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Peanut cross contamination

Q: I have a 7-year-old patient who has been diagnosed with peanut allergy. She has a bonafide history of anaphylaxis following peanut ingestion and carries an epinephrine autoinjector with her at all times. The parents have a disagreement about whether she should also avoid foods that are labeled as having been "manufactured in a facility" that produces peanut products.

The mother feels that all such foods should be avoided, both at home and at school. The father doesn’t feel that such precautions are necessary since the likelihood that a food will be contaminated is extremely small.

How many cases of allergic reaction have occurred as a result of cross-contamination of a non-peanut food with peanut because both are produced in the same factory? Is this really a problem or is the label there merely for the legal protection of the factory in case a claim is made? Should peanut-allergic patients avoid foods labeled this way?

A: There was much discussion on this question. Many respondents feel the risk would indeed be small and that it is likely a legal disclaimer. However, two separate studies done several years ago, one done in the Northeast and one in the Midwest, found that 20% of foods labeled as "manufactured in a facility that also manufactures..." had sufficient contamination to trigger a reaction. Greater risk was noted related to "mislabeling" - citing a death a couple decades ago of a teenager who ate a piece of chocolate candy "with walnuts" where peanuts had been substituted for walnuts.

Pooled data regarding actual reactions to peanut in these circumstances would be helpful (not unlike incidental reactions occurring on airplanes). For such data, there would also be a selection bias, likely with less sensitive individuals being able to tolerate the potential cross-contamination. Any such study would also need to assure that individuals involved were truly peanut-allergic/had a proper diagnosis.

It would be reasonable to assume that in a food processing facility where peanuts are present, risk of accidental contamination is higher. As with any risk with serious consequences, perhaps it is best to assume that the risk should be avoided. The final decision should be based on the patient or parent level of comfort, noting that it is truly difficult to find candies that do not have the "may contain" or "manufactured in" labels. From our perspective, there are no real differences between these two labels!

 
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