PeanutAllergy_Flipbook

PEANUT ALLERGY

Subhashini Balaraj

This document contains the following sections covering the
content ‘Peanut Allergy’

• FAQs for Native app
• FAQS for WEB

FAQ SUMMARY: 2

1. What causes peanut allergy and who are at risk of

developing peanut allergy?

2. What are the symptoms of peanut allergy? 2

3. How will I know if my child is in the high-risk group to develop Peanut allergy? How can I 3
diagnose it?

PREVENTION AND TREATMENT 3

4. Can allergy to peanut be prevented? 3

5. I’m pregnant or breastfeeding. Should I eat peanuts to help prevent food allergies in my baby? 4

6. How do I introduce peanut into my child’s diet? 4

7. What signs should I look out for, if my child is having an allergic reaction to peanut-based food? 4

8. What should I do if my child with Peanut allergy is having a reaction to peanut? 5

9. What are the common treatments and therapies to alleviate an allergic reaction to Peanuts? 6

INTERESTING INSIGHTS 6

10. Are allergy and intolerance the same? 6

11. Can one outgrow peanut allergy eventually? 7

12. If my child has a peanut allergy, does that indicate that my child could be allergic to other nuts
too? 7

13. What are the possible sources of Peanut, besides the obvious food labelled as the Peanut? 7

14. What are the common myths and misconceptions related to peanut allergy? 8

Glossary of Terms: 9

PEANUT ALLERGY: AN OVERVIEW

Peanut allergy is one of the most common food allergies, triggered by our body’s reaction to a certain protein
found in peanuts. Peanuts belong to a type of legumes that grow underground. Examples of legumes are lentils,
peas, beans. These are different from other tree nuts like walnuts, cashew nuts, and almonds. Having an allergic
reaction to peanut does not indicate that one is allergic to all nuts.

Globally, peanut allergy has been on a rise lately affecting close to
2% of children (1 in 50) in U. K, and 2.5% of children in the U.S. Some
studies describe that the recent decades of excessive sanitation
practices, with an intention to stay free from infectious diseases,
may lead to lower exposure to germs during childhood. This
potentially could result in an over-reaction to the allergens resulting
in various allergic diseases. Usually one may develop this allergy in
the early childhood, but it is not rare to develop this allergy later in
life as well.

Research and studies on a permanent cure to the problem are
ongoing, indicating a possible breakthrough. Please note that these
positive results are an outcome of clinical tests in a controlled
environment and is still pending approvals from medical bodies like
FDA.

Our FAQs on the topic will help answer a few common questions.

PEANUT ALLERGY BASICS

1. What causes peanut allergy and who are at risk of developing peanut allergy?

Food allergies are body’s reaction to a particular component in the food. It is our body’s immune system
response to certain proteins found in the food, which is mistaken for a threat. This results in the release of

chemicals that cause an allergic reaction.

Any amount of peanut exposure (either touching/kissing
or ingesting) could trigger an allergic response. Even a
small amount of the proteins present in the peanuts can
set off a severe reaction and is usually the protein in the
peanut after ingesting (swallowing) that triggers a severe
reaction.

Though the exact cause of peanut allergy is not known,
research indicates that it results from a mix of genetic and
environmental factors. It is therefore important to know
who is at risk of developing an allergy to peanuts.
● Age: Most allergies are triggered in the childhood though it is common to have an allergic reaction to food
at any age.
● Family history: Peanut allergy tends to run in the families, increasing the high likelihood to develop an
allergy.
● Existing allergy: Having one food allergy may tend to cause allergy to another food as well
● Medical condition: One may develop multiple related allergic reactions as they progress with age. This
phenomenon, called Atopic March or Allergic march starts early on, like infancy or childhood, and
progresses causing other related allergies as one ages. Few examples are asthma, food allergy, eczema.

2. What are the symptoms of peanut allergy?

Symptoms of peanut allergy include and is not
limited to:

● Itching
● Rashes
● Vomiting
● Diarrhoea
● Swelling of the lips, tongue, face
● Throat constriction
● Difficulty in breathing
Peanut allergy may cause a life-threatening reaction called anaphylaxis and requires immediate medical
attention. This severe form of reaction affects the skin, respiratory, gastrointestinal, and cardiac systems.

