Peanut Allergy

Peanut allergy happens when your body's immune system, which fights off germs, mistakenly attacks peanuts. This is a common cause of a very serious allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening.

More and more children are developing peanut allergies. Even a small, seemingly mild reaction to peanuts can be a warning sign. It's crucial to talk to a doctor or other healthcare provider if you or your child has ever had any reaction to peanuts, no matter how small. A mild reaction now could lead to a more severe reaction later.

Peanut allergies often cause reactions within minutes of eating peanuts. These reactions can show up in several ways:

Skin problems: This might include itchy welts (hives), redness, or swelling.

Mouth and throat issues: You might feel an itch or tingling sensation in your mouth or throat.

Digestive problems: These could be diarrhea, stomach aches, feeling sick to your stomach (nausea), or throwing up (vomiting).

Breathing problems: Your throat might feel tight, and you could have trouble breathing or wheezing. A runny nose can also occur.

Serious Reactions (Anaphylaxis): A peanut allergy is a common reason for a serious allergic reaction called anaphylaxis. This is a medical emergency. It needs immediate treatment with a special medicine called epinephrine (often given with an autoinjector like an EpiPen or Auvi-Q). You also need to go to the hospital right away.

Epinephrine is similar to adrenaline. Anaphylaxis can cause:

• Airway constriction: Your airways narrow, making breathing very difficult.
• Swelling: Your lips, tongue, and throat can swell, blocking your breathing.
• Low blood pressure (shock): Your blood pressure can drop dangerously low.
• Fast heartbeat: Your heart might beat very quickly.
• Dizziness, lightheadedness, or loss of consciousness: You might feel dizzy, lightheaded, or even faint.

What to do: If you have any of these signs or symptoms of a peanut allergy, talk to your doctor or other healthcare provider. If you have a severe reaction—like trouble breathing, severe dizziness, or loss of consciousness—call 911 or your local emergency number immediately. Get help right away.

If you think you might have a peanut allergy, talk to your doctor or other healthcare providers. This is important so they can help you understand your condition and recommend the best course of action.

If you have a serious reaction to peanuts, get emergency help immediately. A serious reaction, called anaphylaxis, can be life-threatening. Call 911 or your local emergency number right away if you experience any of these symptoms:

• