Asia Pac Allergy.  2020 Jan;10(1):e6. 10.5415/apallergy.2020.10.e6.

A 5-year retrospective review of children with peanut allergy in the largest paediatric hospital in Singapore

  • 1Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
  • 2Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Medical School, Singapore.


The prevalence of peanut allergy (PA) among children has increased significantly over the past decade. Even though the prevalence of PA in Singapore is considered low, peanut is the top trigger for food-induced anaphylaxis in Singaporean children.
To describe the demographic characteristics and clinical features of children with PA.
This is a 5-year retrospective review of children diagnosed with PA based on clinical history coupled with a positive skin prick test to peanut or positive oral food challenge results.
There were 269 patients (53.9% males) with a clinical diagnosis of PA. The median age at first allergic presentation for the PA group was 24 months old, with interquartile range of 13-39 months. The most common form of peanut introduced was roasted peanut. The rate of peanut anaphylaxis was 7.1%. Concomitant tree nut sensitization was found in 32.3% of this cohort, predominantly to cashew nut. Majority of them have a personal history of atopy - 75.8% with eczema, 63.6% with allergic rhinitis, and 19.7% with asthma.
This is the first large review of peanut-allergic children in Singapore. Prospective population-based studies are needed to establish the true prevalence and risk factors associated with the development of this potentially life-threatening condition.


Peanut allergy; Children; Singapore; Asia

MeSH Terms

Cohort Studies
Peanut Hypersensitivity*
Prospective Studies
Retrospective Studies*
Rhinitis, Allergic
Risk Factors

Cited by  1 articles

The 10th Anniversary of Asia Pacific Allergy
Yoon-Seok Chang
Asia Pac Allergy. 2020;10(1):.    doi: 10.5415/apallergy.2020.10.e10.