Consuming even a small quantity of peanuts may cause a reaction. A casual skin contact might not directly
cause a severe allergic reaction, but if the area of skin in contact with the peanut touches mouth, eyes or nose,
then there is a possibility of a reaction.

3. How will I know if my child is in the high-risk group to develop Peanut allergy? How can I
diagnose it?

You can evaluate if your child has a higher likelihood of developing peanut allergy:
● if your child has other food allergy or reacts to certain food
● if your child has severe eczema, egg allergy or both
● if an older sibling or a family member has a peanut allergy

If your baby or child is in the high-risk group to develop peanut
allergy and has any of the following symptoms, you must seek
medical advice immediately, as a few of the symptoms may be
life-threatening:

● Itchy skin or rashes
● sore, red, eyes
● swelling of eyes, lips or throat
● Shortness of breath or wheezing/coughing
● Diarrhoea or vomiting

The National Institute for Allergy and Infectious Disease (NIAID)
recommends evaluation of a possible allergy to peanut by testing or evaluation by an allergy specialist, if your
child is in the high-risk group.
There are specific tests to diagnose a Peanut allergy like Skin Prick tests, Blood tests, Basophil Activation test
etc. Though the test results may be positive (the disease is identified as present), the confirmation of peanut
allergy should always be corroborated by a health care expert who will evaluate other factors as well and
explain the test results better.

Also, read the FAQ on What are the symptoms of peanut allergy?
Read more on Peanut allergy in children

^ Go to FAQ Summary ^

PREVENTION AND TREATMENT

4. Can allergy to peanut be prevented?

While peanut allergy cannot be prevented as such, the possibility can be alleviated.
According to a research ‘LEAP*’ conducted by National Institute of Allergy and Infectious Diseases (NIAID), the
possibility of developing peanut allergy is much lower in children introduced to a peanut-based food before
they turn one. It issued official clinical guidelines in January 2017, recommending parents to introduce peanut-

based foods to babies between 4 months to 1 year. Their research suggests that this reduces the possibility of
developing peanut allergy in children.

Though peanut allergies tend to be for life, recent studies indicate that
~20% of children outgrow peanut allergy eventually when compared to
adults.

You must always consult a medical expert to assuming that your child is no
longer allergic to peanut than experimenting on your own, as the
consequences could be serious.
* LEAP–Learn Early About Peanut Allergy is a research conducted by the Immune
Tolerance Network and is sponsored by the National Institute of Allergy and
Infectious Diseases, part of the National Institutes of Health.

5. I’m pregnant or breastfeeding. Should I eat peanuts to help prevent food allergies in my baby?

Eating a variety of nutritious food during pregnancy and breastfeeding provides beneficial nutrition to the
baby. Research does not associate any direct relationship between eating peanuts during pregnancy and
reduced chance of peanut allergy in babies.

A nutritious diet will help avoid possible food allergies in general.

Read more on maternal peanut exposure and risk of peanut allergy in children.

6. How do I introduce peanut into my child’s diet?

Ensure that your baby is ready for any solid food before introducing a peanut-based food. Feed a tiny portion
of a peanut butter puree by adding hot water to 2 teaspoons of peanut butter. You may continue feeding after
observing for at least 30 minutes for any reactions.

You can start feeding from 4 months to 10 months but do not
attempt to feed whole peanuts as it may result in choking.
Introducing a peanut-based food from 4 months onward
reduces the likelihood of developing peanut allergy by
80%. National Institutes of Health (NIH) recommends
introducing peanut-containing food based on individual
child's’ risk scenarios.

● Low-risk babies: If your child has no other food allergy or reactions till date, then

you may feed peanut-based food as with other solid food.

● Medium-risk babies: IF your child has an allergy to other food like a mild eczema, you may cautiously

introduce a peanut-based food as suggested above while observing for any untoward reactions. This

could be advised by your paediatrician who might suggest trying this at home or under medical

supervision.

