Peanut Allergy
Peanut allergies usually occur when the immune system mistakenly identifies peanut proteins as harmful. This triggers an allergic reaction, which may include symptoms such as hives, swelling, or vomiting.
Peanut allergies are the leading food-related reason for anaphylaxis, a severe allergic reaction that can result in airway swelling or a dangerous drop in blood pressure. Seek emergency medical attention immediately by calling 911 or go to the nearest ER if you experience swelling in the mouth, face, or throat, trouble swallowing or breathing, or feelings of faintness.
Symptoms of Peanut Allergies
Peanut allergy symptoms, including those of anaphylaxis, can appear suddenly and may involve:
- Itchy skin
- Hives or skin rash
- Flushing
- Vomiting or diarrhea
- Swelling of the face, mouth, lips, or tongue
- Itchy throat and mouth
- Hoarseness or difficulty swallowing
- Wheezing or shortness of breath
- Abdominal pain
- Lightheadedness or fainting
- Runny nose or sneezing
Peanut allergy symptoms can escalate quickly, even when you’ve previously had mild reactions. Dial 911 or head to the emergency room immediately if you experience severe symptoms.
Symptoms in babies and young children:
In infants and toddlers, peanut allergies may present with:
- Hoarse crying or noisy breathing
- Hiccups
- Rubbing their eyes, scratching their ears, or pulling at their tongue
- Arching their back in discomfort
When do symptoms appear?
Symptoms of a peanut allergy typically begin within two hours of consuming peanuts or peanut-containing foods.
Causes
Peanut allergies arise whenever the immune system accidentally categorizes peanut proteins as harmful. Upon exposure, the immune system reacts by releasing chemicals to protect the body. This triggers symptoms that can range from mild to life-threatening.
Who is at risk for peanut allergies?
The likelihood of developing a peanut allergy increases if you have:
- Other food allergies, particularly to eggs.
- Allergies to pets, pollen, or other substances.
- Eczema or asthma.
- A biological parent(s) with other allergies, asthma, eczema, or a peanut allergy.
Complications
The most severe complication is anaphylaxis, a life-threatening reaction that affects multiple body systems. Symptoms of anaphylaxis include:
- Severe vomiting
- Breathing difficulties
- Anaphylactic shock (a dangerous drop in blood pressure)
Severe anaphylaxis requires immediate treatment, as it can be fatal.
Diagnosis
Talking with your healthcare provider about your symptoms and medical history is the first step in diagnosing a peanut allergy. This discussion is typically followed by a physical exam and, if necessary, additional diagnostic steps such as:
- Food diary: You may be required to keep a food diary that tracks your symptoms, eating habits, and medications.
- Skin test: During this test, a small amount of the suspected allergen is placed on your skin, after which it is pricked using a needle. If you’re allergic, an elevated bump or reaction will develop at the test site.
- Blood test: This assesses the immune system’s reaction to specific foods by checking for allergy-related antibodies called immunoglobulin E (IgE).
- Elimination diet: If multiple food allergies are suspected, your care team might recommend an elimination diet. This involves avoiding peanuts or other potential allergens for one to two weeks. Afterward, foods are reintroduced one at a time to identify which ones trigger symptoms. This method is not safe for individuals who have experienced severe allergic reactions.
These diagnostic tools can help validate a peanut allergy or identify another cause, like a food intolerance.
Management and Treatment
The primary approach to managing peanut allergies is to refrain from peanuts and any foods containing them. However, several treatment options are available to minimize the risk of an allergic reaction following accidental exposure. These include:
Omalizumab Injections (Xolair®):
Omalizumab injections are administered every two to four weeks by your healthcare provider (or you may be trained to administer them yourself). These injections can lower your risk of a severe reaction in case of accidental peanut exposure. However, avoiding peanuts and peanut-containing foods remains essential even while using omalizumab.
Oral Immunotherapy (OIT):
Oral immunotherapy involves gradually building tolerance to peanuts by consuming increasing peanut protein dosages over several months. They are available in peanut butter and peanut allergen powder (Palforzia®) form.
OIT aims to reduce the likelihood of a reaction to small accidental exposures (referred to as being “bite-proof”). In some cases, individuals may eventually tolerate eating peanuts freely. Your healthcare provider will closely monitor and adjust dosing to ensure safety.
