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We would like to report an interesting observation which we came across over a four month period. Five children (table 1), presented at a regional allergy clinic with a history of contact allergy of the hands; wide spread erythema and itch. Four of them also complained of sneeze, itchy eyes, and facial swelling. Three children had upper airway involvement (one throat tingling, one wheeze, and one “difficulty breathing”, requiring “steaming overnight”). In all five cases, contact exposure was the first noted allergic reaction to peanuts, but in two cases it was not until there was a subsequent oral reaction to peanut that parents attended medical services. RAST investigation confirmed raised specific peanut IgE in all five (table 1). All children developed reactions while attending the same local park. There was no consistent history of season or section visited, except that all five children fed birds and squirrels with a feed purchased from the gardens for the purpose. The park authorities confirmed that the feed contained peanut (and now offers a nut-free feed).
Peanut allergy is increasingly common, and many parents have concerns about how they should react should their child have an allergic reaction.1 While many parents might expect a reaction during ingestion of a food substance, many would not suspect a food related reaction when not dining. Such unexpected reactions are probably under-reported or considered environmental in origin.2 Diagnosis of peanut allergy is generally made secondary to a history of ingestion. This report confirms the significant allergenicity of peanut, in causing allergic reactions in children who were not known (at the time) to react to ingested peanuts. Peanut allergy diagnosis following contact reaction is uncommon, although there are reports of allergic reaction by particle inhalation during commercial flights and also by kissing. The ability of nuts, especially peanut, to cause such reactions without significant evidence of exposure, highlights the need for vigilance in determining the cause of reactions and the difficulties faced by parents in protecting children in apparently “safe” environments.
Nut allergy should be suspected in all cases of unexplained contact urticaria or systemic allergic reaction, even when there is no clear history of ingestion. Bird feed should be avoided in children with previous history of atopy, and nut-free feeds may be more appropriate for use by young children.