Published: April 2, 2015

Peanuts can be dangerous even if you are not allergic

We have seen a flurry of communication in the media and the medical literature about peanut allergy, specifically the concept that early introduction of peanuts to infants and young children may help prevent development of this serious food allergy.

By David E. Tunkel, MD, Chair, AAO-HNS Pediatric Otolaryngology Committee, and Director of Pediatric Otolaryngology, Johns Hopkins Institutions, Baltimore, MD

Tell parents that these young children do not have the molar teeth needed to grind nuts and seeds effectively, and that nuts are not for children under 4 years of age!Tell parents that these young children do not have the molar teeth needed to grind nuts and seeds effectively, and that nuts are not for children under 4 years of age!

We have seen a flurry of communication in the media and the medical literature about peanut allergy, specifically the concept that early introduction of peanuts to infants and young children may help prevent development of this serious food allergy. This attention to the peanut gives otolaryngologists the opportunity to emphasize and educate parents and caregivers about another well-known risk of the peanut—choking and aspiration of nuts by infants and young children.

Foreign body aspiration continues to be a danger to young children. A recent review of the Nationwide Inpatient Sample from 2009 to 2011 by Kim, et al., showed more than 1,900 pediatric admissions per year for a diagnosis of bronchial foreign body aspiration. Fifty-six percent of these admitted children had bronchoscopy, and 41.5 percent of those had foreign bodies removed. Even more concerning was the finding of a hospital mortality rate of 1.8 percent for the children admitted with a diagnosis of foreign body aspiration, and 2.2 percent of these children were diagnosed with anoxic brain injury. The average age of the children in this database review was 3.6 years.

A recent review of the “foreign body literature” by Sidell, et al., noted that food foreign bodies were the most frequent aspirated object in 94 percent of the 49 relevant studies. These authors also noted that seeds, nuts, and legumes were the most commonly aspirated food items. Peanuts were the “prime offender,” as the peanut was the aspirated object in the majority of the patients in 85 percent of relevant studies. A similar meta-analysis of pooled data by Foltran, et al., showed that nuts were the aspirated item 40 percent of the time, with 67 percent of children age 3 years or younger with a male preponderance.

Otolaryngologists often see young children with ear, sinus, and tonsillar diseases that can accompany environmental and food allergy. These encounters give us the opportunity to reinforce the efforts of pediatricians and primary care providers to inform parents and other caregivers about the risk of foreign body aspiration in infants and young children. Tell them that these young children do not have the molar teeth needed to grind nuts and seeds effectively, and that nuts are not for children under 4 years of age! If our pediatric colleagues start to recommend early introduction of peanut protein in an attempt to reduce risk of allergy to our young patients, emphasize that this should NOT include peanuts, tree nuts, or nut fragments.


  2. Kim IA, Shapiro N, Bhattacharyya N. The national cost burden of bronchial foreign body aspiration in children. Laryngoscope. 2014; Nov 1. doi: 10.1002/lary.25002. [Epub ahead of print]
  3. Sidell DR, Kim IA, Coker TR, Moreno C, Shapiro NL. Food choking hazards in children. Int J Pediatr Otorhinolaryngol. 2013; 77:1940-1946.
  4. Foltran F, Ballali S, Passali FM, Kern E, Morra B, Passali GC, Berchialla P, Lauriello M, Gregori D. Foreign bodies in the airways: a meta-analysis of published papers. Int J Pediatr Otorhinolaryngol. 2012; 76S:S12-S19.
  5. Gruchalla RS, Sampson HA. Preventing peanut allergy through early consumption—ready for prime time? NEJM. 2015; 372(9):875-877.




