Which peanut-allergic patients are at highest risk of anaphylaxis?

Although acute allergic reactions after ingestion of peanuts and tree nuts are common, fatalities, which are most commonly due to anaphylaxis, are rare.

Which peanut-allergic patients are at highest risk of anaphylaxis?

Factors predicting anaphylaxis to peanuts and tree nuts are:

- serum angiotensin-converting enzyme (ACE) concentrations of less than 37.0 mmol/L are associated with a 9-fold risk of severe pharyngeal edema
- severe asthma -- relative risk 6.8
- severe rhinitis
- severe eczema


Eight top allergens account for 90 percent of all food allergies. See more Allergy and Immunology mind maps here.

Remission of peanut allergy can be predicted by low levels of IgE antibodies to peanut in the first 2 years of life or decreasing levels of IgE sensitization by the age of 3 years.



AAAAI: Gradual Exposure Reduces Kids' Peanut Allergy. MedPage Today, 03/2008.

References:
Factors predicting anaphylaxis to peanuts and tree nuts in patients referred to a specialist center. J Allergy Clin Immunol. 2008 Jan 17.
Early clinical predictors of remission of peanut allergy in children. JACI, 03/2008.
Peanut Allergy: An Evolving Clinical Challenge (review), 2011.
Food Allergy: Brief Review. Allergy Cases.

@AllergyNet: Coroner's Report of anaphylactic death due to food allergy in Australia http://bit.ly/k2QK0c - A lot to be learned from this tragic episode.
Image source: Wikipedia, public domain.