Peanut Allergy

Peanut allergy is one of the most common food allergies.

Peanut allergy usually shows up in early childhood. Unlike most other food allergies, it often lasts into adulthood. Peanuts are not actually "nuts", but a type of bean (legume). However, some people who are allergic to peanuts are also allergic to tree nuts, such as cashews or walnuts.

A food allergy occurs when the body mistakes a normally harmless substance as a threat. The immune system tries to "attack" the substance the next time it comes into contact with it. The attack includes in the release of histamine, which causes allergic symptoms ranging from an itching skin rash and nasal congestion to life-threatening anaphylaxis.

How are people exposed to peanuts?

The most obvious way to be exposed to peanuts is by eating them. There are there several ways to be exposed:

  • Direct contact. In addition to ingesting peanuts by mouth, direct skin contact with peanuts can cause an allergic reaction, such as hives or redness and itching around the mouth.
  • Cross-contact. This occurs when peanuts are unintentionally introduced into another food during processing, such as when food is produced on the same equipment used to process peanut-containing foods.
  • Inhalation. If you are around flour, dust, or sprays that contain peanuts, you may inhale these peanut-containing ingredients.

What are the symptoms of peanut allergy?

Symptoms of peanut allergy  affect all areas of the body, including the skin, digestive system, and respiratory system. Reactions range from mild to life-threatening and include:

  • Skin rash, such as hives, eczema, or itching
  • Itching or tingling around the mouth and throat
  • Indigestion, including diarrhea, cramps, nausea, or vomiting
  • Congestion
  • Shortness of breath or wheezing
  • Runny nose
  • Chest tightness

Anaphylaxis: Get help right away

People with severe peanut allergies may experience a sudden, life-threatening type of shock called anaphylaxis, which is considered a medical emergency. Anaphylaxis can cause constricted airways, dizziness, lightheadedness, a swollen throat, and a fast drop in blood pressure. As a result, the allergic person may have trouble breathing and could lose consciousness.

Anaphylaxis should be treated immediately with a rescue medication called an epinephrine injector, commonly known by the brand names EpiPen® and Twinject®. Symptoms should subside immediately after this first-line treatment, but the person should be taken to an emergency room as soon as possible for follow-up treatment (symptoms can return after the first injection wears off).

How is peanut allergy diagnosed?

Your health care provider will want to know about your symptoms and gather a family medical history. A physical exam may also be necessary. The following tests may be ordered as well, for a more precise diagnosis:

Skin test

During this test, your skin is pricked and an allergy specialist will introduce a small amount of peanut-containing substance to the skin. If you allergic, your skin will respond by developing a raised bump.

Blood test

This test, also called RAST (radioallergosorbent test), detects certain antibodies in the blood that can be identified as evidence of peanut sensitivity.

Are is peanut allergy treated?

The best way to manage peanut allergy reactions is to avoid peanuts and peanut-containing foods completely. However, because peanuts are included in so many unexpected places (such as in canned chili, where peanut paste is sometimes used as a thickener), an allergic person is likely to be exposed to peanuts at some point. In such cases, mild symptoms can be eased with antihistamines.

For severe reactions, allergic people should be prepared by carrying an epinephrine pen with them whenever possible. After initial symptoms subside, follow up with a trip to the emergency room for follow-up care (symptoms can return when the initial epinephrine injection wears off).

Desenstization to peanuts can be achieved in very select cases, but there are risks to this treatment approach. Peanut desensitization does not offer a cure for peanut allergy because small amounts of peanut must continue to be consumed in a very controlled manner on an ongoing basis.

How can an allergic reaction be prevented?

Because of the widespread use of peanuts in various foods, the best way to prevent allergic reactions is to know and avoid those foods. The most common peanut-containing foods include:

  • Cookies, pastries and other baked goods
  • Frozen desserts, especially in ice cream parlors, where shared scoops may transfer peanut-containing ingredients from one flavor to the next
  • Granola bars and cereal
  • Candy, including marzipan or other homemade sweets, which may not have ingredient labels

Less obvious peanut-containing foods include salad dressing, foods from different parts of the world (Asian, African, Mexican), and grain breads.

Take these steps to prevent and manage allergic reactions:

  • Read food labels carefully and look for phrases such as "produced in a facility that also processes nuts."
  • If you've suffered from a severe reaction to peanuts, consider wearing a medical alert bracelet or necklace, and carry rescue medications with you.

Keeping children safe

Take these precautions if you have a child who is allergic to peanuts:

  • Notify other adults about your child's allergy, including teachers, child care providers, parents of your children's friends, coaches, and anyone who had regular interaction with your child. Make sure these adults know what symptoms to look for during an allergic reaction. Be sure to mention that an allergic reaction can be life-threatening, requiring immediate action.
  • Make sure your child knows to ask for help right away if he or she has a reaction.
  • Have your child carry an epinephrine injector at all times. Check regularly to make sure it is in working order and that your child and the adults around him know how to use it. Be sure to change the medication before its expiration date.
  • Get a medical alert bracelet or necklace for your child (containing the child's name, allergy type, possible triggers, and brief emergency instructions) and make sure he wears it.
  • Make sure your child knows not to share foods with others and to be especially mindful during classtime activities involving food or shared treats.

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Last updated: 5/13/2022