More from April 2015 - Vol. 34 No. 03

Dr. Curotta, nurse, and a happy patient at Baucau, East Timor.
Australian otolaryngology outreachExpanded from the print edition
By John Curotta, FRACS, Director of the Department ENT Surgery, Head of the Discipline ENT Surgery, Sydney University, Australia, and Immediate Past President of ASOHNS Australian otolaryngologists provide clinic and surgical ENT services mainly to South Pacific island nations, to Papua New Guinea, and to Timor Leste. Our humanitarian missions are tasked to those with the least ability to access care and to training, mentoring, and supporting those who will continue their care when we leave. The islands in the South Pacific, while beautiful, are small, remote, and very dispersed—Tonga, Vanuatu, Cook Islands, Solomon Islands (Guadalcanal), Samoa, Tuvalu, and Kiribati are visited. Kiribati is halfway from Australia to Hawaii, and has only 100,000 people on 33 islands totalling 350 square miles land (about six times the size of the District of Columbia) dotted over 1.35 million sq. miles of ocean. So there is little movement within the country and major difficulties for teams to get there, then get around. Timor Leste (East Timor), with a population of 1.1 million, is one of the newest nations. It shares a border with Indonesia, population 250 million. Four out of five Timorese live on less than US $2 per day. At Independence 12 years ago there was one doctor and the remains of a couple of hospitals and 90 percent of the population was unable to read or write. This is already down to 50 percent and the Guido Valdares National Hospital is running well with a strong educational ethos. Our ENT team consists of a surgeon, anaesthesiologist, audiologist, and a nurse or sometimes a surgical resident. The standard tour is one week, with four to five trips to Timor each year. Microscopes have been prepositioned but all other special equipment and medications are taken in. The first day or two is clinical assessment, including audiology, and usually 50 to 150 patients are seen and about 20 offered surgery. Four to five mastoidectomies and eight to 12 myringoplasties are done. Reinforcing instruction and training of ear care nurses, supplying medications, and reminding these people in remote places that they are not forgotten probably give more benefit than our few surgeries can accomplish.
Whether physicians like it or not, politics play a significant role in healthcare. It is tempting to ignore this fact, but to do so is a disservice to our patients and our profession. Accepting and embracing the situation allows us the opportunity to ensure that the impact of legislative policies on our patients is understood and that the voice of the physician is heard. Go, team, go Though physicians are thought to be independent, in fact we work in teams on a daily basis. Whether we are in the operating room or the office, we work with the anesthesiologists, nurses, techs, medical assistants, and administrative staff to achieve the ultimate goal of high quality, efficient patient care. We could not achieve our goals if we were not working together in a concerted effort. When it comes to advocacy, however, physicians struggle with pulling together, especially when compared to groups such as the trial attorneys or various nonphysician providers. Also, politics is a numbers game, and success is often quantified by who can garner the most signatures, who can raise the most money, or who has the greatest number of supporters. To increase the impact of our specialty’s message, we need clout in the form of numbers. To do this, we need to increase Academy member involvement in our legislative and political programs. Members of Congress are increasingly savvy at deciphering the number of otolaryngologists (constituents) represented by a particular initiative. So, every person who gets involved in AAO-HNS’ respective legislative or political programs ultimately helps us to achieve our goals. This “head count” is very important! Look for ways to participate in legislative and political advocacy, and show Members of Congress that all otolaryngologists are interested in protecting high-quality patient care. No ‘i’ in team Life teaches us that one-to-one interactions make the greatest impressions. By reaching out to a Member of Congress, we have the opportunity to make our message personal. There is also the opportunity to educate. Physicians have the best perspective of the impact governmental policy has on the delivery of healthcare. Our patients may feel the effects, but in most cases, they are not aware of the policies that lead to those outcomes. And though they vote on the policies, most Members of Congress are not intimately aware of the impact those policies have on patients and the practice of medicine. As physicians, we are the bridge between our patients and our legislators, and we owe it to our patients to advocate for their care. Fortunately, through the In-district Grassroots Outreach (I-GO) program, the Academy has staff dedicated to assisting otolaryngologists with arranging individualized interactions. These events can be tailored to each member’s comfort level and range from one-to-one meetings, practice visits, fundraising events, or larger town hall events. There is no “I” in team, but there is an “I” in I-GO! So, the answer to the question whether advocacy is an individual or team sport is … YES. By combining efforts on an individual basis that make our message personal with a collective voice to make sure we are heard, we can achieve our advocacy and patient care goals. *Contributions to ENT PAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of the American Academy of Otolaryngology-Head and Neck Surgery have the right to refuse to contribute without reprisal. Federal law prohibits ENT PAC from accepting contributions from foreign nationals. By law, if your contributions are made using a personal check or credit card, ENT PAC may use your contribution only to support candidates in federal elections. All corporate contributions to ENT PAC will be used for educational and administrative fees of ENT PAC, and other activities permissible under federal law. Federal law requires ENT PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.