1. Sicherer SH, Sampson HA. Peanut allergy: emerging concepts and approaches for an apparent epidemic. J Allergy Clin Immunol. 2007; 120:491–503.
2. Togias A, Cooper SF, Acebal ML, Assa'ad A, Baker JR Jr, Beck LA, Block J, Byrd-Bredbenner C, Chan ES, Eichenfield LF, Fleischer DM, Fuchs GJ 3rd, Furuta GT, Greenhawt MJ, Gupta RS, Habich M, Jones SM, Keaton K, Muraro A, Plaut M, Rosenwasser LJ, Rotrosen D, Sampson HA, Schneider LC, Sicherer SH, Sidbury R, Spergel J, Stukus DR, Venter C, Boyce JA. 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. J Allergy Clin Immunol. 2017; 139:29–44.
3. Kim M, Lee JY, Jeon HY, Yang HK, Lee KJ, Han Y, Kim YH, Kim J, Ahn K. Prevalence of Immediate-Type Food Allergy in Korean Schoolchildren in 2015: A Nationwide, Population-based Study. Allergy Asthma Immunol Res. 2017; 9:410–6.
4. Tham EH, Lee BW, Chan YH, Loo EXL, Toh JY, Goh A, Teoh OH, Yap F, Tan KH, Godfrey KM, Chong MFF, Van Bever HPS, Chong YS, Shek LP. Low food allergy prevalence despite delayed introduction of allergenic foods-data from the GUSTO Cohort. J Allergy Clin Immunol Pract. 2018; 6:466–75. e1.
5. Koplin JJ, Wake M, Dharmage SC, Matheson M, Tang ML, Gurrin LC, Dwyer T, Peters RL, Prescott S, Ponsonby AL, Lowe AJ, Allen KJ. HealthNuts study group. Cohort Profile: The HealthNuts Study: Population prevalence and environmental/genetic predictors of food allergy. Int J Epidemiol. 2015; 44:1161–71.
6. Venter C, Maslin K, Patil V, Kurukulaaratchy R, Grundy J, Glasbey G, Twiselton R, Dean T, Arshad SH. The prevalence, natural history and time trends of peanut allergy over the first 10 years of life in two cohorts born in the same geographical location 12 years apart. Pediatr Allergy Immunol. 2016; 27:804–11.
7. Sicherer SH, Muñoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol. 2010; 125:1322–6.
8. Lee AJ, Thalayasingam M, Lee BW. Food allergy in Asia: how does it compare? Asia Pac Allergy. 2013; 3:3–14.
9. Beyer K, Morrow E, Li XM, Bardina L, Bannon GA, Burks AW, Sampson HA. Effects of cooking methods on peanut allergenicity. J Allergy Clin Immunol. 2001; 107:1077–81.
10. Chiang WC, Kidon MI, Liew WK, Goh A, Tang JP, Chay OM. The changing face of food hypersensitivity in an Asian community. Clin Exp Allergy. 2007; 37:1055–61.
11. Liew WK, Chiang WC, Goh AE, Lim HH, Chay OM, Chang S, Tan JH, Shih E, Kidon M. Paediatric anaphylaxis in a Singaporean children cohort: changing food allergy triggers over time. Asia Pac Allergy. 2013; 3:29–34.
12. Chong KW, Saffari SE, Chan N, Seah R, Tan CH, Goh SH, Goh A, Loh W. Predictive value of peanut skin prick test, specific IgE in peanut-sensitized children in Singapore. Asia Pac Allergy. 2019; 9:e21.
13. Sampson HA, Gerth van Wijk R, Bindslev-Jensen C, Sicherer S, Teuber SS, Burks AW, Dubois AE, Beyer K, Eigenmann PA, Spergel JM, Werfel T, Chinchilli VM. Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology-European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol. 2012; 130:1260–74.
14. Simons FE, Ardusso LR, Bilò MB, Cardona V, Ebisawa M, El-Gamal YM, Lieberman P, Lockey RF, Muraro A, Roberts G, Sanchez-Borges M, Sheikh A, Shek LP, Wallace DV, Worm M. International consensus on (ICON) anaphylaxis. World Allergy Organ J. 2014; 7:9.
15. Singapore Department of Statistics. Singapore census of population 2010. Statistical release 1: demographic characteristics, education, language and religion. Singapore: Singapore Department of Statistics;2011.
16. Shek LP, Cabrera-Morales EA, Soh SE, Gerez I, Ng PZ, Yi FC, Ma S, Lee BW. A population-based questionnaire survey on the prevalence of peanut, tree nut, and shellfish allergy in 2 Asian populations. J Allergy Clin Immunol. 2010; 126:324–31. 331.e1-7.
17. Lao-araya M, Trakultivakorn M. Prevalence of food allergy among preschool children in northern Thailand. Pediatr Int. 2012; 54:238–43.
18. Hu Y, Chen J, Li H. Comparison of food allergy prevalence among Chinese infants in Chongqing, 2009 versus 1999. Pediatr Int. 2010; 52:820–4.
19. Leickly FE, Kloepfer KM, Slaven JE, Vitalpur G. Peanut allergy: an epidemiologic analysis of a large database. J Pediatr. 2018; 192:223–8. e1.
20. Sicherer SH, Furlong TJ, Muñoz-Furlong A, Burks AW, Sampson HA. A voluntary registry for peanut and tree nut allergy: characteristics of the first 5149 registrants. J Allergy Clin Immunol. 2001; 108:128–32.
21. Du Toit G, Katz Y, Sasieni P, Mesher D, Maleki SJ, Fisher HR, Fox AT, Turcanu V, Amir T, Zadik-Mnuhin G, Cohen A, Livne I, Lack G. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol. 2008; 122:984–91.
22. Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G. LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015; 372:803–13.
23. Al-Muhsen S, Clarke AE, Kagan RS. Peanut allergy: an overview. CMAJ. 2003; 168:1279–85.
24. Yang L, Clements S, Joks R. A retrospective study of peanut and tree nut allergy: Sensitization and correlations with clinical manifestations. Allergy Rhinol (Providence). 2015; 6:39–43.
