Like asthma and other allergic diseases, peanut allergies are on the rise in the United States, and the symptoms can range from mildly annoying to severe or even life-threatening. Allergic reactions to peanuts typically start in childhood, and they can be more serious than other food allergies.

It's important that parents of children with food allergies learn to recognize the symptoms of an allergic reaction, seek proper medical diagnosis, take precautions to avoid exposure to the offending food, and be able to treat the child quickly when exposure occurs. It's also important for parents of children at risk for developing food allergies to understand how they can reduce this likelihood.

Like any other food allergy, peanut allergy involves an overreaction of the immune system to substances called allergens that are found in a particular food, in this case, peanuts. The body develops antibodies, called IGE, that are activated by the allergen. The immune system's response leads to inflamed body tissues, such as the skin, eyes, nose, lungs and airways.

• Symptoms
• When to Seek Emergency Care
• Risk Factors
• Prevention
• Avoiding the Allergen

Symptoms

Symptoms, including hives, an itching sensation (especially in the mouth and throat), swelling of the throat and lips, difficulty breathing and stomach aches, can occur within seconds or minutes of exposure. A child can have a severe reaction on what appears to be the first exposure, or may be exposed to a food many times with only mild effects before he or she has a severe allergic reaction. Some reactions can grow worse with each exposure.

The most severe type of allergic reaction is called "anaphylaxis," which affects the entire body and can cause serious breathing difficulties, unconsciousness, shock or even death. Peanut allergies are the No. 1 cause of food-induced anaphylaxis episodes seen in U.S. emergency rooms.
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When to Seek Emergency Care

In the event of an anaphylactic reaction, emergency medical care is critical. If your child has been diagnosed with severe peanut allergy, he or she should wear a MedicAlert wristband to let others know of this condition in the event of an emergency. Your child should also carry an "anaphylaxis kit" at all times, containing epinephrine (adrenalin) in a preloaded syringe (called an EpiPen®) and antihistamine syrup or tablets. The epinephrine injection should be given as soon as a reaction starts, and the child should then be rushed to receive emergency care since some reactions can continue despite the use of epinephrine. Having and knowing how to use this medication can mean the difference between life and death.

My personal experience with peanut allergy started with mild reactions in early childhood (a little itching and an occasional rash) and led to a full and unexpected anaphylaxis my freshman year in college. Since my reaction became more severe, I have had five life=threatening episodes, where the use of my EpiPen® and hospitalization saved my life. I want very much to help children avoid developing such an invasive, threatening condition.
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Risk Factors

Factors that increase an individual's risk for developing peanut allergies include:

A family history of allergies (including hay fever, eczema, food allergies and asthma).

Young age. Infants are more likely to develop food allergies because of their immature digestive tracts.

Other food allergies during infancy and early childhood.
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Prevention

One of the most concerning facts about peanut allergy is that, unlike many other childhood food allergies to products such as milk and eggs, 80 percent of children with peanut reactions will carry the allergy into adulthood.

Therefore, for children who are at higher risk for developing food allergies, it is vital to delay the introduction of peanuts until as late as possible in childhood. The American Academy of Pediatrics recommends waiting until after 3 years of age in children whose families have histories of allergic diseases. Some experts recommend that mothers of children at risk abstain from eating peanuts if they are breastfeeding, since the peanut protein can be transferred into breast milk.
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Avoiding the Allergen

Currently, the main "treatment" for peanut allergy is avoiding the allergen, but this can be difficult. Your child may have an allergic reaction by simply being near peanuts. For example, people with peanut allergies have been known to suffer allergic reactions when fellow airplane passengers open packages of peanuts, or after using a utensil previously used for a peanut product and then not thoroughly cleaned. As a result, some preschools and class-rooms have implemented nut-free policies.

Even with strict avoidance, the average patient with peanut allergy will probably have an exposure every three to five years from sources that seem unlikely.

While peanuts are legumes, not true nuts, 30 percent of patients with peanut allergy are also allergic to tree nuts (almonds, walnuts, etc.)

This means that all nuts can be a threat to a child with a peanut allergy.

While researchers are developing some exciting new treatments for food allergies, none are yet widely available or practical. If you suspect your child is having allergic reactions to foods, seek advice from your pediatrician regarding testing and treatment.

While most peanut allergies tend to continue into adulthood there are many ways you can help your child stay healthy, avoid coming into contact with the allergen, and be prepared for the cases when exposure cannot be avoided.

For more information, visit The Food Allergy & Anaphylaxis Network. Accessed November 2007.

Previously published in the Redwood Shores Pilot, column editor Arian Dasmalchi. November 2003
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