Correspondence

Peanut Allergy

N Engl J Med 2002; 347:1534-1535November 7, 2002

Article

To the Editor:

Regarding the article on peanut allergy by Sampson (April 25 issue),1 one should note that although anaphylaxis is the hallmark of peanut allergy, this allergy can also manifest in the form of such chronic, non–life-threatening entities as atopic dermatitis. In addition, there may be a link between the growing availability of infant formulas containing isolated soy protein during the past 40 years and the increasing prevalence of peanut allergy. During the 30 years of my practice in the field of allergy, especially pediatric allergy, 62 percent of 82 patients with confirmed cases of peanut allergy had a history of feeding difficulties resulting in attempts to substitute one or more brands of soy formula for cow's-milk formula. It seems possible that cross-sensitization between soy-protein antigens and peanut-protein antigens results in sensitivity to peanuts, because both belong to the legume family. Most of the infants in need of soy formula either had atopy or were predisposed to atopic diathesis in the first place.

S. Paul Kuwayama, M.D.
Children's Hospital of Wisconsin, Milwaukee, WI 53226
kuwayama@execpc.com

1 References

1. 1

   Sampson HA. Peanut allergy. N Engl J Med 2002;346:1294-1299
   Full Text | Web of Science | Medline

Author/Editor Response

Dr. Sampson replies:

To the Editor: I agree with Dr. Kuwayama that peanut allergy can manifest as a chronic condition such as atopic dermatitis in young infants, but I have not seen this presentation in older children. It is certainly possible that the increasing use of soy protein might be partially responsible for the increase in the prevalence of peanut allergy. However, a number of factors should be kept in mind. First, children are typically given soy formula because of a suspected allergy to milk, and about 35 percent of children who are allergic to milk will later have another food allergy.1 Second, the allergenic epitopes on soy and peanut proteins are unique, and only about 10 percent of persons who are allergic to peanuts have an allergic reaction to soy protein.2 Finally, the substantial increase in the prevalence of peanut allergy appears to have occurred during the past 10 years, whereas the use of soy formula does not appear to have increased substantially over this period. What is responsible for the apparent increase in peanut allergy in Westernized countries remains a critical question.

Hugh A. Sampson, M.D.
Mount Sinai School of Medicine, New York, NY 10538
hugh.sampson@mssm.edu

2 References

1. 1

   Host A. Cow's milk protein allergy and intolerance in infancy: some clinical, epidemiological and immunological aspects. Pediatr Allergy Immunol 1994;5:Suppl:1-36
   CrossRef | Medline

2. 2

   Eigenmann PA, Burks AW, Bannon GA, Sampson HA. Identification of unique peanut and soy allergens in sera adsorbed with cross-reacting antibodies. J Allergy Clin Immunol 1996;98:969-978
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   T. Daengsuwan, K. Palosuo, S. Phankingthongkum, N. Visitsunthorn, O. Jirapongsananuruk, H. Alenius, P. Vichyanond, T. Reunala. (2005) IgE antibodies to omega-5 gliadin in children with wheat-induced anaphylaxis. Allergy 60:4, 506-509
   CrossRef