INFORMATION FOR HEALTH PROFESSIONALS
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Web site: November 2000
Prescriber Update No.20:22-26
Mary Louise Hannah, Advisor (Nutrition), Ministry of Health
Key messages:
New Zealand has no prevalence data for peanut allergy but nut allergy is probably in the order of 1-2%.1 The general belief amongst immunologists is that peanut allergy is increasing.1,2,3 Peanut allergy is the most common cause of food-related anaphylaxis. In New Zealand between 1995 and 1997 out of a total 221 cases of reported food-related anaphylaxis, there were 32 hospital admissions reported as being due to peanut/nut allergy.4
The Ministry of Health’s Food and Nutrition Advisory Committee recently agreed that it would be useful for medical practitioners in New Zealand to receive information on peanut allergy, including the implications of a recent UK report. This circular letter is to provide practitioners with the most recent developments in the field. Previous information in Prescriber Update1 by Dr Penny Fitzharris, a Wellington based immunologist, discussed the possibility of prevention of peanut allergy by the avoidance of peanut products in pregnancy, during breastfeeding and in early life.1 This advice has been confirmed in the UK report.
During 1998 in the United Kingdom, the Department of Health’s Committee on the Toxicology of Chemicals in Food, Consumer Products and the Environment, produced a report to:
The Committee’s work was prompted by recent publications in scientific literature suggesting that the incidence of peanut allergy was increasing. Peanut allergy can be very severe, with fatal anaphylaxis, and is a potentially serious health hazard. Due to this severity, peanut allergy prevention is an important measure. Peanut allergy is normally a life-long allergy.
Recommendations from UK report
To attempt prevention of peanut allergy, the UK report recommends the avoidance
of peanuts and peanut products for the following people:
For the non-atopic families, avoidance of peanuts or peanut products is not considered necessary during pregnancy or breastfeeding. For infants, who are not in the above risk categories, it is acceptable for smooth peanut products, such as smooth peanut butter, to be used as a weaning food at about eight to nine months, as recommended in New Zealand Food and Nutrition Guidelines for Healthy Infants and Toddlers. As there is the possible risk of choking it is also advised that whole peanuts are not given to children until five years of age.6
For individuals with peanut allergy it is essential that all foods containing peanut products, even in minute amounts, be avoided completely. Highly peanut-sensitive individuals who have a history of systemic reaction, need to carry kits with adrenaline and antihistamines on hand for self-administration promptly at the first sign of a systemic reaction. People allergic to peanuts should avoid all tree nuts such as walnuts, almonds, hazelnuts and pecans, even if they are not sensitised to these, to minimise the risk from contamination or confusion with peanuts.1 The reintroduction of peanuts should only be carried out when no reaction to peanut and nut products has occurred for three to five years, and under strictly supervised conditions at a specialised centre.2
Information on the likely peanut content of foods, or the content of other food allergens, is available to the consumer from two sources; food labels and the New Zealand Therapeutic Database. Currently general provisions for food labelling are required to comply with the New Zealand Food Regulations 1984 or the Australian Food Standards Code. In the New Zealand Food Regulations, the only instance in which peanuts may not be declared is if they are a minor component of a mixed ingredient added to a food. However, by about May 2002 Australia and New Zealand will have a joint standard for labelling of foods and all manufacturers should be working to a single standard. The Australia New Zealand Food Authority is awaiting final agreement on the draft Australia New Zealand Food Code.8 There is a mandatory labelling requirement for peanuts and peanut products in the draft Code.
The draft Code will also require a number of other significant food allergens to be declared on all food labels. Those food allergens include cereals containing gluten; crustacea and their products; egg and egg products; fish and fish products; milk and milk products; nuts, sesame seeds and their products; soybeans and their products; and sulphites in concentrations of 10mg/kg or more.
In addition to legal labelling requirements, those consumers with food allergies may be assisted by the New Zealand Therapeutic Database, which is funded by the New Zealand Ministry of Health. This database contains information obtained from food manufacturers and distributors to enable the compilation of lists of commercial foods that are free of specific allergens. The data are available to inform health professionals and people with allergies to assist them in allergy management. Lists of foods free of the common food allergens are updated and published annually and are available on the website www.nztd.co.nz or by writing to: Mrs Alannah Steeper, NZ Therapeutic Database, Auckland Hospital, Private Bag 92024, Auckland 1.
Allergy Awareness Association (PO Box 56-117, Dominion Rd, Auckland) can provide practical support to individuals and families with peanut or other allergies.
The author would like to thank a number of reviewers who provided comments on this article including: Dr John Birkbeck, Dr Jan Sinclair, Dr Rodney Ford, Dr Pat Tuohy, Dr Alison Roberts, Elizabeth Aitken, Carolyn Watts, Jane McLennan, Clare Chandler and Lyn Gillanders, and in particular Dr Penny Fitzharris.