study on casual contact with pnut butter on peanut allergic kids.

[eragon]

http://www.ncbi.nlm.nih.gov/m/pubmed/12847496/ 


only 30 kids in study. how do you feel about this?

[CMdeux]

Honestly, I've stated for over a decade that this particular study is probably only valid for lower three quartiles of the sensitivity distribution-- the stats seem suspect to me to even make such a sweeping statement at the 90th percentile (which means that the most sensitive 10% might have problems), even by the authors' admission in the original publication.

The thing is, I'm also not convinced that they had much of a handle on the statistics associated with the original PATIENT sample in that thirty individuals, either.  It was extremely routine a decade ago to systematically exclude any PA patients who had ever experienced severe anaphylaxis.  It was also routine to exclude those who had comorbid asthma, and those who had evinced exceedingly low reaction thresholds.

I do not know precisely what exclusion criteria were applied to those 30 individuals in this study-- nor how rigorously they were applied.    It appears to be a highly mixed sort of patient sample, frankly.  This has always bothered me about this particular study.  MOST people with PA don't worry about inhalation (or contact) reactivity-- and just as clearly, most of them are correct in feeling that way.   However, there are a subset of allergic persons who have experienced this far, far too often for it to be anything but real-- whether it's somatic or not, SOMETHING is up with it.

DD regularly experiences such reactivity-- regularly.  And it doesn't matter if the scent is "masked" or not, or if it's inconvenient, if she's distracted, happy/anxious/sad, whatever.  It's not dependent upon her state of mind at all.  It doesn't matter who she's with.  Her friends would all vouch for it, too-- because anyone that has hung out with her for long has seen what happens if someone sits next to her with trail mix and starts munching.  She puffs up, her eyes and nose stream, and she begins to experience asthma.    Whether she notices the threat or not, I mean.   

The first time someone sees it happen, it makes them a believer. 

[eragon]

This study has been linked to the AAAAI16 conference on twitter, one doc stating how he uses this contact as a tool to reduce stress from contact allergies with parents and patients.

[CMdeux]

Well, my feelings about that are "It's complicated."

On the one hand, for probably 70-80% of those people, it's correct for clinicians to reassure them that this is simply NOT something to worry over.

On the other hand, for the others, this is simply alienating and harms the working doctor-patient relationship, quite frankly.  Our allergist, as terrific as he is, tried to use this study that way with US, back when DD was young.  It did absolutely nothing to mitigate our lived experience, however-- all it did was make us feel like telling him about it was only going to make him believe that we were crazy.   "Those" parents.

Where I object is that for that subset of patients and families-- they are the ones that MOST desperately need a positive, extremely cooperative kind of relationship with a trusted clinician.  They have the most difficult management job, relative to the patient cohort with food allergies-- and they MOST need to feel supported, not dismissed.

[lakeswimr]

They would not study the transmission of a cold virus by putting it only on a person's skin(we discussed this year years ago) and putting pb on skin isn't the best way to tell if contact ingestion can cause a reaction.  If instead they had put the pb on the kids' hands and then had them touch eyes, nose, or mouth, that would be a better test.  What amount of pb from hands to eyes, nose, or mouth can cause ana? 

My son has had multiple contact ingestion ana.  I have always been clear that for him there had to be the ingestion part, not just the contact, which is good to know.   If he gets some on him he can avoid touching their faces and wash or wipe it off.  All good to know.  And most won't have contact ingestion ana, it seems, also good to know.

I don't see any of those qualifications given with this study and suspect it or something that was the result of it being published is why my son's school tried to take away his major FA accommodations 2 years ago.  I had to spend countless hours preparing for the meeting I had with them and going to that meeting to save the accommodations.

Thankfully now he doesn't seem contact ingestion sensitive any longer but he for sure was. 

Our first allergist was excellent but didn't believe in contact ingestion ana.  It wasn't that helpful to us.  We didn't start out taking precautions for contact ingestion and found out the hard way we had to do so.  I don't recommend everyone take all those precautions as it is not common to have contact ingestion ana, but it is good to know it is possible.  More than the freedom of having DS outgrow allergies, having to not worry so much about contact ingestion ana has been an even bigger relief.