup being 30.9IU/ml (range: 0.75 t 100 IU/ml). fd challenges were nt perfrmed in three f the children with a histry f anaphylaxis. labial fd challenge [simple cntact f fd with lips] was psitive in 85 cases (64.8%) an ral fd challenge was carried ut in 45 children (34.3%) and the mean reactive dse was 850 mg (range: 1 mg t 7gm). labial fd challenge with peanut il was psitive in 2 cases f 50 tested (4%) and 17 f 63 children (29.9%) tested by ral fd challenge were als fund t be sensitive t peanut il. half the children were als allergic t ther fds, as demnstrated by fd challenge (53.7%) r t airbne allergens (62.8%). Hypersensitivity in the very yungest children raises questins abut hw sensitizatin ccurs. Diagnsis was cnfirmed by fd challenge. Peanut prducts are very difficult t eliminate frm the diet because f inadequate labeling f fd prducts. An ELISA test, available in a number f cuntries, can be used t detect peanut in fds. Rance F, Dutau G.: Peanut hypersensitivity in children. Pediatr Pulmnl Suppl 1999;18: After a retrspective review f all fd-sensitive children wh underwent fd challenges at the Children's Hspital f Philadelphia in a 5 year perid, authrs cncluded that "Patients will typically experience similar reactin n re-expsure t the initial reactin. Hwever, multiplergan system reactins can ccur after any initial clinical presentatin, with milk, egg, and peanut having mre multiple-rgan reactins than ther fds." Spergel JM, Beausleil JL, Fiedler JM, Ginsberg J, Wagner K, Pawlwski NA. Crrelatin f initial fd reactins t bserved reactins n challenges. Cmment in: Ann Allergy Asthma Immunl Feb;92(2):195-7.

5 Prevalence The exact prevalence f fd allergy, specifically peanut sensitivity, is nt knwn. Reprts vary. Canadian Our prevalence study is the first in Nrth America t crrbrate histry with cnfirmatry testing and the largest wrldwide t incrprate these techniques. We have shwn that, even with cnservative assumptins, prevalence exceeds 1.0%. Kagan RS, Jseph L, Dufresne C, Gray-Dnald K, Turnbull E, Pierre YS, Clarke AE. Prevalence f peanut allergy in primary-schl children in Mntreal, Canada. J Allergy Clin Immunl Dec;112(6): A study was cnducted n 33,110 persns wh answered a questinnaire addressed t a sample f the French ppulatin persns with fd allergy selected during phase I received a secnd questinnaire. Results: the reprted prevalence f fd allergy is 3.52%: 3.24% evlutinary and 0.12% nw asymptmatic due t avidance f the fd, and 0.17% cured. 80% were city dwellers 63% were female 11% were health-care wrkers 57% presented with atpic diseases fd allergy was ften persistent, lasting mre than 7 years in 91% f the adults mst frequent allergens: rsaceae (peach, plum, pear, cherries, apple) fruit sensitivities in sme pllen sensitive individuals 14% vegetables 9% milk 8% crustaceans 5% fruit crss-reacting with latex 4% tree nuts 3% peanut 1% fd allergy was 4 times mre frequent in patients with latex allergy the main manifestatins f fd allergy were: atpic dermatitis fr children under 6 yrs f age asthma fr subjects 4 and 6 yrs f age, anaphylactic shck in adults ver 30 yrs f age. Shcks were crrelated with alchl r nn-streridal anti-inflammatry drug (NSAID) intake. Prevalence f fd allergy is estimated at 3.24% in France. The study emphased the increasing risk f fd allergy in well-develped cuntries, drawing attentin t certain risk factrs, such as the intake f drugs (NSAID, beta-blckers, and angitensin-cnverting enzyme inhibitrs) r alchl, intlerance f latex glves, and sciprfessinal status. Kanny G, Mneret-Vautrin DA, Flabbee J, Beauduin E, Mrisset M, Thevenin F. Ppulatin study f fd allergy in France. 