SingaporeMotherhood | Baby & Toddler

October 2011

Peanut Allergy in Singaporeans

Many Singaporeans think peanut allergy is an ‘angmo’ affliction; strictly a Caucasian condition. Research done by Chiang Wen Chin, an allergy specialist at the KK Women’s and Children’s Hospital (KKH), reveals otherwise.

Peanut allergies are on the rise in Singapore, just like elsewhere in the world. Nearly one-third of Singaporean children who have allergies tested positive on a separate skin-prick test for peanuts, according to a study published by Dr Chiang in 2007.

That makes peanuts the third-most common food allergy here, after eggs and shellfish. What’s more, Asian children with peanut allergies may have reactions that are potentially as severe as their Western counterparts, another study published by Dr Chiang in 2010 found.


That debunks a second myth: that Asian kids who are allergic to peanuts don’t have as bad a reaction. Many Singaporeans seem to think that peanut allergies will induce vomiting or a rash, at worst. But peanuts now cause the most cases of anaphylaxis — the most deadly form of allergic reaction — in Singapore than any other food allergen.

Two decades ago, peanut allergy was indeed pretty rare in Asia, giving rise to the belief that it was a Western problem. The scale does remain somewhat lower: In a recent survey in Singapore and the Philippines, the prevalence of peanut allergy in local children was 0.3 to 0.6 per cent, compared with 1.2 per cent in expatriate children residing in Singapore. But those figures won’t stay static; the rate of increase in peanut allergy among Asian families here is now taking off, just like the West.

Nobody is sure why there’s been a global allergy explosion. One theory is the “hygiene hypothesis”, which argues that super-cleanliness and the overuse of antibiotics in developed countries have left the human immune system with little to do but turn on itself. While researchers worldwide continue to chew that one over, the facts remain: food allergies — including peanut — are on the rise in Asia’s more developed countries.


What concerns medical experts like Dr Chiang is the lack of awareness: most Asian countries don’t have strict food labelling laws, some Singaporean parents aren’t aware how severe their child’s allergies might be, and many schools don’t have enough staff, if any at all, trained to use an Epi-pen. This is a pen-like device that auto-injects a patient with a measured dose of a form of adrenaline which helps treat allergic reactions.

In another study of 62 KKH patients who had tested positive on a peanut skin prick test, two-thirds said they had accidentally ingested peanut within a few months of diagnoses — and a whopping 50 per cent said they had done it twice. Half of those reactions were more severe than the first time.

“To me, that’s not great news… 50 per cent is high,” says Dr Chiang. “We haven’t educated them enough.” Part of the problem is poor food labelling, she says. Japan is pretty much the only Asian country that requires food manufacturers to list every single ingredient and highlight whether any of the top eight allergens are in a particular product. Restaurants are another problem. The chef might assert the dish he’s just served you contains no peanuts – but it may have been cooked in a pan that was used to make another dish that did.

To be sure, nobody has died of an anaphylactic peanut reaction in Singapore in the last 20 years that Dr Chiang is aware of. But as incidences of peanut allergy in Singaporean children continue to rise, that may change — unless the community gets way more prepared. Right now, says Dr Chiang, the nationwide level of awareness is not great. But she remains optimistic. “It’s not that it’s not going to happen. If the numbers are there, it could,” Dr Chiang confirms.


Warning Signs

The signs of immediate allergy (also called IgE food allergy) are skin reactions: itchy rashes in the form of hives, redness and swelling (often of the eyelids and lips), and gut reactions: vomiting, itchiness of the mouth and/or throat.

The signs of a life threatening or serious reaction are any form of breathing problems, coughing, choking, wheezing, or a hoarse voice. Also in this category are a fall in blood pressure: drowsiness, paleness. All of these tend to occur very soon after exposure to the food allergen (most within a few minutes, but can be delayed to about two hours).

Approved Allergy Tests

If you suspect that your child has a peanut allergy, get him tested. If you suspect a severe or anaphylactic allergy, ask for the IgE blood test — not to be confused with the IgG blood test. Otherwise ask for the Skin Prick Test. This is not a painful test although the name may suggest otherwise! These are widely accepted and standard ways of testing for allergies. These are the only two tests that are recommended in terms of diagnosing food allergy.

Just Peanuts Right? Wrong!

A peanut allergy means it’s only for peanuts, right? Wrong! The thing about peanuts is that even a trace amount can cause serious side effects (even death) if you are allergic to them. Most tree nuts are processed in the same facilities as peanuts, therefore it is recommended that all tree nuts are avoided — unless you can find a product that is processed in a dedicated peanut-free facility. Any product, including skin care, which contains peanut oil or peanut by-products has a chance of being contaminated with peanut protein. Therefore think along the lines of “it is better to be safe than sorry”. Read labels, double check, ask questions.

Food For Thought

The following foods contain peanuts (this is by NO means an exhaustive list)

• Chicken Satay
• Rojak
• Laksa
• Chicken Rice
• Most Indian & Asian foods
• Some pestos, salad dressing and mayonnaise
• Most cookies, candies, chocolate bars
• Some pet food

Note that these are just a few examples. Many more local dishes contain peanut oil. You can’t “cook out” a peanut allergy. If you or a friend or family member has a peanut allergy, you always need to be on the look out. Peanut oil lurks in many unsuspecting places, read labels and know your stuff!

Food Labelling and the AVA

It is worth noting that the Agri-Food & Veterinary Authority of Singapore (AVA) has amended The Sale Of Food Act. From April 2012, the top eight food allergens (as defined by the AVA) must be declared. However, this does not include where or how the food is processed.

In the US there were two deaths recently from products that “may contain” peanuts. They did. We need the “may contain” information to be included too for products here. Although the new labelling law is a huge step in the right direction, more still needs to be done to ensure that shoppers can safely by products, knowing for sure that they are free of peanuts and any chance of cross contamination.

Cris Sivashanmugam and Vicky Henniker-Anandraj are the editors of, Singapore’s only allergy blog.

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Peanut Allergy in Singaporeans