A Parent's Guide to Peanut Allergy
Learn what peanut allergies involve, how to manage peanut allergies, and how to help prevent peanut allergies before they start.
Peanut allergy is one of the top three food allergies affecting young children, along with milk allergy and egg allergy.
Peanut allergies are often lifelong, as only around 20% of children with peanut allergies eventually outgrow their allergy. In addition, peanut allergies tend to cause severe, life-threatening allergic reactions more often than other food allergies.
Here’s what families need to know about peanut allergies, including how to manage them and how to prevent them before they start.
What is a Peanut Allergy?
If your child has a peanut allergy, their immune system over-defends the body against peanut proteins.
Normally, our immune systems protect us from viruses, bacteria, and other foreign invaders that could harm the body. But a child with peanut allergies has an immune system that mistakenly treats peanut proteins like these harmful invaders.
Their immune system makes allergy antibodies, called specific IgE antibodies, that are designed to detect and fight off peanut proteins. These antibodies cause symptoms of an allergic reaction each time your child eats a food that contains peanuts. An allergic reaction to peanut could be mild, moderate, or severe, and it could be life-threatening.
Peanut Allergies vs. Tree Nut Allergies
Peanut allergies are a completely different allergy category from tree nut allergies.
Peanuts are legumes that grow underground. They belong to the same family as soybeans and lentils. Tree nuts like hazelnuts, macadamia nuts, pecans, and cashews grow on trees.
But peanut allergies and tree nut allergies still seem to be closely connected. 30% of people with peanut allergies are also allergic to tree nuts.
Peanut Allergy Trends
Peanut allergy affects up to 2% of children, making it one of the three most common food allergies in young children.
Compared to all other food allergies, peanut allergy is the one most associated with severe and life-threatening allergic reactions.
And only around 20% of children outgrow their peanut allergy, so it is more likely to be lifelong than other allergies (like egg allergy and milk allergy).
In recent years, the prevalence of peanut allergy in children has more than tripled in the US.
In recent years, the prevalence of peanut allergy in children has more than tripled in the US
Also, a survey suggests that peanut is the second-most common cause of allergic reactions in schools overall (only slightly behind milk allergy), and the most common cause of allergic reactions in schoolchildren older than preschool age.
Symptoms of Peanut Allergy
Peanut allergy reactions can range from mild to severe, and can sometimes be life-threatening. The same person can experience different symptoms from reaction to reaction. And a reaction that starts out mild could become severe.
Some common symptoms of a peanut allergy reaction include:
Hives
Itchiness on the skin
Itchiness in/around the mouth
Red rash
Swelling of the skin, face, lips, or tongue
Vomiting
Red, watery, or itchy eyes
Worsening eczema
Runny nose
Congestion
Sneezing
Coughing
Wheezing
Tightness in the throat
Tightness in the chest
Diarrhea
Stomach pain
Nausea
Difficulty breathing
Difficulty swallowing
Low blood pressure
Rapid heartbeat
Dizziness
Fainting
When a peanut allergy reaction involves severe symptoms in more than one organ system, this is known as anaphylaxis. Anaphylaxis can be life-threatening.
Swelling of the tongue, throat or face, difficulty breathing, wheezing, breathing, and significant cardiovascular symptoms (including fainting) may be signs of anaphylaxis. If your child shows any signs of anaphylaxis, immediately call 911 and give an epinephrine injection (use an Epi-Pen).
How Is A Peanut Allergy Diagnosed?
Peanut allergies can be diagnosed with three types of tests: a skin prick test, a blood test, and an oral food challenge.
Skin prick test: An allergist pricks your child's forearm with a needle that contains peanut protein. Then, the allergist monitors your child to see if an allergic reaction develops around the area where the skin was pricked.
Blood test: An allergist checks your child's blood for the specific IgE antibodies that respond to peanut proteins.
Oral food challenge: This is the most accurate way to diagnose a peanut allergy. During an oral food challenge, your child eats small amounts of peanut under allergist supervision. Then, the allergist watches your child closely to see if an allergic reaction develops.
Peanut Allergy Management
There is no known cure for peanut allergy, or for any other food allergy.
There is no known cure for peanut allergy.
Managing your child’s peanut allergy involves avoidance, knowing how to recognize the symptoms of an allergic reaction, and giving epinephrine if your child shows signs of anaphylaxis.
Children with peanut allergies will need to avoid all foods with peanut in them, as even a small amount of peanut can cause an allergic reaction.
Foods containing peanut are required to be labeled "contains peanut" under U.S. federal law, as peanut is one of the top 8 allergens.
Still, many foods contain hidden peanut ingredients. Be sure to read all food labels carefully!
These ingredients contain peanuts, so children with peanut allergies must avoid them:
Peanut butter
Peanut flour
Peanut protein hydrolysate
Cold-pressed, expelled or extruded peanut oil
Arachis oil (another name for peanut oil)
Mandelonas (these are peanuts soaked in almond flavoring)
Goobers (another name for peanuts)
Monkey nuts (another name for peanuts)
Highly refined peanut oils are safe for some children with peanut allergy, as this type of oil rarely causes allergic reactions in people with peanut allergies. But other types of peanut oils (cold-pressed, expelled, and extruded oils) are not safe for people with peanut allergies. Your child’s allergist will give you guidance on whether to avoid peanut oil.
