Dietitian CE

Prevention of Peanut Allergy

Primum non nocere - first do no harm. And then feed peanut

1. In the absence of specific IgE mediated symptoms, a positive skin / food-specific IgE test represents sensitization and proves clinical reactivity to the food.

A. True B. False

2. Individuals with atopic dermatitis, or other allergic conditions, are more likely to have:

A. Elevated IgE levels B. False positive food-specific IgE tests C. Both (A) and (B) D. None of the above

3. When sIgE testing is ordered for peanut, the Guidelines recommend ordering testing to foods other than peanut as well.

A. True B. False

4. The Guidelines recommend that infants who tolerate peanut should continue to consume 6 - 7 grams:

A. Over 3 servings each week B. Split between 2 servings per week C. At each serving several times per week

5. The overwhelming majority of infants, including those with mild to moderate eczema, can introduce peanut early and at home without investigation.

A. True B. False

6. Early introduction of peanut is the primary goal as it is evident that there is an early window of opportunity for the development of tolerance.

A. True B. False

Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel

7. Peanut allergy is the leading cause of death related to food induced anaphylaxis in the United States.

A. True B. False

8. The guidelines indicate that insufficient evidence exists for delaying introduction of solid food, including potentially allergenic foods, beyond _____, even in infants at risk of developing allergic disease.

A. 10 to 12 months B. 8 to 10 months C. 6 to 8 months D. 4 to 6 months E. 2 to 4 months

9. What observation was associated with the prevalence of peanut allergy being tenfold higher among Jewish children in the United Kingdom compared with Israeli children of similar ancestry?

A. In Israel, peanut-containing foods are usually introduced in the diet when the infants are approximately 7 months of age and consumed in substantial amounts. B. In the United Kingdom, children do not typically consume any peanut-containing foods during their first year of life. C. Both (A) and (B) were observed. D. None of the above.

10. Other solid foods should be introduced before peanut-containing foods to show that the infant is developmentally ready.

A. True B. False

11. Infants in which category can be sensitized without being allergic to peanut and might benefit from early peanut consumption?

A. A wheal diameter of 2 mm or less above saline control during a SPT. B. A wheal diameter of 3 to 7 mm above saline control during a SPT. C. A wheal diameter of 8 mm or greater above saline control during a SPT.

12. Infants with _____ are at high risk for the development of peanut allergy.

A. Severe eczema B. Egg allergy C. Either (A) and/or (B) D. None of the above

13. Older age at screening is associated with larger wheal diameter induced by peanut SPT and hence a higher likelihood of established peanut allergy.

A. True B. False

14. No evidence exists for restricting allergenic foods in infants without known risks for food allergy.

A. True B. False

15. In countries where peanut products are not widely consumed by adults, early dietary introduction of peanut could lead to an increase in sensitization and allergic manifestations, hence, the EP cautions that this guideline be implemented in the context of societal routines / norms.

A. True B. False

16. Which of the following is an instruction for home feeding of peanut protein for infants at low risk of an allergic reaction to peanut?

A. The caregiver should feed their infant only when he or she is healthy and not when the infant has a cold, vomiting, diarrhea, or other illness. B. The first peanut feeding should be at home and not at a daycare facility or restaurant. C. At least 1 adult should be able to focus all of his or her attention on the infant without distractions from other children or household activities. D. The caregiver will need to be able to spend at least 2 hours with the infant after the feeding to watch for any signs of an allergic reaction. E. All of the above are instructions for home feeding of peanut protein for infants at low risk of an allergic reaction to peanut.

17. All of the following are mild symptoms of an allergic reaction, except for:

A. A new rash B. A few hives around the mouth or face C. Repetitive coughing D. All of the above are mild symptoms of an allergic reaction

18. Whole nuts should not be given to children less than:

A. 5 years of age B. 4 years of age C. 3 years of age D. 2 years of age E. 1 year of age

19. Peanut butter directly from a spoon or in lumps / dollops should not be given to children less than:

A. 5 years of age B. 4 years of age C. 3 years of age D. 2 years of age E. 1 year of age

20. If after a week or more of eating peanut, the infant or child displays mild allergic symptoms within 2 hours of eating peanut, the caregiver should contact their health care provider.

A. True B. False

Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants

21. There is now scientific evidence that healthcare professionals should recommend introducing peanut-containing products into the diets of “high-risk” infants early on in life in countries where peanut allergy is prevalent because delaying the introduction of peanut can be associated with an increased risk of peanut allergy.

A. True B. False

22. Without intervention by healthcare professionals, there is the potential that such high-risk infants will remain at risk for delayed introduction of solids and allergenic foods into their diet because of the widespread belief that such foods may exacerbate eczema.

A. True B. False

Peanut sensitization pattern in Norwegian children and adults with specific IgE to peanut show age related differences

23. Ara h2, one of the major peanut allergens, is a seed storage protein belonging to the _____ family.

A. Vicilin B. Conglutin C. Glycinin D. All of the above

24. The storage protein Ara h6 has sequence identities to _____ and is also reported to be associated with clinical reactivity to peanut.

A. Ara h1 B. Ara h2 C. Ara h3 D. All of the above

25. The relationship between allergy to pollen and _____ is caused by cross-reacting epitopes due to homology between proteins and often give rise to milder symptoms such as the oral allergy syndrome.

A. Vegetables B. Nuts C. Peanuts D. Fruits E. All of the above

26. Studies have shown that peanut allergies have different clinical and immunological patterns due to difference in pollen exposures and differences in dietary traditions.

A. True B. False

27. The sensitization pattern showed highest frequency of sIgE in the youngest age group to all of the following, except:

A. Ara h1 B. Ara h2 C. Ara h3 D. Ara h6 E. Ara h8

28. There is an observed 76:24 % male:female ratio in the oldest age group for both asthma and allergy that is explained by hormonal changes, genetic susceptibility, and differences in environmental exposure.

A. True B. False

29. A recent study has shown that the greater frequency of clinical peanut allergy and hence responsible for the increased prevalence in the youngest children is due to:

A. Dietary changes with an increase in the overall use of peanuts in foods and as snacks over the last decades. B. An intestinal permeability in genetically predisposed children. C. Delayed oral exposure to peanut.

30. The early onset of sensitization to the main peanut allergens found in children below the age of 6 years showed highest frequency of sIgE to Ara h6, indicating the importance of using Ara h6 in diagnosing small children sensitized to peanut.

A. True B. False

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