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Peanut Fears Allayed
335
Simpson, C and Pirrie, L (1991). Walking aids: A survey of suitability and supply’, Physiotherapy,77, 3, 231-234. Webber, M and Pryor, J (1993). Physiotherapy for Respiratory and Cardiac Problems, Churchill Livingstone, Edinburgh.
Acknowledgements Many thanks to Adele Reece BSc MCSP for her ideas and support in preparing this paper. Thanks are also due to the physiotherapy staff at St Richard’s Hospital, Chichester, and to Peter Rice for their encouragement, help and feedback.
Author Chris Wilkin MSc MCSP works freelance in neurosciences.
This article was received on September 4, 1995, and accepted on February 29, 1996.
for Correspondence Mrs C Wilkin, 19 Lerryn Road, Gospott, Hants PO13 OYG.
letters Peanut Fears Allayed MADAM - Following the letter on arachis oil in your January issue, readers may wish for some further discussion. The major allergen of peanuts is thought to be a substance named peanut-/. This and other minor allergens are known to be proteins. Arachis oil (ground nut oil) is the fixed oil obtained from the shelled seeds of the peanut (Arachis hypogaea L) and refined. Due to this latter process all proteins should be removed along with carbohydrates, water, ash and fibre. Thus it would seem that arachis oil could not be responsible for anaphylaxis or associated reactions in peanut-sensitiveindividuals. In America a trial was undertaken in ten peanut-sensitive individuals to determine whether arachis oil could induce an adverse reaction (Taylor ef a/, 1981). The ten patients had previously experienced allergic reactions to peanuts and tests showed they had antibodies to crude peanut extract and to the purified peanut allergen (peanut-/). Skin-puncture
tests with both arachis oil and olive oil (the control oil which is nonallergenic) were negative. The ten patients then proceeded to ingest, at 30-minute intervals, 1, 2 and 5 ml of either arachis oil or olive oil (in capsule form) and were observed for adverse reactions. This was repeated two weeks later with oil not received the first time. No untoward reactions were observed in any of the ten patients with either the arachis or olive oil. It was concluded that arachis oil is not allergenic in peanut-sensitive individuals. However, the investigators did state that only one brand of arachis oil was investigated, albeit virtually all arachis oil sold in the USA is processed by the same supplier and thus undergoesthe same processing. Nevertheless, although all protein should be removed during the refining process, the possibility of the presence of minute traces of peanut protein cannot be ruled out. Several products are available on the market which contain arachis
Comparative Success MADAM - In reply to Mr Clemence’s letter regarding long-wave therapy (April, page 279), I feel that I should apologise to him if my best attempts at providing a comparative study have failed to satisfy him totally. It is through no lack of effort on my behalf. First, may I point out that Hashish (1986) used a placebo which was blind to the patient but not to the operator. This is exactly the same method of sham treatment that was used in the longwave therapy paper. Consequently, I did not regard this as a failure to provide placebo as the patient was unaware of the placebo being given.
It should be pointed out that not everything in life can be imitated by placebo: it is not possible to manipulate someone’s back in a placebo manner, nor is it possible to give placebo hypnotherapy, it is totally impossible to give placebo acupuncture and I am afraid that it is also not possible to provide placebo longwave ultrasound therapy as the therapist would know whether the patient was being treated with an inactive machine. Notwithstanding this drawback in the study that Mr Clemence points out, the patients were assessed using a sophisticated gait analysis system
oil: Fletcher’s arachis oil enemas (Pharmax), Cerumol ear drops (LAB), Hydromol cream (Quinoderm Ltd) and Oilatum cream (Steifel). The manufacturersof both the enema and Cerumol ear drops recommend that the products should not be used in peanut-sensitive individuals although neither company has received any reports of such adverse reactions to date. The manufacturers of Hydromol cream recommend that it should not be used in patients with a true hypersensitivity to any of the ingredients. In conclusion, although it appears that arachis oil is unlikely to induce an anaphylactic reaction in peanutsensitive individuals, one can not be 100% sure. Thus, if an alternative agent is available, for example to prevent ice burns (ie liquid paraffin) it seems sensible, as a precautionary measure, to use that instead.
Julie Gershkoff MRPharmS Drug Information Department North Hampshire Hospital Basingstoke Reference Taylor, S L, Busse, W W, Sachs, M I e t a / (1981). ‘Peanut oil is not allergenic to peanut-sensitiveindividuals’, Journal of Allergy and Clinical Immunology, 68, 5, 372-375.
before and after treatment and this takes all the observer bias out of the study. The results were subjected to rigorous statistical analysis and found to be significant. I should point out that for the purpose of this study, the ultrasound equipment was validated by the Medical Physical Department and the National Physical Laboratory. In short, I do not think there is anything else that I could have done to make this study better in any way, due to the nature of the equipment being used.
