From the Guidelines
No, a patient with a nut allergy should not eat in a dining room where other patients are eating nuts due to the risk of cross-contamination and airborne particles. Even if the allergic patient doesn't directly consume nuts, proteins from nuts can become airborne when nuts are cracked open, handled, or eaten nearby, as noted in studies on food allergy management 1. These particles can travel through the air and potentially trigger a severe allergic reaction, including anaphylaxis, in highly sensitive individuals. The risk is particularly concerning in enclosed spaces like dining rooms, where the concentration of airborne allergens can be higher. Healthcare facilities should implement allergen management protocols, which might include designated allergen-free dining areas, separate meal times, or meal service in the patient's room. Staff should also be trained to recognize and respond to allergic reactions, with emergency medications like epinephrine readily available, as recommended for patients at risk for anaphylaxis 1. The severity of the patient's allergy and their history of reactions should guide specific precautions, but generally, separation from potential allergen exposure represents the safest approach, considering the potential for severe reactions to foods like nuts 1. Some key considerations include:
- The potential for anaphylactic reactions to occur immediately after exposure to the allergen, and the possibility of symptoms recurring several hours later 1
- The importance of skin tests and food challenges in diagnosing food allergies, and the need for these tests to be conducted in a medical facility with personnel experienced in treating anaphylaxis 1
- The fact that certain foods, including nuts, can cause anaphylaxis even through inhalation exposure, highlighting the need for caution in environments where these foods are being consumed 1
From the Research
Risk of Accidental Exposure
- Patients with nut allergies are at risk of accidental exposure to nuts in dining rooms where other patients are eating nuts 2, 3.
- The risk of peanut contamination in foods with precautionary allergen labeling (PAL) can range from 0.9-32.4% 3.
- However, the risk of contamination in non-snack items with PAL is far less common 3.
Management of Nut Allergies
- Dietary management of peanut and tree nut allergy involves strict avoidance of nuts and provision of emergency medication 3, 4.
- Patients with nut allergies should be educated on avoidance of triggers and appropriate use of an epinephrine auto-injector 5.
- Selective introduction of specific nuts to which the patient is not allergic may improve quality of life 3, 4.
Dining Room Precautions
- Patients with nut allergies should take precautions when eating in dining rooms where other patients are eating nuts, such as avoiding cross-contamination and carrying emergency medication 2, 3, 5.
- However, there is no clear evidence to suggest that patients with nut allergies cannot eat in dining rooms where other patients are eating nuts, as long as proper precautions are taken 3, 4.