These ingredients often contain peanuts, so read labels carefully to keep your child safe:
Artificial nuts
Beer nuts
Ground nuts/groundnuts (sometimes a name used to refer to peanuts)
Mixed nuts
Nut meat
Nut pieces
Children with peanut allergies may also need to avoid lupin (lupine). Lupin is a legume in the same family as peanuts. Recent research shows that one in five people with peanut allergy also develop allergic reactions to lupin.
And these foods sometimes contain hidden peanut:
Egg rolls (may be sealed with peanut butter)
Specialty pizzas
Sauces
Dressings
Baked goods
Pastries
Other nut butters not labeled as peanut butter
Pancakes
Vegetarian/vegan food products
Candies
Chocolates
Nougat (made with roasted nuts, but not always peanuts)
Ice cream
In addition, many Asian (particularly Thai and Chinese) dishes, African dishes, and Mexican dishes also contain peanut. So, peanut allergy families should use extra caution when visiting restaurants that serve foods from these cuisines.
Food Allergy Research & Education (FARE) provides more information on managing a peanut allergy:
YouTube video: Food Allergy 101: Peanut Allergy Symptoms | Peanut Allergy Reaction
Avoiding Cross-Contamination
You'll also need to avoid cross-contamination. Cross-contamination is the accidental mixing of a food with peanut into a food without peanut.
Avoid foods that were processed on the same equipment as foods that contain peanut. These foods will say "may contain peanuts" on their labels.
And if you choose to go to a restaurant, be sure to alert the server and person preparing the food that your child has a peanut allergy. This way, they'll know to avoid using peanut ingredients and equipment that touched peanuts. A chef card is helpful for this process.
Follow the same process for anywhere else outside the home that prepares food for your child.
Peanut Allergy Treatment
Usually, peanut allergy treatment involves treating allergic reactions after they start.
Mild allergic reactions are treated with antihistamines or steroids that your child's allergist or pediatrician prescribes.
But if your child develops a severe allergic reaction, an epinephrine (Epi-pen) injection is the only way to treat it. Epinephrine is the only medication that can stop anaphylaxis.
Your child also needs emergency care if they develop anaphylaxis. This is because a second phase of allergic reaction (called a biphasic reaction) might occur. Your child may also need two doses of epinephrine if severe symptoms reappear.
Immunotherapy or food desensitization has been explored as a more preemptive food allergy treatment option, but it is still undergoing studies. Desensitization involves exposing children to very small amounts of peanut, and gradually increasing the dose. This is meant to help keep them from developing an allergic reaction to small amounts of peanut, if they accidentally eat a peanut-containing food.
One immunotherapy treatment, PALFORZIA, has been approved by the FDA for desensitizing children to peanut. But this is only meant to lessen the probability of a severe reaction if a child is accidentally exposed to peanut. Even children undergoing PALFORZIA treatments can’t safely choose to eat peanut, because PALFORZIA is not a cure for peanut allergy.
The Impact of Peanut Allergy On Quality Of Life
Peanut allergy can be frustrating and isolating for children. Many children with peanut allergies miss out on experiences outside of the home, because foods served at these experiences could possibly contain peanut.
Children with peanut allergies may also be excluded or bullied because of their allergy. As many as 1 in 3 children with food allergies has experienced bullying at least once.
As many as 1 in 3 children with food allergies has experienced bullying at least once.
Eating out can be difficult to manage, as many foods may have peanut as an ingredient. And peanut cross-contamination concerns can make things even more complicated. If you can't guarantee that a food preparer avoided cross-contamination, your child will need to skip the food (and sometimes, they'll miss out on part or all of an experience).
Schools are starting to adopt peanut-free policies, making the school experience safer and more inclusive for children with peanut allergies. But not all schools have adopted this policy --- and more allergy awareness is needed in school so children with peanut allergies aren’t excluded or bullied.
How to Prevent Peanut Allergy
Fortunately, thanks to landmark clinical studies and recent medical guidelines, we now know that there is a way to prevent peanut allergies before they start.
The landmark LEAP (Learning Early About Peanut Allergy) study examined peanut allergy rates in two groups of children starting at 4-11 months of age, to see if early peanut introduction had a protective effect against developing a peanut allergy.
One group of children ate at least 6 grams of peanut protein per week, divided into three or more doses per week.
This group started eating peanut between 4 and 11 months of age, and continued to eat peanut regularly until they reached age 5.
The other group avoided peanut completely until they reached age 5.
Compared to the group that avoided peanut, the children who consumed peanut regularly were over 80% less likely to develop a peanut allergy.
The LEAP study’s groundbreaking results have shown that introducing babies to peanut early and often can help prevent peanut allergies.
Introducing babies to peanut early and often can help prevent peanut allergies.
Introduce peanut early: Start to introduce peanut as early as 4-6 months of age, and within baby’s first year.
Introduce peanut often: Continue to feed baby peanut multiple times per week, for at least six months.
Around 4 months of age, babies enter a critical window where introducing peanut helps their immune system build up a tolerance to peanut. But if you delay the introduction of peanut, this increases a baby’s risk of developing a peanut allergy.
The landmark LEAP study’s results have prompted several leading medical organizations to publish guidelines on peanut allergy prevention.
Most notably, guidelines from the American Academy of Allergy, Asthma and Immunology (AAAAI) state, “To prevent peanut and/or egg allergy, peanut and egg should be introduced around 6 months of life, but not before 4 months.”
How to safely introduce baby to peanut? Learn more on our Recipes page.
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All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship. Always seek the advice of your own pediatrician in connection with any questions regarding your baby’s health.
These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease.
