Improving quality of life for those with food allergies and their families is an increasingly important topic among clinicians and the food allergy community. Few fears impact quality of life more than the fear of anaphylaxis due to inhalation or casual contact with food allergens, including peanuts. However, Dr. Dinakar and his colleagues have used proximity challenges (bringing open jars of peanut butter and other allergens into close-proximity of allergic individuals in controlled clinical environments) to reduce fear and reverse unwarranted fears. Continuing our coverage of the Power of Proximity Challenges, we asked Dr. Chitra Dinakar how parents and caregivers, as well as health professionals, can use the information from proximity challenges to improve quality of life for those with food allergies. Here’s what we learned.

NPB: How can parents and caregivers use this information to benefit those with peanut allergies?

Dr. Dinakar: Parents and caregivers should feel reassured that there is a very strong possibility that casual or airborne contact with the peanut allergen may not be life-threatening for their child/family member. They should be aware that the answer to this question will help them and their child fit in better in their community activities. This awareness should help empower them to seek guidance on whether casual contact is a trigger for their child/family member from a knowledgeable provider in a safe and monitored setting. Patients will most certainly find that the peace of mind they gain after the test is done is well worth their efforts.

In case they are unable to get the test done, the knowledge that, in general, it is rare for individuals to get severe reactions (i.e., more than one or few welts/swelling) from casual contact with the suspect food allergen, should help make them feel more comfortable as they lead their lives.

NPB: What would you like health professionals to do as the result of the findings?

Dr. Dinakar: I would like health professionals to a) help dispel some of these myths and b) if their clinic facilities permit, they can also bring up the option of performing these challenges during the visit.

The first myth is that casual contact (through the air, on skin contact or just being in the presence of a trigger) will cause anaphylaxis that could be life-threatening.

This is not true. In general, the food allergen needs to be absorbed into the body to cause a reaction. In other words, one has to eat a food or have it touch mucus membranes (e.g., inside of the eyes, nose) or broken skin (e.g., individuals with open sores, eczematous lesions) to have systemic symptoms and anaphylaxis. Other types of exposure can cause skin rashes and swelling of eyes, lips, fingers etc (and of course, can be extremely anxiety provoking), but typically does not cause anaphylaxis. Rarely, inhalation of aerosolized food allergen (as when shellfish is being cooked, or peanuts are shelled) can cause systemic symptoms.

The second myth is that epinephrine is a dangerous treatment.

Again, not true. All humans produce epinephrine or “adrenalin”. Epinephrine is naturally produced in our body when we get excited or do a burst of physical activity. It is therefore a safe drug that is extremely effective for allergic reactions. Unfortunately, many individuals fear that epinephrine is a dangerous treatment and use antihistamines such as Benadryl instead. While Benadryl may be appropriate for very mild reactions only, if 2 body systems are involved or the patient is having difficulty breathing or has low blood pressure, epinephrine should be given first. The sooner the better. If you wait too long (such as more than 6 minutes) it will not work as well.

NPB: Many peanut allergic individuals (or their caregivers) have a fear of being near peanuts or someone eating peanuts. What can be done to help them overcome this fear – in addition to in-clinic exposure?

Dr. Dinakar: As in Q 3.

Parents and caregivers should feel reassured that recent studies indicate a high chance that casual or airborne contact with the peanut allergen will not be life-threatening for their child/family member. Unless there is contact with the insides of the eyes, mouth, nose or abraded skin with the peanut allergen, or direct inhalation of peanut dust, casual contact typically will not trigger a severe life-threatening reaction, other than (at the most) hives/swelling at the site of contact.

If they have an allergist taking care of their child, they may consider talking to them about the possibility of performing a proximity food challenge. The one-hour procedure allows families a new alternative for evaluating ability of the child with food allergies to tolerate casual exposure, and enables them to undergo exposure to the suspect food in a controlled, safe setting. This gives them freedom from their fears and empowerment to engage in community activities with greater confidence.

Managing food allergies is an ongoing journey. For specific questions about your situation or regarding the care of your food allergic child, please contact your physician. Staying connected with a board-certified allergist can help provide the best care, including improving quality of life through supervised proximity challenges, oral food challenges, and other testing and monitoring.

Meet Dr. Chitra Dinakar

Dr. Chitra Dinakar is an award winning Professor at the University of Missouri-Kansas City, and Director, Food Allergy Center, Division of Allergy/Immunology at Children’s Mercy Hospital, Kansas City. She completed her fellowship in Allergy/Immunology at the Cleveland Clinic Foundation, Ohio. She is the Children’s Mercy’s Principal Investigator of the Food Allergy Research and Education (FARE) Clinical Trials Network a member of the Clinical Advisory Board of FARE and serves on the Editorial boards of four reputed Allergy/Immunology journalsand the USA Regional Editor of the World Allergy Organization Web Editorial Board. She has been involved in more than 50 investigator-initiated, NIH-sponsored, and industry-sponsored clinical trials, and has over 55 peer-reviewed publications, and 2 book chapters. She is an invited speaker at national and international allergy conferences, and mentors junior faculty, A/I fellows, residents and medical trainees.

Reference: Dinakar C, Shroba J, Portnoy J. The transforming power of proximity studies. Ann Allergy Asthma Immunol. 2016:117; 135-137.