25. Cianferoni A, Muraro A. Food-induced anaphylaxis. Immunol Allergy Clin North Am. 2012; 32:165–95.
26. de Silva IL, Mehr SS, Tey D, Tang ML. Paediatric anaphylaxis: a 5 year retrospective review. Allergy. 2008; 63:1071–6.
27. Silva R, Gomes E, Cunha L, Falcão H. Anaphylaxis in children: a nine years retrospective study (2001-2009). Allergol Immunopathol (Madr). 2012; 40:31–6.
28. Anagnostou A. Insights into tree nut and sesame consumption from a cohort of 80 peanut-allergic children. Pediatr Allergy Immunol. 2019; 30:389–92.
29. de Leon MP, Glaspole IN, Drew AC, Rolland JM, O'Hehir RE, Suphioglu C. Immunological analysis of allergenic cross-reactivity between peanut and tree nuts. Clin Exp Allergy. 2003; 33:1273–80.
30. Maloney JM, Rudengren M, Ahlstedt S, Bock SA, Sampson HA. The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy. J Allergy Clin Immunol. 2008; 122:145–51.
31. Ball H, Luyt D, Bravin K, Kirk K. Single nut or total nut avoidance in nut allergic children: outcome of nut challenges to guide exclusion diets. Pediatr Allergy Immunol. 2011; 22:808–12.
32. de Leon MP, Drew AC, Glaspole IN, Suphioglu C, O'Hehir RE, Rolland JM. IgE cross-reactivity between the major peanut allergen Ara h 2 and tree nut allergens. Mol Immunol. 2007; 44:463–71.
33. Barre A, Sordet C, Culerrier R, Rancé F, Didier A, Rougé P. Vicilin allergens of peanut and tree nuts (walnut, hazelnut and cashew nut) share structurally related IgE-binding epitopes. Mol Immunol. 2008; 45:1231–40.
34. Chitta S, Lian BX, Rao R, Loh W, Goh A, Chong KW. Cashew nut allergy in Singaporean children. Asia Pac Allergy. 2018; 8:e29.
35. Barnett D, Bonham B, Howden ME. Allergenic cross-reactions among legume foods–an in vitro study. J Allergy Clin Immunol. 1987; 79:433–8.
36. Sicherer SH, Sampson HA, Burks AW. Peanut and soy allergy: a clinical and therapeutic dilemma. Allergy. 2000; 55:515–21.
37. Bock SA, Atkins FM. The natural history of peanut allergy. J Allergy Clin Immunol. 1989; 83:900–4.
38. Lack G, Fox D, Northstone K, Golding J. Avon Longitudinal Study of Parents and Children Study Team. Factors associated with the development of peanut allergy in childhood. N Engl J Med. 2003; 348:977–85.
39. Brown SJ, Asai Y, Cordell HJ, Campbell LE, Zhao Y, Liao H, Northstone K, Henderson J, Alizadehfar R, Ben-Shoshan M, Morgan K, Roberts G, Masthoff LJ, Pasmans SG, van den Akker PC, Wijmenga C, Hourihane JO, Palmer CN, Lack G, Clarke A, Hull PR, Irvine AD, McLean WH. Loss-of-function variants in the filaggrin gene are a significant risk factor for peanut allergy. J Allergy Clin Immunol. 2011; 127:661–7.
40. Asai Y, Greenwood C, Hull PR, Alizadehfar R, Ben-Shoshan M, Brown SJ, Campbell L, Michel DL, Bussières J, Rousseau F, Fujiwara TM, Morgan K, Irvine AD, McLean WH, Clarke A. Filaggrin gene mutation associations with peanut allergy persist despite variations in peanut allergy diagnostic criteria or asthma status. J Allergy Clin Immunol. 2013; 132:239–42.
41. Tay YK, Kong KH, Khoo L, Goh CL, Giam YC. The prevalence and descriptive epidemiology of atopic dermatitis in Singapore school children. Br J Dermatol. 2002; 146:101–6.
42. Loo EX, Shek LP, Goh A, Teoh OH, Chan YH, Soh SE, Saw SM, Kwek K, Gluckman PD, Godfrey KM, Chong YS, Lee BW, Van Bever HP. Atopic dermatitis in early life: evidence for at least three phenotypes? Results from the GUSTO Study. Int Arch Allergy Immunol. 2015; 166:273–9.
43. Guo MM, Tseng WN, Ou CY, Hsu TY, Kuo HC, Yang KD. Predictive factors of persistent infantile atopic dermatitis up to 6 years old in Taiwan: a prospective birth cohort study. Allergy. 2015; 70:1477–84.
44. Park YM, Lee SY, Kim WK, Han MY, Kim J, Chae Y, Hahm MI, Lee KJ, Kwon HJ, Park KS, Park JS, Ahn K. Risk factors of atopic dermatitis in Korean schoolchildren: 2010 international study of asthma and allergies in childhood. Asian Pac J Allergy Immunol. 2016; 34:65–72.
45. Wang XS, Tan TN, Shek LP, Chng SY, Hia CP, Ong NB, Ma S, Lee BW, Goh DY. The prevalence of asthma and allergies in Singapore; data from two ISAAC surveys seven years apart. Arch Dis Child. 2004; 89:423–6.
46. Goksör E, Loid P, Alm B, Åberg N, Wennergren G. The allergic march comprises the coexistence of related patterns of allergic disease not just the progressive development of one disease. Acta Paediatr. 2016; 105:1472–9.
47. Alduraywish SA, Lodge CJ, Campbell B, Allen KJ, Erbas B, Lowe AJ, Dharmage SC. The march from early life food sensitization to allergic disease: a systematic review and meta-analyses of birth cohort studies. Allergy. 2016; 71:77–89.
48. Hill DA, Grundmeier RW, Ram G, Spergel JM. The epidemiologic characteristics of healthcare provider-diagnosed eczema, asthma, allergic rhinitis, and food allergy in children: a retrospective cohort study. BMC Pediatr. 2016; 16:133.
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