We’ve recently become more aware of peanut allergies, especially in schools. To keep children safe, many schools have banned peanut butter and other peanut products. But even with these precautions, there’s still a lot of confusion about peanut allergies. In this article, we’ll explore what peanut allergies are, why they’re a concern, and what you need to know to stay informed and safe.
If you have a child with peanut allergies — or if you care for one — here are some facts to keep in mind.
For one thing, a peanut is not a nut — it’s a legume. Peanuts grow in a pod and are part of the pea family, which includes beans and lentils. Nuts and legumes contain dietary protein, but the specific type that’s found in peanuts (Ara h1 and Ara h3) causes reactions in people who are allergic.
Allergic reactions to peanuts occur in people whose immune systems mistake peanut proteins for pathogens — something that could harm the body, such as a parasite.
Immune reactions cause inflammation and a range of allergy symptoms that can vary considerably among people who are allergic to peanuts, including:
Many of the symptoms of allergic reactions to peanuts can also vary from mild to severe. Having a mild reaction to many exposures could mean the next reaction may be life-threatening. Reactions to food allergies are hard to predict.
Symptoms of a food allergy reaction can also differ in how long they take to start and how long they last. For instance, some reactions may occur in a few minutes, and others happen within a couple of hours.
Approximately 2.5 percent of children in the United States are believed to have an allergy to peanuts, which is one of the most common food allergies. Research indicates that the rate of peanut allergy diagnoses among children in the U.S. may have increased as much as 21 percent since 2010 and has been steadily rising since 1997.
There are several theories as to why allergies to peanuts and other foods are on the rise in children. One factor may be due to damage to the skin barrier, which functions as a defense against allergens. An increase in chemicals in detergents and synthetic clothing may affect the skin barrier and cause damaged and dry skin in children.
Another factor may be that young children in recent decades are not eating a diverse diet that exposes them to a variety of foods at an early age, including peanuts and other foods that can cause allergies. Children in urban areas also have less exposure to animals, which may help them develop a healthy and well-balanced gut microbiome. However, keep in mind that these are theories and not clinically validated.
Peanut allergies are associated with other food allergies. Although peanuts are not tree nuts, approximately 40 percent of children with allergies to nuts that grow on trees (such as walnuts, almonds, pecans, or cashews) are also allergic to peanuts.
An allergy to peanuts does not increase the risk of an allergy to most legumes, such as peas, lentils, or soybeans. However, peanut allergies do raise the risk of an allergy to lupine, also known as lupin or lupini beans, which are popular in Italian and Mediterranean cuisines.
Peanut allergies may also be linked to egg allergies and atopic dermatitis, the most common form of eczema. A family history of food allergies may increase the risk of a child having a peanut allergy.
People with severe allergies are at risk of anaphylactic shock — also known as anaphylaxis — a potentially life-threatening reaction that can quickly cause the respiratory system to shut down. Death from anaphylaxis is rare, but approximately 90 percent of deaths from anaphylactic shock occur among people with peanut or tree nut allergies.
Research shows that approximately 54 percent of children with peanut allergies have experienced a severe allergic reaction. In one study from the journal Allergy, as many as 52 percent experienced life-threatening anaphylaxis symptoms within five years. Recent surveys showed that 23 percent of children with peanut allergies receive emergency care annually.
While reactions from exposure to peanuts can be life-threatening, fatalities are rare. One large-scale study showed that a history of asthma was a risk factor that raised the chances of a fatal peanut allergy reaction. However, it’s important to note that most food allergy-related deaths have occurred in people whose previous allergic reactions had been mild. The severity of reactions is unpredictable, so it’s vital to be prepared for emergencies and take extra precautions with other medical conditions like asthma.
Read more about food allergies and the risk of asthma.
Parents, caregivers, and older children with peanut allergies should be prepared for anaphylactic shock with an emergency plan. Your doctor can advise you on preparing an emergency plan that can always be with you, other family members, and your child to provide teachers, emergency responders, and hospitals with crucial information on your child’s allergies and medication.
An emergency epinephrine auto-injector — EpiPen is one common brand name — should always be on hand in case of accidental exposure to peanuts or another allergen. Your doctor can provide training on how to use an EpiPen.
“I recently bought my daughter her own medical bag, which carries her EpiPen and cetirizine,” wrote one MyFoodAllergyTeam member. “It has all her information and my contact number. I also bought her a peanut allergy bracelet, which she loves!! I have found that the bag is helpful with her anxiety, as she always has her medicine with her just in case she comes into contact with peanuts.”
Many children experience an allergic reaction due to cross-contact when peanut products such as peanut butter, peanut flour, or another allergen are unintentionally transferred to another food. Cross-contact can occur with tiny amounts of peanut protein or another food allergen.
To prevent any chance of cross-contact, it’s essential to thoroughly clean utensils, cutting boards, countertops, cookware, and dishes. Wash them with warm, soapy water, rinse with clean water, and let them air dry. Wash your hands with soap before preparing food.
Trace amounts of peanut protein can be in foods that don’t contain peanuts. The U.S. Food and Drug Administration (FDA) requires food labels to list major food allergens, such as peanuts, or if there is a risk that the food has come in contact with an allergen during manufacturing. Foods that have a high risk of containing peanuts or cross-contact with peanuts include:
“My oldest has been having issues with hives, and the foods she’s been eating are the same. So now we think it was a new cookie,” a MyFoodAllergyTeam member shared. “Reading the labels again.”
Be sure to discuss cross-contact with restaurants and schools. Although the term “cross-contamination” is sometimes used for cross-contact, it’s important to know that in the restaurant business, cross-contamination implies that a contaminant can be killed by cooking. This is not the case with an allergen.
Although many people have lifelong peanut allergies, studies from the American College of Allergy, Asthma & Immunology show that approximately 20 percent of children with peanut allergies will eventually outgrow them. However, it’s important to work carefully with your doctor for supervised testing to determine if an allergy has been outgrown, rather than trying this at home.
“Heading to the allergist tomorrow to have my son tested for peanut/tree nut allergies. Praying he has outgrown the peanut allergy,” wrote one MyFoodAllergyTeam member.
The most important step in managing a peanut allergy is prevention. Avoid contact with peanuts by always reading ingredient lists, consistently taking care with food preparation, and having a good emergency plan in case of a severe allergic reaction. Treatment options for mild allergy reactions to peanuts include antihistamines and corticosteroids.
You may want to discuss newer treatments with your allergist, who can advise you on current developments in peanut allergy therapies. It’s important to stay engaged with your allergist and health care team in order to learn about evolving treatment options that may be appropriate for your child.
Immunotherapy is a treatment option that slowly exposes children to peanut protein in order to train the immune system not to overreact. Oral peanut immunotherapy (OIT) is not a cure for peanut allergies and is not designed to introduce peanut products into a child’s diet. However, OIT can help some children avoid serious reactions if exposed to peanut protein. Palforzia is the first oral immunotherapy treatment approved by the FDA.
Newer therapies are in development, and promising drugs are in the pipeline for treating peanut allergies. For instance, omalizumab is an injected biologic drug — a human-made version of an immune system protein — that targets immunoglobulin E (IgE). IgE is a protein responsible for setting off allergic reactions. By binding with and neutralizing IgE, biologic drugs could help prevent the processes that lead to allergic reactions and life-threatening anaphylaxis. Omalizumab has been shown in clinical immunology research to quickly reduce a person’s sensitivity to peanuts.
MyFoodAllergyTeam is the social network for people with food allergies and their loved ones. On MyFoodAllergyTeam, more than 39,000 members come together to ask questions, give advice, and share their stories with others who understand life with food allergies.
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