1: J Allergy Clin Immunl 2001 Jul;108(1 Pt 1): The apparent increase in the prevalence f peanut allergy has been difficult t explain, althugh it parallels an verall increase in allergic diseases in childhd. Lack G, Fx D, Nrthstne K, Glding J; Avn Lngitudinal Study f Parents and Children Study Team. Factrs assciated with the develpment f peanut allergy in childhd. N Engl J Med 2003 Mar 13;348(11): Peanut allergy is characterized by mre severe symptms than ther fd allergies and by high rates f symptms n minimal cntact. In a questinnaire study f 622 self-reprted allergic subjects, a ttal f 406 patients (66%) reprted symptms n cntact with peanut. Only 121

6 (19%) had been knwingly expsed t peanut befre the first dcumented reactin implying a high frequency f ccult sensitizatin. Hurihane JO, Kilburn SA, Dean P, Warner JO: Clinical characteristics f peanut allergy. Clin Exp Allergy 1997 Jun;27(6): The incidence f fd allergy in children is apprximately 1.3% and amng adults 0.3%. Chandra RK.: Fd hypersensitivity and allergic disease: a selective review. Am J Clin Nutr 1997 Aug:66(2):526S-529S. True fd allergies are much less prevalent than is generally believed. They are mre cmmn in infants and children under age three than in lder children and adults. Infant clic generally is nt caused by a fd allergy. In infants, urticaria, eczema r gastrintestinal bleeding may be due t fds such as milk and eggs, but clinical tlerance usually develps within a few years. Peanuts, tree nuts, seafd and seeds, as well as milk and eggs, can cause anaphylaxis in highly allergic children, and re-expsure t such fds presents the risk f life-threatening reactins. Andersn JA: Milk, eggs and peanuts: fd allergies in children. Am Fam Physician 1997 Oct 1;56(5): Apprximately 5% f children yunger than 3 years and 1.5% f the general ppulatin experience fd allergic disrders, indicating that abut 4 millin Americans suffer frm fd allergies. Sampsn HA.: Fd Allergy. JAMA 1997 Dec 10;278(22): A dichtmy exists between perceived fd allergy and that cnfirmed by apprpriate challenge prcedures. Only 40% f suspected fd allergy has been cnfirmed by duble-blind, placebcntrlled fd challenges. In a recent survey f 5000 American hmes, the percentage f individuals reprting peanut allergy was 7.2%. Altman DR, Chiaramnte LT.: Public perceptin f fd allergy. J. Allergy Clin Immunl 1996;97: Allergy t peanuts represents 28% f fd allergies and ccurs under 1 year f age in 46% f cases, under 15 years f age in 93%. Mneret-Vautrin DA, Rance F, Kanny G, Olsewski A, Gueant JL, Dutau G, Guerin L:Fd allergy t peanuts in France--evaluatin f 142 bservatins.clin Exp Allergy 1998 Sep;28(9): cases f peanut and/r nut allergy evaluated in a ne year perid. Peanuts accunted fr nearly half f the allergies, with 55% f the allergies presenting by age 2 years and 92% by age 7 years. Ewan PW. Clinical study f peanut and nut allergy in 62 cnsecutive patients: new features and assciatins. BMJ 1996;312: Prevalence f peanut and tree nut (TN) allergy in the US determined by a randm digit dial telephne survey. Findings: A ttal f 4374 husehlds cntacted by telephne participated (participant rate, 67%), representing 12,032 individuals.) Peanut r TN allergy was self-reprted in 164 individuals (1.4%)... the prevalence f reprted allergy in adults (1.6%) was higher than that fund in children under 18 years f age (0.6%). In 131 individuals, details f the reactins were btained. When applying criteria requiring reactins t be typical f IgE-mediated (allergic) reactins (hives, angiedema, wheezing, thrat tightness, vmiting, and diarrhea) within an hur f ingestin, 10% f these subjects were excluded.

