Allergy & Asthma-Kent H. DeYarman, MD

Topics in Allergy

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Peanut Allergy

Peanuts are the most common food in the United States to cause IgE allergic reactions (see Food Allergy handout). IgE types of food allergies cause immediate and potentially very severe life threatening reactions when even small amounts of the food are ingested. Managing this type of reaction requires awareness of sources of peanuts, having adrenalin (usually in the form of an EpiPen) available, and use of Medic Alert bracelets.

 

Peanuts are legumes, not nuts. Beans, peas, and soy are also legumes. Many people with peanut allergies show skin test or RAST test reactions to legumes but most people allergic to peanuts do not have problems eating other legumes. Commercial peanut oils do not contain the protein that causes allergic reactions and may be consumed. This is not true of "cold pressed" peanut oils. These may contain the protein causing allergic reactions and should be avoided. These are usually "gourmet" oils and are very expensive. Though peanuts are not directly related to “tree nuts” 25-50% of peanut allergic people do develop an allergy to tree nuts and it is best to avoid all nuts and seeds (sunflower seeds, pine nuts,etc) as well as peanuts.

 

The most common sources of peanuts in foods are candies and cookies. We recommend only eating commercial candies and cookies, avoiding homemade sources. Read labels carefully and form a list of candies and cookies that you know are safe. Only eat candies and cookies from your "safe" list. Use extreme caution when trying a new product. Be cautious with Asian restaurants where peanuts are added to some dishes. Make sure the dishes and pans have been washed with soap and water before your meal is prepared in them. If one person in a home is allergic to peanuts it is best to keep all peanut products out of the home. Schools should consider adopting a no peanut policy-no peanuts served by the school and a request to parents that no snacks with peanut ingredients be brought to the classroom. The FOOD ALLERGY NETWORK has additional and frequently updated information about sources of peanuts in commercial foods.

 

Food Allergy Network
10400 Eaton Place, Suite 107
Fairfax, VA 22030-3179
703.691.3179 Fax 703.691.2713
http://foodallergy.org

 

You should carry an EpiPen and know how to use it. Caregivers also need to be instructed. Children can carry an EpiPen at school with a note from our office. EpiPens may be given through clothing. If the EpiPen is used, you need to be seen and observed in an emergency room. Reactions have recurred even 2-3 hours after the initial reaction seemed to be improving.

 

If you have an anaphylactic reaction to peanuts, spit the food out of your mouth, rinse and spit with water or other liquid, and use the EpiPen. USE THE EPIPEN AT THE EARLIEST SIGN OF A REACTION. You should also consider going to an emergency room unless the reaction was very mild. Even then there is a risk it could recur. Do not go to a restroom or other private place to use the EpiPen. Notify someone you are having an allergic reaction, tell them you are giving yourself a shot, and ask them to call 911. Wearing your Medic Alert bracelet is important and lets emergency personnel know what is happening if you are unable to communicate with them.

 

Patients at risk of anaphylaxis to foods or other materials should avoid beta blocker medications (used for heart, blood pressure, and glaucoma problems) as these will block the effect of the EpiPen.

 

With these precautions of avoidance, Medic Alert bracelet and availability of EpiPen peanut allergy is a manageable problem. Although there have been rare exceptions fatal reactions almost never occur when an EpiPen is available and used early in the event of a reaction. New treatments for peanut and similar food allergies may be available within the next few years.