● High-risk babies: Always check with your healthcare expert before introducing peanut-based food in

children with a history of severe allergy to other foods. You should introduce peanut under medical

supervision.

Watch this video on introducing peanut-containing foods children.
Read more on introducing peanuts to infants with a low risk of developing an allergy.

7. What signs should I look out for, if my child is having an allergic reaction to peanut-based
food?

Children express themselves in unique ways. It is important to watch out for the signs or expressions to
understand the seriousness or rush for medical assistance. Observe the signs keenly while introducing a new
food type or food that may have peanut or peanut butter in them. Follow your paediatrician’s advice if your
baby is prone to allergies. It is a safe practice to attempt this in a hospital setting.

Babies or toddlers may:
● Fall unconscious or become floppy
suddenly
● Turning pale
● Have difficult in swallowing
● Noisy or difficulty in breathing
● Have garbled or incoherent words
● Cough persistently
● Have a hoarse or high-pitched voice
● Scratch or tug their tongue or lips
● Put hands into their mouth

A little older child, who can speak may
express:

● Tongue or mouth being itchy or
burning

● Tongue being heavy or swollen or
stinging

● Lump in the throat or something
being stuck back there

● Not able to swallow
● Unusual itching inside the ears or the skin
● Itching of the eyes or swollen eyelids
● Pain in the tummy
● Dizziness

You must seek medical assistance immediately if you witness or hear the above as it could lead to the life-
threatening condition anaphylaxis.

Read more on child's reaction to allergies.

8. What should I do if my child with Peanut allergy is having a reaction to peanut?

The signs of peanut allergy could start showing up within a few
minutes to an hour of consuming it or coming in contact with it. The
response could vary from being mild or insignificant to severe or life-
threatening anaphylaxis. Children with Asthma or Bronchitis may
develop severe allergic reaction to Peanuts compared to other
children, in which case, you must pay more attention to the
symptoms.

● For a mild reaction (itching, hives, rashes): Your Paediatrician
would recommend antihistamines, which blocks chemicals
released by the body during an allergic reaction, like a
diphendydramine (Benadryl®) and cetirizine.

● For a severe reaction (anaphylaxis): This is a medical emergency. EpiPen shots are given
intramuscularly ASAP for an immediate rescue. These are prescribed for use in children with a history
of peanut allergy or in medium to high-risk children. You would receive training and relevant advice
on the EpiPen usage in an emergency.

● Usually, EpiPen Jr.®, a reduced dosage meant for children, is prescribed and you must keep it handy.
It is a self-injectable brand of an emergency drug called epinephrine, a.k.an adrenalin. You must still
rush the child for a medical assistance immediately as the child would need more help even after the
shot.
In case of a severe reaction, lay your child flat and call for medical assistance immediately as it could

be a life-threatening reaction.
Read more about EpiPen Jr®.

If your child has a peanut allergy, you must always keep an epinephrine auto-injector as prescribed by the
paediatrician. You must inform your child’s school about the allergy and ensure that they have an EpiPen
handy at School as well.
Epinephrine relaxes the muscles in the airway passage while improving heartbeat as well. It reduces swelling
and regulates the blood flow to heart and brain.

That said, the best way to prevent an allergic reaction to peanut would be to avoid it.
Read more on an immediate response to severe allergic reaction with an adrenaline pen.

9. What are the common treatments and therapies to alleviate an allergic reaction to Peanuts?

If your child has a reaction to peanuts, you should:
1. Clinically validate if the child is allergic to peanuts and avoid all peanut-based food
2. Record the symptoms and reactions in a food diary
3. Have access to an adrenaline / epinephrine auto-injectors all the time

A few common treatments used to treat allergic reaction
to peanuts are:
● Antihistamine: This can help relieve symptoms of
a mild to moderate allergic reaction.
● Adrenaline / epinephrine auto–injectors: This is
essential in severe allergic reactions and in anaphylaxis. It
is a device like an injector pen that releases a prescribed
dosage of adrenaline.

