Peanut Allergy
Peanut allergy is a condition that causes the body’s germ-fighting immune system to react to peanuts. It’s one of the most common causes of a life-threatening allergic reaction to food. This life-threatening reaction is known as anaphylaxis.
Peanut allergy has been increasing in children. Even if you or your child has shown only a mild reaction to peanuts, it’s important to talk to a healthcare professional. There is still a risk of a more serious future reaction.
An allergic response to peanuts usually occurs within minutes after exposure. Peanut allergy signs and symptoms can include:
- Skin reactions, such as hives, redness or swelling.
- Itching or tingling in or around the mouth and throat.
- Digestive problems, such as diarrhea, stomach cramps, nausea or vomiting.
- Tightening of the throat.
- Shortness of breath or wheezing.
- Runny nose.
Anaphylaxis: A life-threatening reaction
Peanut allergy is the most common cause of anaphylaxis due to food. This medical emergency requires treatment with an epinephrine autoinjector (EpiPen, Auvi-Q, others) and a trip to the emergency room. Epinephrine is also called adrenaline.
Anaphylaxis signs and symptoms can include:
- Constriction of airways.
- Swelling of the lips, tongue and throat that makes it hard to breathe.
- A severe drop in blood pressure, also known as shock.
- Rapid pulse.
- Dizziness, lightheadedness or loss of consciousness.
When to see a doctor
Talk to your care team if you have had any signs or symptoms of peanut allergy. Seek emergency treatment if you have a severe reaction to peanuts.
Call, or have someone else call 911 or your local emergency number if you have any signs or symptoms of anaphylaxis such as:
- Severe dizziness.
- Severe trouble breathing.
- Loss of consciousness.
Peanut allergy occurs when the immune system flags peanut proteins as harmful. When exposed to peanuts, the immune system releases symptom-causing chemicals into the bloodstream. These chemicals cause an allergic reaction.
Direct and cross-contact with peanuts could cause a reaction:
- Direct contact. The most common cause of peanut allergy is eating peanuts or foods that contain peanuts.
- Cross-contact. This happens when peanuts get into a product by mistake. It often happens when food is exposed to peanuts during processing or handling.
- Inhalation. Breathing in dust or aerosols containing peanuts, such as peanut flour, may cause an allergic reaction.
It isn’t clear why some people develop allergies while others don’t. However, people with certain risk factors have a greater chance of developing peanut allergy.
Peanut allergy risk factors include:
- Age. Food allergies are most common in children, especially toddlers and infants. As a person grows, the digestive system matures. Then the body is less likely to react to food that triggers allergies.
- Past allergy to peanuts. Some children with peanut allergy outgrow it, though it can recur. So be cautious even if you seem to have outgrown peanut allergy.
- Other allergies. If you’re already allergic to one food, you have a higher risk of being allergic to another. Also, having another type of allergy, such as hay fever, raises your risk of having a food allergy.
- Family members with allergies. Your risk of peanut allergy is higher if other allergies are common in your family, especially other food allergies.
- Atopic dermatitis. Some people with the skin condition atopic dermatitis, also called eczema, have a food allergy as well.
Complications of peanut allergy can include anaphylaxis. Children and adults who have a severe peanut allergy are especially at risk of having this life-threatening reaction.
Studies have shown a strong link between early peanut exposure and lower food allergy risk. In the studies, peanuts were introduced to high-risk babies and children from 4 months to 3 years old. By doing so, their food allergy risk was reduced up to 80%. Children at risk of peanut allergy include those with mild to severe eczema, egg allergy, or both. Before introducing your child to peanuts, discuss the best approach with your child’s healthcare professional.
Talking with your healthcare team about your symptoms and medical history starts the process of diagnosis. A physical exam usually follows and these next steps may be needed:
- Food diary. Your care team may ask you to keep a food diary of your eating habits, symptoms and medicines.
- Skin test. A small amount of food or other substance is placed on your skin. Then, your skin is pricked with a needle. If you’re allergic to that substance, you’ll develop a raised bump or reaction.
- Blood test. A blood test can measure your immune system’s response to certain foods. It checks the amount of allergy-type antibodies in your bloodstream, also known as immunoglobulin E (IgE) antibodies.
- Elimination diet. Your team may suggest an elimination diet if you could be allergic to more foods in addition to peanuts. You might be asked to stop eating peanuts or other suspect foods for a week or two. Then, you’ll add the food items back into your diet one at a time. This process can help link symptoms to certain foods. If you’ve had a severe reaction to foods, this method can’t safely be used.