B Bradnock BSc MB ChB FRCSEd FRCSOrth Royal National Orthopaedic Hospital London
Physiotherapy, May 1996, vol82, no 5
Simpson, C and Pirrie, L (1991). Walking aids: A survey of suitability and supply’, Physiotherapy,77, 3, 231-234. Webber, M and Pryor, J (1993). Physiotherapy for Respiratory and Cardiac Problems, Churchill Livingstone, Edinburgh.
Acknowledgements Many thanks to Adele Reece BSc MCSP for her ideas and support in preparing this paper. Thanks are also due to the physiotherapy staff at St Richard’s Hospital, Chichester, and to Peter Rice for their encouragement, help and feedback.
Author Chris Wilkin MSc MCSP works freelance in neurosciences.
This article was received on September 4, 1995, and accepted on February 29, 1996.
for Correspondence Mrs C Wilkin, 19 Lerryn Road, Gospott, Hants PO13 OYG.
letters Peanut Fears Allayed MADAM - Following the letter on arachis oil in your January issue, readers may wish for some further discussion. The major allergen of peanuts is thought to be a substance named peanut-/. This and other minor allergens are known to be proteins. Arachis oil (ground nut oil) is the fixed oil obtained from the shelled seeds of the peanut (Arachis hypogaea L) and refined. Due to this latter process all proteins should be removed along with carbohydrates, water, ash and fibre. Thus it would seem that arachis oil could not be responsible for anaphylaxis or associated reactions in peanut-sensitiveindividuals. In America a trial was undertaken in ten peanut-sensitive individuals to determine whether arachis oil could induce an adverse reaction (Taylor ef a/, 1981). The ten patients had previously experienced allergic reactions to peanuts and tests showed they had antibodies to crude peanut extract and to the purified peanut allergen (peanut-/). Skin-puncture
tests with both arachis oil and olive oil (the control oil which is nonallergenic) were negative. The ten patients then proceeded to ingest, at 30-minute intervals, 1, 2 and 5 ml of either arachis oil or olive oil (in capsule form) and were observed for adverse reactions. This was repeated two weeks later with oil not received the first time. No untoward reactions were observed in any of the ten patients with either the arachis or olive oil. It was concluded that arachis oil is not allergenic in peanut-sensitive individuals. However, the investigators did state that only one brand of arachis oil was investigated, albeit virtually all arachis oil sold in the USA is processed by the same supplier and thus undergoesthe same processing. Nevertheless, although all protein should be removed during the refining process, the possibility of the presence of minute traces of peanut protein cannot be ruled out. Several products are available on the market which contain arachis
Comparative Success MADAM - In reply to Mr Clemence’s letter regarding long-wave therapy (April, page 279), I feel that I should apologise to him if my best attempts at providing a comparative study have failed to satisfy him totally. It is through no lack of effort on my behalf. First, may I point out that Hashish (1986) used a placebo which was blind to the patient but not to the operator. This is exactly the same method of sham treatment that was used in the longwave therapy paper. Consequently, I did not regard this as a failure to provide placebo as the patient was unaware of the placebo being given.
It should be pointed out that not everything in life can be imitated by placebo: it is not possible to manipulate someone’s back in a placebo manner, nor is it possible to give placebo hypnotherapy, it is totally impossible to give placebo acupuncture and I am afraid that it is also not possible to provide placebo longwave ultrasound therapy as the therapist would know whether the patient was being treated with an inactive machine. Notwithstanding this drawback in the study that Mr Clemence points out, the patients were assessed using a sophisticated gait analysis system
oil: Fletcher’s arachis oil enemas (Pharmax), Cerumol ear drops (LAB), Hydromol cream (Quinoderm Ltd) and Oilatum cream (Steifel). The manufacturersof both the enema and Cerumol ear drops recommend that the products should not be used in peanut-sensitive individuals although neither company has received any reports of such adverse reactions to date. The manufacturers of Hydromol cream recommend that it should not be used in patients with a true hypersensitivity to any of the ingredients. In conclusion, although it appears that arachis oil is unlikely to induce an anaphylactic reaction in peanutsensitive individuals, one can not be 100% sure. Thus, if an alternative agent is available, for example to prevent ice burns (ie liquid paraffin) it seems sensible, as a precautionary measure, to use that instead.
Julie Gershkoff MRPharmS Drug Information Department North Hampshire Hospital Basingstoke Reference Taylor, S L, Busse, W W, Sachs, M I e t a / (1981). ‘Peanut oil is not allergenic to peanut-sensitiveindividuals’, Journal of Allergy and Clinical Immunology, 68, 5, 372-375.
before and after treatment and this takes all the observer bias out of the study. The results were subjected to rigorous statistical analysis and found to be significant. I should point out that for the purpose of this study, the ultrasound equipment was validated by the Medical Physical Department and the National Physical Laboratory. In short, I do not think there is anything else that I could have done to make this study better in any way, due to the nature of the equipment being used.
B Bradnock BSc MB ChB FRCSEd FRCSOrth Royal National Orthopaedic Hospital London
Physiotherapy, May 1996, vol82, no 5