Few alternative immunotherapy modalities that are being tried to prevent allergic reaction long-term are:

● Skin patch: A small adhesive patch releases small doses of peanut protein into the skin. Research suggests
positive results in children and young adults. This trains the body’s immune systems to the peanut protein
and protects against accidental exposure or consumption.
Read more on skin patch for peanut allergy by NIHAID.

● Oral immunotherapy (OIT): This involves consuming small portions of peanut protein-based food in the
form of powder mixed with regular food and daily increasing the amounts progressively. This low dose
introduction builds resistance in the form of desensitisation to the allergens.
Read more on oral immunotherapy by NIHAID.

Latest research also recommends introducing peanut-based food to infant early on, in a moderated way.

^ Go to FAQ Summary ^

INTERESTING INSIGHTS

10. Are allergy and intolerance the same?

Food allergy and food intolerance are commonly misunderstood terms and used synonymously.
● Food allergy: These are reactions when our body’s immune system creates antibody (IgE) to combat
allergens from a certain food erroneously. Allergic reactions are mostly immediate responses to
exposure to allergens and could range from being mild to severe.
Food allergies could be confirmed relatively easier by health experts. Even trace amounts of the food
may cause severe allergic reactions.
● Food intolerance: This is an unpleasant physical reaction to a certain food and difficulty in digesting
the food. Generally, issues related to digesting a particular food indicates an intolerance. It may take
several hours for the symptoms to show up and is usually gut-related like bloating and stomach pain.

Diagnosing is relatively difficult as the symptoms could be vague and mimic those due to other health
conditions. Besides, food intolerance is also associated with lifestyles habits, poor nutritional or unhealthy
food intakes, etc.

Food intolerances are related to the digestive system whereas food allergies are related to the immune
system.

Know more from the food allergy and intolerance factsheet.

11. Can one outgrow peanut allergy eventually?

Though peanut allergies tend to be for life, recent studies indicate that ~20% of children outgrow peanut
allergy, eventually. Children, especially school-going, developing an allergy to peanuts seem to be on the rise
lately.
You must consult a medical expert to conclude that your child is no longer allergic to peanut than
experimenting on your own as the consequences could be serious.
Babies or young children may develop a peanut allergy if their older sibling is allergic to peanuts. However, an
early introduction of a peanut-based food helps to combat this allergy in the early stages.

Research for a permanent cure is still ongoing and there is an indication of a possible breakthrough. Read to
gain some insights on the research.

Read more about studies on outgrowing the food allergy.

12. If my child has a peanut allergy, does that indicate that my child could be allergic to other nuts
too?

Peanuts are legumes and are not the same as
nuts from trees like walnuts, almonds.
Developing an allergy to peanuts are common.
But it does not mean that a child allergic to
peanut will be allergic to other nuts as well.
However, it may be possible that the child is
allergic to legume-based food and nuts from
trees.

It is quite possible that a child with peanut
allergy may be allergic to Lupin or Sesame as well, as it contains the same proteins as peanuts. It is important
to read the ingredients while buying a food product. Though Lupin is common in Europe and Middle-East, its
flour or seeds may be used in making bread, pasta, etc.

Download for more information on a quick guide about peanut allergy.

13. What are the possible sources of Peanut, besides the obvious food labelled as the Peanut?

Peanuts are known by several names and can be a
hidden ingredient in a variety of regular food
products. Hence it is important to pay extra
attention to listed ingredients and allergy
information on a food package or container.

The following insights will help.
● Always read the food labels and note the
ingredients listed therein. Look for the
allergy information in particular
● Educate your child about the implications of allergic reactions to peanuts and insist that they always
read the food labels or inform anyone preparing food for them at school or outside. Teach your child
on reading food labels or ingredients and also on what to look out for.

