Diagnosing peanut allergy in a child with severe atopic dermatitis

Children with atopic dermatitis (AD) pose a higher risk of peanut allergy. However, these children may have more raised sensitization measures, including serum IgE (sIgE) and skin prick testing (SPT) at baseline, without necessarily having a clinical allergy. A recent report describes a case of a child who, despite having AD and significantly elevated sIgE and SPT to peanut, passed an oral food challenge (OFC).

The study described a case of a 16-month-old patient who presented for evaluation of severe eczema and food allergy. He familiarized peanuts in the form of Bamba at home, which overlapped with an atopic dermatitis flare, although cutaneous symptoms did not appear immediately. The patient received an intensive skin care regimen with clinical improvement. His SPT to peanut came positive with a wheal of 7 × 5 mm. His total sIgE was 10,229 kU/L, sIgE to peanut was 39.7 kUA/L, and sIgE to Ara h 2 was 1.72 kUA/L. A 5-dose OFC to peanut butter came negative. His parents received instructions to incorporate peanut butter into his diet regularly.

Given the significance of early exposure in clinical allergy prevention, it may be worth using an OFC for children without a clear history of immediate type 1 hypersensitivity reactions to peanuts, even with elevated sensitization measures. Before OFC, close attention to skin care is also essential so that a cutaneous reaction to the culprit food is not confused with a background eczema flare that may have happened without food exposure.

Nevid M, Rabinovitch N. A LEAP FORWARD IN EVALUATION OF PEANUT ALLERGY IN A CHILD WITH SEVERE ATOPIC DERMATITIS. Annals of Allergy, Asthma & Immunology. 2022;129(5): S148. https://doi.org/10.1016/j.anai.2022.08.935.