INFORMATION SHEET FOR CANDIDATE:

Your next patient in general practice is Mr. Brown, whose son, Jamie, age 5 years,
was taken from kindergarten to an emergency department yesterday, because he
developed a flushed face, generalized rash of his body and mild wheeze after sharing
a friends peanut butter sandwich. He was treated at the hospital and his mother was
called to take him home and she was told to see the GP for further information about
peanut allergy. How do you manage this situation?

INFORMATION SHEET FOR CANDIDATE:

Your next patient in general practice is Mr. Brown, whose son, Jamie, age 5 years,
was taken from kindergarten to an emergency department yesterday, because he
developed a flushed face, generalized rash of his body and mild wheeze after sharing
a friends peanut butter sandwich. He was treated at the hospital and his mother was
called to take him home and she was told to see the GP for further information about
peanut allergy.

How do you manage this situation?

INFORMATION SHEET FOR CANDIDATE:

Your next patient in general practice is Mr. Brown, whose son, Jamie, age 5 years,
was taken from kindergarten to an emergency department yesterday, because he
developed a flushed face, generalized rash of his body and mild wheeze after sharing
a friends peanut butter sandwich. He was treated at the hospital and his mother was
called to take him home and she was told to see the GP for further information about
peanut allergy.

How do you manage this situation?

INFORMATION SHEET FOR CANDIDATE:

Your next patient in general practice is Mr. Brown, whose son, Jamie, age 5 years,
was taken from kindergarten to an emergency department yesterday, because he
developed a flushed face, generalized rash of his body and mild wheeze after sharing
a friends peanut butter sandwich. He was treated at the hospital and his mother was
called to take him home and she was told to see the GP for further information about
peanut allergy.

How do you manage this situation?

INFORMATION SHEET FOR CANDIDATE:

Your next patient in general practice is Mr. Brown, whose son, Jamie, age 5 years,
was taken from kindergarten to an emergency department yesterday, because he
developed a flushed face, generalized rash of his body and mild wheeze after sharing
 a friends peanut butter sandwich. He was treated at the hospital and his mother was
called to take him home and she was told to see the GP for further information about
peanut allergy. How do you manage this situation?

Peanut allergy is an IgE-mediated hypersensitivity allergic reaction which occurs soon

after exposure to peanuts or peanut products. About 1% of children are allergic to peanuts
but 20% of them “grow out of it”.

Symptoms: can range from a mild form with itchy wheals or hives appearing around the
mouth where peanut has touched the skin, or more generalised on other parts of the body,
or vomiting and abdominal pains can occur soon after eating peanuts.

More pronounced episodes cause flushing, blotchiness or pallor, generalized urticaria,

cough and wheeze, even difficulty breathing.

In the most sever form the patient can develop angiooedema, anaphylactic shock, loss of
consciousness and even death.

Pathology: Usually an IgE mediated reaction (type I hypersensitivity) with allergen

induced IgE molecules cross-linking on the surface of mast cells or basophils,
causing degranulation and release of inflammatory mediators. There can be cross
reactivity with other nuts or foods like shell fish!
Diagnosis: 1. clinically, usually no doubt if nuts identified
2. skin test (although can be positive without the patient showing
symptoms!)
3. RAST (radio allergosorbent test, an enzyme and fluorescent based.
assay) test

Management:

1. Allergen Avoidance!
This may be difficult in children, kindergarten and school and should be discussed
with the people in charge of the children.
Be aware of cross allergy with other nuts!!! Avoid peanut- oils, - butter and –
cakes!!!
Read food labeling very carefully!!! the following foods that could
contain peanut products as an ingredient:
Cake Kebabs
Hydrolysed or textured vegetable
Biscuits Salad dressing protein
(HVP & TVP, usually soy)
Crackers Soups Chocolates
Pastries Spaghetti sauces Health bars, eg muesli bars
Chinese meals Thai dishes Ice creams
Ethnic cooking Turkish delight Marzipan
Indonesian dishes Breakfast cereals Nougat

2. Medications:
A) Epi-pen
B) Medihaler Epi MDI
C) Antihistamines
D) Prednisolone

3. Consider a medical alert bracelet!

What about foods with a label that says "may contain traces of peanuts"?

Many foods carry a warning on the label "may contain traces of peanuts". This usually
indicates that the food is made in a facility that also makes a food containing peanuts,