● There’s a possibility of cross-contact in restaurants serving cuisines like Mexican, Asian, and African
food

● Equipment making alternate butters like almond butter or sunflower seed butter may be used to
make peanut butter too

● Check the labels or with the manufacturer of the following food products:
˗ Ice creams
˗ Candy, Nougat
˗ Marzipan
˗ Pancakes
˗ Egg rolls
˗ Glazes, marinades, and salad dressing
˗ Sauces such as pesto, gravy, chilli / hot sauce, mole sauce and enchilada sauce
˗ Other nuts and seeds (equipment sharing risk)
˗ Food or drinks such as hot chocolate, cookies, pudding, pies, and other baked foods
˗ Vegetarian food labelled as meat substitutes
● Pet food (cross-contact risk)
● Compost used as fertiliser may also contain peanut shells (cross-contact risk)

Peanut may also be known as:
● Earthnuts
● Groundnuts
● Chinese nuts
● Goober nut/pea
● Arachis hypogaea
● Beer nuts
● Cacahuete
● Madelonas

14. What are the common myths and misconceptions related to peanut allergy?

As peanut allergy is a very common food allergy, it is
important to understand the common misconceptions
and myths on the topic.

● Myth: Peanut allergy is the more common than
other food allergies in children.
Fact: No, Peanut allergy is only one of the most
common allergy among the top eight food
allergens that contribute to 90% of food allergies.
Eggs and milk are equal culprits when it comes to
causing allergic reactions. The fact remains that possibility of anaphylaxis, a serious life-threatening
reaction, makes peanut allergy more popular.

● Myth: You would develop an allergic reaction to peanuts only in the childhood. Then, it becomes a
permanent condition.
Fact: No, while it is common to develop a peanut allergy in childhood, you may also develop it at any
point. Even if you were fine with peanuts earlier, you may grow an allergic reaction to it at any later point
in life. However, research states that a small percentage of children will outgrow the allergy as they age,
as their immunity could change with time.

● Myth: You will have an allergic reaction almost instantly after consuming peanut-based food.
Fact: Yes, you may have a reaction instantly or after a few hours. The time to have an allergic reaction to
peanuts differ each time and even the intensity of the reaction varies.

● Myth: If you have an allergic reaction to peanuts, you should avoid consuming all related food.
Fact: Yes, if you have a peanut allergy, it is important to avoid consuming peanut-based food as peanut as

the reactions may be serious at times. However, until you are diagnosed with an allergy to related or other
food as well, you must not cut out all of them entirely from your diet as you may miss out on essential
nutrients. Consult a healthcare professional before omitting any food group.

● Myth: I can diagnose food allergies myself.
Fact: No, you may record your observations but are not advised to conclude if you have a specific food
allergy. While you might experience the symptoms, it should always be vetted by a healthcare expert
instead of assuming. There is a possibility of misdiagnosis and the risk associated could be serious as
severe reactions warrant an immediate medical assistance. It is common to associate an allergic reaction
to a food, like peanuts, especially if you have intolerance or allergy to other food.
Even the commercial home test kits to self-diagnose food allergy is not recommended as they may not be
of the required standards.

● Myth: If a dish or a food product does not list peanut/allergen, then it is safe.
Fact: No, you must always pay close attention to the ingredients in a food product or a dish served or
clarify. Though Food Allergen Labeling and Consumer Protection Act (FALCPA) mandates listing the 8
common allergens in the labels, it may not be in obvious places. Read more about it in this FAQ on
possible sources of peanut. When in doubt, ask.

● Myth: Peanut allergy can be cured permanently.
Fact: Not yet. However, research for a permanent cure is ongoing, implying a positive progress made in
the direction. Research conducted by various health bodies indicate a possible breakthrough and of late,
there are instances of desensitisation to the allergen though it cannot be construed as a permanent cure.
As these are not yet approved by FDA, we cannot categorically conclude that there is a time-tested cure.
Read to gain some insights on the research.
You can treat the symptoms and prevent allergic reactions by avoiding the peanut-based food.
Nevertheless, it is possible that a small percentage of children will outgrow the allergy as they age, and
immunity develops.

● Myth: Eating just a little peanut-based food won’t cause any problem.
Fact: No, even a trace amount of peanut-based food can cause a severe reaction. You must avoid
consuming it directly or even by a cross-contact (when an allergen is inadvertently mixed or passed on
from one source to another).

● Myth: You only need to carry your allergy medications if you’ve had a severe reaction in the past.
Fact: Absolutely not. It is critical for anyone diagnosed with a peanut allergy to carry the medication
prescribed by the physician as you can never be sure of the intensity of the reaction. Your healthcare
expert may recommend an antihistamine for mild reaction and an adrenaline auto-injector pen for a
severe reaction.