7 Amng the remaining 118 subjects, reactins related t: peanut (58), walnut (24), cashew (8), Brazil nut (8), almnd (7), pecan (7), hazelnut (3), Macadamia nut (2), unspecified mixed nuts (6) (Only fur [all adults] reprted bth peanut and TN allergy, and 5 reprted reactins t mre than ne TN). Allergic reactins invlved: 1 rgan system (skin, respiratry, r gastrintestinal systems) in 50 subjects (42%), 2 in 45 subjects (38%), and all 3 in 23 subjects (20%). Frty-five percent f these 118 respndents reprted mre than 5 lifetime reactins... 51% had ther fd allergies 35% had atpic dermatitis (eczema) 34% had asthma 33% had allergic rhinitis... [94% f the subjects reprted at least ne f these atpic diseases (eczema, asthma r rhinitis). Cnclusins: Peanut and/r tree nut allergy affects apprximately 1.1% f the general ppulatin, r abut 3 millin Americans, representing a significant health cncern. Despite the severity f reactins, abut half f the subjects never sught an evaluatin by a physician, and nly a few had epinephrine available fr emergency use. Sicherer SH, Munz-Furlng A, Burks AW, Sampsn HA: Prevalence f peanut and tree nut allergy in the US determined by a randm digit dial telephne survey. J Allegy Clin Immunl 1999;103: Accrding t Statistics Canada, there were 6 deaths due t fd anaphylaxis in 1997 and 8 in 1998 in Canada. Attempts t btain figures frm Statistics Canada fr subsequent years were unsuccessful because cding f deaths fllwing WHO guidelines n lnger specifies any deaths caused by anaphylaxis related t fds r ther causes. In the UK, f the 20 fatal reactins recrded each year, 5 are due t fd. Pumphrey RS.: Lessns fr management f anaphylaxis frm a study f fatal reactins. Clin Exp Allergy 2000 Aug;30(8): reprted cases f serius anaphylactic reactins due t fd allergy in 2002 (in 33 children and 74 adults), including tw fatalities due t sy and peanut. (France). The prevalance f fd allergy in the French ppulatin is estimated t be 3.24%. Anaphylactic shck was reprted in 59.9% f the cases invlved (ne fatal t peanut), ther systemic reactins: 18.7%, laryngeal edema:15.9%, serius acute asthma: 5.6% (ne fatal, t sy), The mst frequent allergens were: peanut (14), nuts (16), shellfish (9), latex-fruit grup (9), lupine flur (7), wheat flur (7), celeri (5), and snails (5). M. Mrisset, M. Bulègue, E. Beauduin, F. Pirsn, F. Rancé, C. Gallen et al. Anaphylaxie alimentaire sévère et léthale : cas rapprtés en 2002 par le réseau d'allergvigilance Revue française d'allerglgie et d'immunlgie clinique Vlume 43 - Numér 8 - pp: This study was als published in the Feb Allerg Immunl (Paris) : Severe fd anaphylaxis: 107 cases registered in 2002 by the Allergy Vigilance Netwrk. The authrs cnclude "Setting up such a netwrk in ther cuntries wuld leas t a significant advance in knwledge f the peculiarities f allergies...the aims are t recrd cases f severe anaphylaxis, t establish an epidemilgical data bank frm prspective multicenter studies, and t mnitr the allergic risk f nvel fds." Mneret-Vautrin DA, Kanny G, Mrisset M, Rance F, Fardeau MF, Beauduin E. Severe fd anaphylaxis: 107 cases registered in 2002 by the Allergy Vigilance Netwrk. Allerg Immunl (Paris) Feb;36(2):46-51.

