Continuation of Case 1
Skin prick testing reveals the following: Histamine (positive control): 3 mm wheal Serum specific IgE testing reveals: Peanut: 15 kU/L
Saline (negative control): 0 mm wheal
Peanut: 7 mm wheal
Walnut: 2 mm wheal
Cashew: 3 mm wheal
Almond: 3 mm wheal
Pecan: 2 mm wheal
Hazelnut: 1mm wheal
Fish: 2 mm wheal
Walnut: < 0.35 kU/L
Cashew: < 0.35 kU/L
Almond: < 0.35 kU/L
Pecan: < 0.35 kU/L
Hazelnut: < 0.35 kU/L
Fish: < 0.35 kU/L
Jack is a 26 month old male who returns to your clinic after an ER visit for food allergy. He ate a piece of a granola bar that was produced on a line with peanut and tree nuts. Fifteen minutes later he developed hives on his arms, legs, and trunk. His mother next noticed periorbital edema and wheezing. He was taken to a nearby ER and was treated with IM epinephrine, diphenhydramine, steroids, and one albuterol nebulized treatment. He was observed in the ER and then discharged home that evening. He was sent home with a prescription for an epinephrine auto-injector.
Jack has a history of eczema that is well controlled with topical emollients and occasional topical steroid use. He has no prior history of wheezing. His parents do not report any previous exposure to peanuts. He eats eggs, milk, soy and wheat with no symptoms of food allergy. He has never eaten tree nuts, fish, or shellfish.
