Hand Wipes Versus Hand Washing For Removal Of Peanut Allergen From Children At School

Peanut allergy is an enormous clinical problem. It is the third most common food allergy in young children and the most common food allergy in older children, adolescents, and adults. In addition to its substantial prevalence, it is the food allergen most capable of causing severe, life-threatening, and even fatal allergic reactions. The diagnosis of peanut allergy therefore carries tremendous medical and emotional significance.

Because avoidance is the only available treatment for food allergy at this time, patients with peanut allergy must take extraordinary care to eliminate all peanut-containing foods from the diet. This is far more difficult than it sounds, especially because of the cross-contamination of foods that may occur in the manufacturing process. In addition to the obvious goal of avoiding peanuts in the diet, another key issue facing patients with peanut allergy and their families involves other potential sources of accidental exposure. Inadvertent exposure has been reported to occur in environmental settings such as restaurants, schools. and other public places—for instance, sporting events and commercial airline flights. Although these reactions are presumed to occur by exposure through skin contact or inhalation of airborne allergen, in most of these reports, accidental ingestion of peanut could not be entirely ruled out. A recent study by Simonte et al reported that casual contact or inhalation of peanut butter does not pose a significant risk for severe reactions, suggesting that many of the reports of casual contact or inhalation reactions may in fact be caused by inadvertent ingestion.

The purpose of the current study was to determine the prevalence and levels of exposure that may be encountered in home and school settings and under several simulated environmental conditions. We included environments such as those present in homes and public eating areas as well as those that may be present at sporting events or during commercial airline flights.

Hand wipe samples (METHODS)

Approximately 5 mL peanut butter was applied to the hands of volunteers, and some samples were taken before hand washing. Persons were then asked to wash their hands by using their normal hand washing techniques with various cleaning agents or plain water. Participants were also asked to clean their hands with a nonsoap antibacterial hand sanitizer after the application of 1 mL peanut butter. Participants were not instructed on specific hand washing techniques but were told to wipe or wash their hands as they normally would to remove the peanut butter. After hand washing, a 37-mm glass fiber filter was moistened with extract solution, and wipe samples were taken from the hands of participants.

Hand wipe samples (RESULTS)

Nine hand samples were taken before cleaning, and the range of Ara h 1 was 480 to 5.6 × 104 ng/mL. Hand wipe samples were taken after each of the following cleaning methods: plain water, antibacterial hand sanitizer, hand wipes, Wet Ones antibacterial wipes, liquid soap, and bar soap (Table IITable II). Water and hand sanitizer left residual Ara h 1 on 3 of 12 and 6 of 12 hands each (range, 164-8274 ng/mL and 132-1711 ng/mL, respectively). Ara h 1 was undetectable with all other hand cleaning techniques.

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