8 Impact Given the cnsiderable disruptin in daily activities and family relatins reprted by the parents f peanut-allergic children, accurate diagnsis f peanut allergy is essential. Our wrk shuld make health care prfessinals dealing with children with cnfirmed peanut allergy mre aware f the supprt that these families may require. Furthermre, we hpe t mtivate fd industries t ffer mre 'peanut free' prducts t decrease the dietary restrictins f these patients while minimizing their ptential fr accidental ingestin." Primeau M, Kagan R, Jseph L, Lim H, Dufresne C, Duffy C, Prhcal I, Clarke A: The psychlgical burden f peanut allergy as perceived by adults with peanut allergy and the parents f peanut-allergic children. Clin Exp Allergy 2000 Aug;30(8): Childhd fd allergy has a significant impact n general health perceptin, n the parents, and limitatin n family activities. Factrs that influence reductins in theses scales include assciated atpic disease and the number f fds being avided. Sicherer SH, Nne SA, Munz-Furlng A. The impact f childhd fd allergy n quality f life. Cmment in: Ann Allergy Asthma Immunl Dec;87(6): The quality f life (QL) was measured in 20 children with peanut allergy (PA) and 20 children with insulin-dependent diabetus mellitus (IDDM) using tw disease-specific QL questinnaires. Cameras were given t the subjects t recrd hw their QL is affected ver a 24-h. perid. Mean ages f subjects was 9.0 and 10.4 years fr PA and IDDM. Results: Children with PA reprted a prer quality f life than children with IDDM. PA children reprted mre fear f an adverse event and mre anxiety abut eating, especially when eating away frm hme. Mst phtgraphs related t fd and management issues and revealed difficulties fr bth grups regarding fd restrictins. PA subjects felt mre threatened by ptential hazards within their envirnment, felt mre restricted by their PA regarding physical activities, and wrried mre abut being away frm hme. Hwever, they felt safe when carrying epinephrine kits and were psitive abut eating at familiar restaurants. The authrs cncluded: The quality f life in children with PA is mre impaired than in children with IDDM. Their anxiety may be cnsidered useful in sme situatins, prmting better adherence t allergen avidance advice and rescue plans. Natalie J. Avery1, Rsemary M. King2, Susan Knight3, and Jnathan O'B. Hurihane1,2 Assessment f quality f life in children with peanut allergy Pediatric Allergy and ImmunlgyVlume 14 Issue 5 Page Octber 2003

9 Additinal Materials frm Health Canada Frm the Paper n the Allergen Cntrl Activities within the Canadian Fd Inspectin Agency Exhibit 3 Class 1 Recalls (Cmparisn f Hazards) Pie charts shwing the percentage f Class 1 recalls that invlve a particular type f hazard. The categry f hazards depicted are micrbilgical, chemical, extraneus material, allergen and ther. Each pie chart represents a year f Class 1 recalls t 1998; 1998 t 1999; 1999 t 2000 and 2000 t In 1997 t 1998, the percentage f Class 1 recalls invlving a micrbilgical hazard was 18.2%, chemical was 2.3%, allergen was 75.0% and ther was 4.5%. There were n Class 1 recalls invlving extraneus material in 97/98. In 1998 t 1999, the percentage f Class 1 recalls invlving a micrbilgical hazard was 24.8%, chemical was 5.0%, allergen was 69.2% and ther was 1.0%. There were n Class 1 recalls invlving extraneus material in 98/99. In 1999 t 2000, the percentage f Class 1 recalls invlving a micrbilgical hazard was 32.1%, chemical was 1.9%, extraneus material was 6.6%, allergen was 58.5% and ther was 0.9%.

10 In 2000 t 2001, the percentage f Class 1 recalls invlving a micrbilgical hazard was 16.0%, chemical was 5.5%, extraneus material was 1.7%, allergen was 75.7% and ther was 1.1%. 57. We als reviewed the same data in rder t determine the key allergens that were implicated in the recalls. We fund n average, a higher percentage f recalls invlving peanuts/tree nuts, dairy, sulphites, and eggs cmpared t ther allergens (see Exhibit 4). It is nted that CFIA nly has analytical methds fr peanuts/tree nuts, dairy, sulphites and eggs. There are n lab tests fr the ther pssible allergens. Health Canada is in the prcess f develping further allergen analytical methds but they are nt yet available fr rutine use. 58. At the time f ur interviews and infrmatin gathering, the CFIA did nt have any trend analyses cmpleted fr recalls. This capability t d trend analyses culd be useful t CFIA prgram staff in develping strategies fr reducing allergen recalls as they wuld prvide infrmatin n the underlying r rt causes fr the recalls. The Agency indicated that it wuld analyze trends in allergen recalls as part f the envirnmental scan wrk it is ding in preparatin fr upcming Science Cmmittee meetings. Exhibit 4 Allergens Peanuts & Tree Nuts Class 1 by Identified Allergen Ttal Recalls Dairy # Sulphites Egg Sya Wheat Seafd ~1 Sesame Seed ~1 Multiple Allergens Ttal recalls by year Overall %* * percentages are estimates based n a review f CFIA s data # increase culd be due t imprved methd detectin and targeted enfrcement activity Surce