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Wed May 23 16:52:32 BST 2007

1. This can be true anaphylaxis and thus rapidly fatal.

2. Immediate assessment and prioritised care.

3. The allergy is to the peanut (groundnut) protein mediated (of course) via
IgE but also IgG to a lesser extent. I'm not able to retrieve much at
present but this may be a good starting point:

Ann Allergy Asthma Immunol. 2004 Nov;93(5 Suppl 3):S12-8
    Peanut allergenicity.

        * Scurlock AM,
        * Burks AW.

    Division of Pediatric Allergy and Immunology, Duke University Medical
Center, Durham, North Carolina 27710, USA.

    OBJECTIVE: To provide the reader with a relevant review of the structure
and allergenicity of the major peanut allergens, while also exploring
predictors of clinical reactivity to peanuts, the natural history of peanut
allergy, and novel therapeutic strategies for peanut hypersensitivity. DATA
SOURCES: A PubMed search for the years 1980 to 2004 was performed using the
following search terms: peanut allergy, food allergy, anaphylaxis, peanut
allergen structure, and peanut immunotherapy. STUDY SELECTION: Articles
highlighting major advances in the study of peanut allergy were selected for
further review. RESULTS: Peanut allergy is the most serious of the
hypersensitivity reactions to foods due to its persistence and high risk of
severe anaphylaxis. The major peanut allergens and their associated
immunodominant IgE-binding epitopes have been characterized. Definition of
these allergens has lead to an increased understanding of the
peanut-specific immunologic response and improved predictors of clinical
reactivity to peanuts. An understanding of these mechanisms is vital for the
eventual development of safe and effective immunotherapy for peanut allergic
patients. Novel therapeutic and diagnostic approaches are being developed
for patients with peanut hypersensitivity. CONCLUSIONS: Improved
understanding of the molecular structure of the major peanut allergens and
the peanut-specific immune response has lead to significant diagnostic and
therapeutic advances in the study of peanut allergy.

4. Standard anaphylaxis treatment; I don't think any of the epitope blockers
are yet available.

5. As before; life support as required.

6. Sorry; can't help as that is US specific.

Blueflightmedic.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: 23 May 2007 16:15
To: trauma-list at trauma.org; ccm-l at ccm-l.org
Subject: Peanut Alergy

I am seeking some practical, immulogical, and therapeutic information  
regarding a patient with known severe peanut allergy.  Detail of the  case
have come 
to me from three different sources.     My  requests will be going to EMTs, 
Paramedics, EMS services, ICUs, EC nurses, EC  doctors, ICU doctors,
hospital 
administrators, and even attorneys if any or all  seek to give discussion.

A patient with a known peanut allergy was taken to a hospital, in the  
attendance of another trained medical personnel.   A phone call was  made
ahead of 
time that the patient was arriving, but upon arrival was put in  line and
had 
to wait, although in severe distress.   Out of  frustration the patient was 
taken out by the attendant and taken to a second  facility, where immediate 
intubation and resuscitation was  required.    

I have several questions:

1.    How severe are peanut allergies
2.    What is the duty of an EC that receives such a  patient at their
triage 
desk
3.    What causes such allergy
4.    What drugs are best used to treat such a  patient
5.    What is done in an ICU with such a patient who  arrives from the EC 
intubated
6.    If I know the name of the city where this  occurred, the name of the 
hospital, the name of the triage personnel, the name  of the attendant that
took 
the patient to the hospital and took the patient out  to the second
hospital, 
etc.  What DUTY do I have to these individuals if  they asked me for help in

preventing this from happening in the future?

k

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Peanut Alergy