Link Between Nut Allergy and Asthma

Does your nut allergic child also have asthma?

If so, which concerns you more – the asthma or the nut allergy? For me, my son’s peanut allergy is my main concern and I’ve tended to focus on the need to control his asthma as a way of trying to reduce his anaphylaxis risk. However, I attended a talk earlier this month which made me appreciate the importance of managing his asthma for its own sake too.

My son’s medical history

When D was around 12 months old, he was poorly every other week, with chest infection after chest infection. He was usually prescribed amoxicillin, sometimes the oral steroid prednisolone, and on one occasion we were issued with a blue reliever inhaler. One afternoon, I received a call from nursery, where his baby room key worker told me “D’s breathing isn’t right”. I remember driving down to nursery with his blue inhaler and to bring him home, with the niggling feeling that “this isn’t normal”. At that stage, we didn’t know for sure that he had asthma, as our GP told us he was too young for them to confirm an asthma diagnosis.

We then went through several months of being regular visitors to both the out of hours GP and A&E, for him to be given steroids or put on the nebuliser. He frequently missed nursery. And I was continuously having to take last minute time off work and then frantically play catch up once he was well. Until the following week, when the coughing would start again.

Despite this history, it was only after he suffered anaphylaxis to peanut at 20 months’ old, that the hospital confirmed he was asthmatic. Once he recovered from the reaction, one of the allergy team’s first priorities was “to get his asthma under control”. He was immediately put on two puffs a day of a brown “preventer” inhaler (Clenil) and, following his second anaphylactic reaction to grass last year, a daily montelukast tablet.

Since having a brown inhaler, he has rarely had a chest infection. He’s gone from being on antibiotics once a fortnight, to needing them once or twice a year. I appreciate there may be other factors at work: for example, he’s older and has built up his immunity over the past two years. However, it’s a marked improvement and I often wonder whether he should have been given a steroid inhaler earlier on. Had his asthma been under control in April 2012, his reaction to peanut might not have been quite as severe.

As a side point, one bee I have in my bonnet is the need for new parents to be more clearly warned about the risks of food allergies. Wouldn’t it be a good idea if GPs warned of the associated (potentially life threatening) peanut allergy risk whenever prescribing eczema creams and asthma inhalers to babies, and advised parents of “higher risk” babies how to go about attempting to introduce peanut during weaning?

Asthma: a life threatening condition

Of my son’s atopic conditions, I’ve always bracketed asthma with his eczema: something for which he needs medication, but in a different league to the looming threat of anaphylaxis.

At the beginning of March, I attended a Manchester Allergy Support Group meeting, where Dr Rob Niven (Consultant Respiratory Physician, Wythenshawe Hospital) gave a talk on “Advances in the Treatment of Asthma”, including, for example, bronchial thermoplasty and the development of new drugs (such as mepolizimab and various other impossible to pronounce names). As well as learning about the potential new treatments, the talk opened my eyes to the potential dangers of asthma. Dr Niven explained that someone dies of asthma every seven hours and that one of the key reasons for this is that person’s asthma is not under control. It made me appreciate that asthma isn’t “just asthma” and that it’s something to manage in it’s own right (as well as managing it, in the hope that doing so would reduce the severity of any allergic reaction).

Some good news is that the odds for outgrowing asthma are more favourable than for outgrowing peanut allergy. Apparently for children with asthma, 1/3 outgrow it, 1/3 grow out of it temporarily (only to see it return in midlife) and 1/3 stay asthmatic throughout.

Further information

4 comments

  1. Very interesting article thanks. Totally agree that there needs to be a more joined up approach by health visitors, GPs etc in the early days. My son had severe eczema from 5 weeks yet at 22 weeks I was advised to wean him early which I now know was inadvisable and no mention of watching for food allergies (which he now has).

    Asthma does tend to take a back seat to allergies but a holistic approach can only be of benefit.

    1. Hi Sheryl, Thanks very much for your comment. Agree – health visitors could help with food allergy awareness too. I remember going to a talk on weaning at a children’s centre. Bit of a haze, but I don’t think they touched on allergies! I did have a copy of the Birth to Five Book which mentioned allergies but I think that’s something new mums turn to IF there’s a problem (rather than reading every page in advance!). I’m not sure hard copies are given out any more either… which could mean even fewer parents are forewarned about the allergy risks.

  2. I was born with asthma and had my first anaphylactic episode at 18 months due to rolling walnuts around the floor. No eating involved. (I am amazed that doctors now say 12 months is too early to be diagnosed, although I was very ill at birth, I was diagnosed then, along with a heart murmer, maybe that made the difference, maybe they just diagnosed easier back in the 70’s)
    I am 38 now and still have asthma although it is pretty well controlled through ventolin inhaler and a large daily dose of Vitamin D (I did some of my own research for alternatives to steroid inhalers. I felt, at age 26 or something, that it was 26 years too long to have this drug in my body and refused it from then)
    I think when I was little they didn’t test, my parents are a little vague as to what happened but I did have an injection of Steroid and Anti Histamine which helped sort out the issue.
    The issue was tricky though as last year I had a dreadful anaphylactic reaction to eating something, but I was on holiday in Turkey at the time. I am lucky to know some Turkish people who rushed me to a pharmacy and they gave multiple injections, steroid, antihistamine and adrenaline.
    I had managed to avoid all nuts from 18 months to 36 years but after that things became difficult. My doctor refused to accept I had an allergic reaction, repeatedly saying I had an asthma attack. My mum came to the doctor with me (she was in Turkey as well) and the doctor still wouldn’t take it seriously, especially with my asthma history, allergies can be present as well.
    In the end we paid for a consultation with a private hospital, £450 all in, for tests and a consultation. Once we explained what happened in Turkey the consultant wouldn’t ‘prick’ test me as it could be too dangerous considering the immediate reaction I had in Turkey. I had blood taken and waited for the results. In the meantime a stern letter was sent to my doctor from the consultant.
    A week later the results… Seriously allergic to tree nuts (all) very allergic to peanuts.
    So it can be a case of which came first, the allergy or the asthma. But the doctor scared me with her insistence and I wanted other people with asthma to be aware. I KNOW the difference between an asthma attack and losing blood pressure, swelling neck and face, itchy burning hands and feet, so it may be a good thing for parents of children with asthma and allergies to be aware as well perhaps.

    1. Thanks very much for this, Ness. Glad you managed to get your allergies diagnosed (and hopefully the GP won’t be so reluctant in future after your consultant’s letter). My son has had 2 anaphylactic reactions but not had an asthma attack. I actually do worry sometimes that it would be difficult to differentiate an asthma attack, particularly if it happened after he’d just eaten (although when I’ve said this to our allergy doctors, they say if in doubt give the EpiPen, as it wouldn’t do him any harm). So, not having allergies myself, that’s interesting to know that an adult would be able to distinguish the two.

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