Read more on peanut allergy myths and misconceptions.

^ Go to FAQ Summary ^

Glossary of Terms:

(All definitions and citations are sourced from: https://medical-dictionary.thefreedictionary.com and
https://medilexicon.com)
● Legume [leg´ūm]: Pod or fruit of one of plants such as a pea or bean. These edible seeds are enclosed in

pods, which are a rich source of protein, complex carbohydrates, dietary fibre, B vitamins and minerals
(calcium, iron, magnesium, potassium and zinc).
● Lupin [Lúpin]: A leguminous plant of the genus Lupinus, of North America, Europe, and Africa, with large
spikes of brightly coloured flowers and flattened pods. This legume related to peanut and soybean and
have been used as human food since ancient times. For thousands of years pearl lupin has been consumed
in the Andean Highlands, and seeds of white lupin have been eaten whole as a popular, traditional, snack
food of the Mediterranean region (lupini beans).
● Anaphylaxis [ăn'əfəlăk`sĭs, pronounced ana-fill-ax-is]: A serious type of allergic reaction, in which the
immune system responds to otherwise harmless substances from the environment. Unlike other allergic

reactions, anaphylaxis may cause death. Reaction may begin within minutes or even seconds of exposure,
and rapidly progress to cause throat or tongue swelling, airway constriction, skin and intestinal irritation,
and altered heart rhythms. In severe cases, it can result in complete airway obstruction, shock, and death.
Emergency treatment of anaphylaxis involves injection of adrenaline (epinephrine) which constricts blood
vessels and counteracts the effects of histamine.
● Atopic March: A.K.A Allergic March, it refers to the natural history or typical progression of allergic
diseases that often begin early in life. These include atopic dermatitis (eczema), food allergy, allergic
rhinitis (hay fever) and asthma.
Src: https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/atopic-march
● Diphendydramine [di″fen-hi´drah-mēn]: It is a sedating antihistamine with anticholinergic (blocking the
passage of impulses) effects used for relief of allergic symptoms, motion sickness, insomnia, and other
conditions.
● Cetirizine [sĕ-tir´ĭ-zēn]: It is a non-sedating antihistamine prescribed orally in the form of the
hydrochloride salt for treatment of allergic symptoms, chronic hives etc.
● Histamine [his´tah-mēn]: It is an organic compound produced by decarboxylation (removal of a molecule
of carbon dioxide) of histidine (a naturally occurring amino acid, one of the essential amino acids,
necessary for optimal growth of infants. It is found in all body tissues and causes capillary dilation (which
increases capillary permeability and lowers blood pressure), contraction of most smooth muscle tissue,
increased gastric acid secretion, and acceleration of the heart rate.
● Antihistamine [an″ti-his´tah-mēn]: These are drugs that respond to the effects of histamine in those who
are hypersensitive to various allergens. These are drugs which have an action opposed to that of
histamine on either H1 or H2 receptors. They are used to relieve symptoms of allergic reactions.
● Asthma [az′mă]: It is an inflammatory disease of the lungs characterized by reversible airway obstruction.
Originally, this term was used to mean “difficult breathing”. This chronic (long-lasting) inflammatory
disease causes the airways to spasm and swell periodically narrowing the airways. The individual then
must wheeze or gasp for air. Obstruction to air flow either resolves spontaneously or responds to a wide
range of treatments, but continuing inflammation makes the airways hyper-responsive to stimuli such as
cold air, exercise, dust mites, pollutants in the air, and even stress and anxiety.
● Bronchitis[brong-kī′tis]: It is an inflammation of the air passages between the nose and the lungs,
including the windpipe or trachea and the larger air tubes of the lung that bring air in from the trachea
(bronchi). Bronchitis can either be of brief duration if it is acute or have a long course if it is chronic. Acute
bronchitis is usually caused by a viral infection, but can also be caused by a bacterial infection and can heal
without complications. Chronic bronchitis is a sign of serious lung disease that may be slowed but cannot
be cured.