The global burden of illness of peanut allergy: A comprehensive literature review

Abstract

Peanut allergy (PA) currently affects approximately 2% of the general population of Western nations and may be increasing in prevalence. Patients with PA and their families/caregivers bear a considerable burden of self-management to avoid accidental peanut exposure and to administer emergency medication (adrenaline) if needed. Compared with other food allergies, PA is associated with higher rates of accidental exposure, severe reactions and potentially fatal anaphylaxis. Approximately 7%-14% of patients with PA experience accidental peanut exposure annually, and one-third to one-half may experience anaphylaxis, although fatalities are rare. These risks impose considerably high healthcare utilization and economic costs for patients with PA and restrictions on daily activities. Measures to accommodate patients with PA are often inadequate, with inconsistent standards for food labelling and inadequate safety policies in public establishments such as restaurants and schools. Children with PA are often bullied, resulting in sadness, humiliation and anxiety. These factors cumulatively contribute to significantly reduced health-related quality of life for patients with PA and families/caregivers. Such factors also provide essential context for risk/benefit assessments of new PA therapies. This narrative review comprehensively assessed the various factors comprising the burden of PA.

Keywords: accidental exposure; anaphylaxis; burden; health-related quality of life; peanut allergy.

Figure 1

History and nature of reactions to peanut from a single‐centre study in 83 children with peanut allergy followed for 5 years. Approximately one‐third of subjects who had non–life‐threatening first reactions (19 of 61; 31.1%), and more than half of those who had life‐threatening first reactions (12 of 22; 54.5%), subsequently experienced a/another potentially life‐threatening reaction. All reactions subsequent to first reaction were from accidental exposure (as opposed to reactions occurring during food challenges). Reproduced with permission from Vander Leek et al ⁵³

Figure 2

A study of all anaphylaxis admissions to North American (United States, Canada and Mexico) paediatric intensive care units between 2010 and 2015 (N = 1989) found that peanut was the most common trigger. FA, food allergy; Hx, history. Reproduced with permission from Ramsey et al ⁵⁷

Figure 3

From an Illinois (United States) state hospital association database study of emergency department (ED) visits or hospitalizations for food‐induced anaphylaxis in Illinois hospitals from 2008 to 2012 (n = 1893; 10.9 ED visits or hospitalizations per 100,000 children). A. Rates of ED visits and hospital admissions due to food‐induced anaphylaxis by food allergen trigger. B. Annual per cent increase in ED visits from 2008 to 2012. Asterisk indicates a statistically significant increase from 2008 to 2012 (p < .005). Reproduced with permission from Dyer et al ⁶¹

Figure 4

Settings of first and subsequent reactions among 5149 registrants in a peanut and tree nut allergy registry, of whom 89% were children (aged <18 years), 68% had isolated peanut allergy, and 23% had both peanut and tree nut allergy. Accidental exposures to peanut subsequent to the first reaction occurred increasingly at school settings. ‘Other’ locations include workplace, stores, malls, sporting event sites, transportation vehicles and houses of worship. Reproduced with permission from Sicherer et al ⁴⁸

Figure 5

Bullying: respondents who reported having been bullied because of their/their child's food allergy (n = 85) from a survey study in 353 individuals with food allergy, including 287 (81.3%) with peanut allergy. Panel A describes the perpetrators of the bullying. Panel B describes the types of physical bullying. Panel C shows the reported emotional effects of bullying. For each parameter, respondents could select more than one perpetrator, type of bullying, and emotional effect. Reproduced with permission from Lieberman et al ¹³⁵

Figure 6

Scores on specific questionnaire items in study comparing quality of life in children with peanut allergy (blue bars; n = 20) and diabetes mellitus (orange bars; n = 20). A, Fear of eating peanuts/having a hypoglycaemic event; B, Chance of having a bad reaction and getting very sick; C, I have to be very careful about what I eat; D, I must take care when eating in a restaurant ¹⁷