Peanut Allergy

What is a peanut allergy?

A peanut allergy is a reaction by your child's immune system to peanuts. Our immune systems normally respond to invaders that attack the body such as bacteria or viruses. With a food allergy, the body's immune system mistakenly attacks harmless things, such as the substances found in peanuts. Peanuts are among the 8 foods that are responsible for most food allergies seen in children. The other foods include milk, soy, eggs, tree nuts (such as walnuts and cashews), wheat, fish, and shellfish. It is common for children to grow out of food allergies such as to egg, milk, or soy, but rarely do people grow out of peanut or tree nut allergy.

Most health care providers warn not to feed your child highly allergic foods, such as shellfish, and food containing peanuts and tree nuts, until age 2. If you have family history of allergies, some recommend waiting until 3 years.

What are the symptoms of an allergic reaction to peanuts?

If you suspect your child is having an allergic reaction to peanuts or any other food, it is important to get a diagnosis from your health care provider or allergist. You should look for the following symptoms, which can develop over several hours or be immediate and severe:

• Skin reactions such as itching, hives, eczema or swelling
• Diarrhea, nausea, vomiting, stomach pain or itching around the mouth
• Running nose, wheezing or trouble breathing
• Rapid heartbeat.

With peanut and tree nut allergy, it is more common to have an anaphylactic reaction. This is a serious reaction that is sudden, severe, and can involve the whole body. The reaction can cause swelling of the mouth and throat, dangerously lower blood pressure, and closure of the airways leading to trouble breathing. This type of reaction calls for immediate medical attention. It is treated with epinephrine (a medicine that is given by a shot). Typically, parents or caregivers of children that have severe reactions to allergies carry their own injection kits in case of emergency.

Is my child also allergic to other nuts?

Peanuts grow underground and are not considered to be a 'true nut.' Peanuts are in the legume family which also contains peas and lentils. Nuts such as walnuts, almonds, pecans and cashews grow on trees. About half of the people with peanut allergy are also allergic to tree nuts. You'll need to check with your health care provider about whether it is safe for your child to eat tree nuts.

How will this affect my child's diet?

Once your child is diagnosed with a peanut allergy, you will need to change the way you shop and be extremely careful when dining away from home. The only treatment for someone with a peanut allergy is to avoid all sources of peanut protein. You will need to read all food labels and provide your child with age appropriate information regarding the importance of their 'special' diet.

The first step to educating yourself in choosing safe, peanut-free foods, is learning to read labels and becoming familiar with ingredients that contain peanuts. Study the lists below to learn more about foods and ingredients to watch out for.

Ingredients to look for in food products

• Peanuts
• Peanut butter
• Mixed nuts
• Artificial nuts (often peanuts that have be deflavored or reflavored)
• Arachis (another name for peanut)
• Lecithins or food additive 322
• Satay (a peanut sauce)
• Peanut oil (nut oils are often tolerated as long as they have NOT been cold-pressed, expelled, or extruded. Inquire with manufacturer to make sure.)

Hidden source of peanuts

Cross contamination is one of the biggest problems when trying to avoid exposure to peanut proteins. It is common for peanuts to come in contact with other foods during processing and in preparation, even if peanuts are not included in the recipe.

Items that could be contaminated with peanut

• chocolate candies and ice cream
• pastries, cookies and cakes where ingredients aren't listed
• sauces such as barbecue and Worcestershire
• mandelonas (peanuts soaked in almond flavor)
• baking mixes
• gravy
• pesto (an Italian sauce made with nuts)
• praline and nougat
• cereals
• baking mixes
• prepared salads and salad dressings
• hydrolyzed vegetable protein (usually soy based, but may come from any non-animal source) emulsified ingredient (may have been thickened with peanuts)
• Asian foods (such as, satay, pad thai, and egg rolls), African, Chinese, Mexican, Tai, Indonesian and Vietnamese foods often use peanuts to flavor sauces or as a garnish.

When dining out:

• Order simple dishes, avoiding sauces unless you're sure they don't contain nuts.
• Inform the waitperson about the allergy.
• Ask whether the same food preparation equipment would be used for nuts as for other recipes, such as food processors, cutting boards, pans and knives.

How can I provide my child with an adequate diet that tastes good?

Your child can still have a nutritionally complete diet. The primary nutrients found in peanuts are protein, healthy fats, fiber, vitamin E, magnesium and folate. There are many other foods that contain the same nutrients as peanuts, so the challenge is not providing adequate nutrition, but to keep your child from unknowingly eating foods that contain them.

You can make baked desserts from scratch or mixes you know don't contain peanuts. Some ice cream and chocolate companies make products without peanuts and that have been processed separately from those prepared with peanuts to eliminate the risk of 'cross-contamination.' This would be stated clearly on the label.

How can I keep my child safe at school?

• Prepare your child's lunch at home.
• Educate your child to the dangers of sharing foods (even young children can grasp this concept, especially once they have experienced feeling sick after eating a particular food).
• Talk with teachers and the school administrator regarding your child's needs. Request that teachers keep an eye out and explain the situation to other children when appropriate.
• Have the teacher call you if there is a special event or party planned so that you can bring a few modified treats that your child enjoys and can share with other kids.
• Make a card that lists foods and ingredients that should be avoided and give one to the teacher. The card can also be helpful to older children in making decisions when out with friends.
• Children who have had previous life-threatening anaphylactic reactions should have access at all times (including school) to injectable epinephrine and an antihistamine (such as Benadryl).