This week we will highlight on clinical pearls and evidence-based advice on what to do if a peanut allergic patient has casual exposure to peanut.

• Being near peanut butter can trigger a reaction. Ingestion is the primary trigger for significant reactions and peanut protein does not aerosolize in significant amounts from peanut butter or undisturbed peanut.
• Being touched by peanut can trigger a reaction. Again, ingestion as the primary trigger of significant reactions. Contact reactions may lead to no symptoms or localized ones such as a rash that often resolves when the area is washed off (exception may be direct eye exposure that could swell the eyelids).
• A kiss can trigger a reaction. There is a big difference between casual versus open-mouth/passionate kissing. A peck on the cheek has minimal risk while passionate kissing and exposure of mucous membranes to peanut is high risk. Ways to decrease risk with passionate kissing is to have the partner avoid the food for at least several hours followed by ingestion of safe foods.
• Peanut dust and/or vapors cause airborne reactions. Studies have consistently demonstrated that peanut dust does NOT remain airborne. Peanut butter vapors contain no intact protein, and that what is being smelled is a volatile organic compound that has been shown not to provoke a reaction when inhaled even at close proximity.

https://www.jaci-inpractice.org/article/S2213-2198(18)30714-1/pdf