All these sources may help confirm a peanut allergy. Or they may point to another cause such as food intolerance.
The standard approach to care for peanut allergy is to avoid foods that contain peanuts. Yet researchers continue to study different therapies that will lessen the chance of severe reactions, including anaphylaxis.
Immunotherapy
Immunotherapy is a treatment that is meant to train the immune system not to react to certain triggers. This process also is known as desensitization. These therapies may not cure peanut allergy, and they cannot replace emergency treatment for anaphylaxis. However, they may reduce the risk of future severe reactions if contact with peanuts happens.
Immunotherapy for peanut allergy includes oral immunotherapy (OIT). In OIT, doses of food with peanuts are given to those with or at risk of developing a peanut allergy. These doses are slowly increased over time until the highest tolerated dose is reached.
The medicine Peanut Allergen Powder-dnfp (Palforzia) is an FDA-approved form of oral immunotherapy. It is meant to treat children ages 4 to 17 years with a confirmed peanut allergy. This treatment isn’t recommended for people with uncontrolled asthma or certain conditions, including eosinophilic esophagitis.
Antibodies
Antibody treatment is another method. This medicine is given through injection. Although antibody treatments also involve the immune system, they work differently from other forms of immunotherapy.
These medicines work by binding to a special protein in the bloodstream that causes a certain allergic reaction. These protective proteins are called antibodies. Once bound to the antibody, the medicine makes the immune system much less sensitive to a certain allergic trigger. Antibody treatments for peanut allergy include omalizumab (Xolair).
Being prepared for a reaction
The only way to prevent a reaction is to avoid peanuts and peanut products altogether. However, peanuts are common. Even when you try your best, you’re likely to come into contact with peanuts at some point.
For a severe allergic reaction, you may need an emergency injection of epinephrine and a visit to the emergency room. Many people with allergies carry an epinephrine autoinjector. This device is a syringe and hidden needle that injects a single dose of medicine when pressed against your thigh.
Know how to use your autoinjector
If your doctor has prescribed an epinephrine autoinjector:
- Carry it with you at all times. It may be a good idea to keep an extra autoinjector in your car and in your desk at work.
- Always replace it before its expiration date. Out-of-date epinephrine may not work properly.
- Ask your doctor to prescribe a backup autoinjector. If you misplace one, you’ll have a spare.
- Know how to operate it. Ask your healthcare team to show you. Also, make sure the people closest to you know how to use it. If someone with you can give you a shot, that person could save your life.
- Know when to use it. Talk to a healthcare professional about how to know when you need a shot. If you’re not sure, it’s usually better to go ahead and use the emergency epinephrine.
References
- Burks AW, et al. Middleton’s Allergy: Principles and Practice. 9th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed May 20, 2024.
- Wang J. Peanut, tree nut, and seed allergy: Management. https://www.uptodate.com/contents/search. Accessed May 20, 2024.
- Rich RR, et al., eds. Clinical Immunology: Principles and Practice. 6th ed. Elsevier; 2023. https://www.clinicalkey.com. Accessed May 20, 2024.
- Keet C, et al. Food allergy in children: Prevalence, natural history, and monitoring for resolution. https://www.uptodate.com/contents/search. Accessed May 20, 2020.
- The current state of oral immunotherapy (OIT) for the treatment of food allergy. American Academy of Allergy, Asthma and Immunology. https://www.aaaai.org/conditions-and-treatments/library/allergy-library/oit. Accessed May 24, 2020.
- Sicherer SH. Food allergy in schools and camps. https://www.uptodate.com/contents/search. Accessed May 24, 2020.
- Campbell RL, et al. Anaphylaxis: Emergency treatment. https://www.uptodate.com/contents/search. Accessed May 24, 2024.
- AskMayoExpert. Food allergy. Mayo Clinic; 2023.
- Food allergy treatment research. NIH: National Institute of Allergy and Infectious Diseases. https://www.niaid.nih.gov/diseases-conditions/food-allergy-treatment-research. Accessed May 28, 2024.
- Oral Immunotherapy. NIH: National Institute of Allergy and Infectious Diseases. https://www.nih.gov/news-events/news-releases/oral-immunotherapy-induces-remission-peanut-allergy-some-young-children. May 28, 2024.
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