Sublingual Immunotherapy (SLIT):
Sublingual immunotherapy works similarly to OIT but involves placing a liquid containing peanut protein beneath your tongue and allowing it to dissolve. Daily exposure helps the body develop tolerance to peanuts. Like OIT, SLIT is conducted under a healthcare provider’s supervision for safety purposes.
Emergency Medications:
For accidental peanut exposure, having emergency medications on hand is critical. These may include:
- Epinephrine auto-injectors (EpiPen® or Auvi-Q®): Administered at the first sign of a serious allergic reaction.
- Corticosteroids: Medications to ease inflammation following a reaction.
- Antihistamines: Used to alleviate or stop symptoms of a mild allergic reaction but not as a preventive measure for peanut allergies.
Prevention
There’s no guaranteed way of preventing peanut allergies, but certain strategies may help reduce the risk, particularly for children:
- Regularly consume peanuts if you’re breastfeeding or chestfeeding and don’t have a peanut allergy yourself.
- Speak with your child’s healthcare provider about the best time and method for introducing potential allergens, including peanuts. Depending on your child’s medical history and risk factors, the provider may suggest introducing common allergens earlier or under medical supervision.
- If you’ve introduced peanuts safely and confirmed that your child isn’t allergic, ensure they consume peanut-containing foods regularly. Consistent exposure may reduce the likelihood of developing a peanut allergy later in life.
Living with Peanut Allergies
Food to avoid with a peanut allergy
These are examples of foods containing peanuts or have a risk of contamination:
- Peanut butter
- Chocolate candy
- Baked foods
- Trail mix
- Granola or energy bars
- Sauces like mole and enchilada sauce
- Nut products, including almond or hazelnut paste (nougat, marzipan)
- Chili dishes
- Some kinds of Asian cuisine (e.g., sauces, egg rolls, noodle dishes)
- Meat substitutes
- Foods with hydrolyzed plant or vegetable protein
- Lupine (commonly causes reactions in those with peanut allergies)
Always check food labels and ingredient lists to determine if a product is safe before consuming.
Strategies to help you avoid food containing peanuts
- Reading labels carefully: All labels must state whether a product has peanuts or has been processed in a facility that handles peanuts. Look for warnings like “may contain,” “manufactured in a facility that also processes peanuts,” or “made on shared equipment.”
- Double-checking the labels: It’s highly recommended to always read labels when buying, storing, and preparing food.
- Being aware of non-food products: Items such as birdseed may contain peanuts. So wash your hands thoroughly after handling them.
- Educating your child: Teach your child not to share food if they’re unsure of its safety.
- Exercising caution at restaurants: Inform staff of your allergy and ask about potential cross-contamination. However, be mindful that not all restaurants can guarantee allergen-free meals.
- Ice cream safety: If ordering ice cream, request a clean scoop to prevent cross-contamination.
- Notifying caregivers: Ensure family members, babysitters, and friends are aware of the allergy and know which foods are safe.
- Working with schools: Inform your child’s school or daycare regarding their allergy and review their management policies. Many schools adopt nut-free or nut-sensitive guidelines.
Being prepared for allergic reactions
- Always have an epinephrine auto-injector (EpiPen® or Auvi-Q®). Request your healthcare provider to demonstrate proper usage.
- Provide your child’s school or daycare with an allergy action plan from your healthcare provider. Include detailed steps to follow in case of an allergic reaction.
- Supply the school or daycare with your child’s prescribed medications, including an epinephrine pen.
When to see your healthcare provider
If you suspect you or your child has a peanut allergy, consult a healthcare provider immediately. They can refer you to an allergy specialist for testing and management. Also, avoid peanuts and peanut-containing products until you have a confirmed diagnosis.
When to seek emergency care
Dial 911 or go to the emergency room if you experience severe allergic reaction symptoms, such as:
- Swelling of the face, tongue, lips, or throat
- Difficulty breathing or chest tightness
- Hives covering the body
- Tingling in feet, hands, or lips
- Feeling dizzy, weak, or faint
- A sudden sense of impending doom
Conclusion
Being diagnosed with a peanut allergy can feel overwhelming — suddenly, peanuts seem to be everywhere. From food labels to a growing list of items to avoid, managing this allergy may initially feel daunting. However, with time and practice, checking labels and being cautious about food choices will become second nature, making the process easy to manage.
While having a peanut allergy is never ideal, advancements in food labeling, allergy awareness, and treatment options mean that managing the condition is more manageable today than ever before. New therapies also bring hope, offering ways to reduce the risk of severe reactions and allow for greater peace of mind with every bite.
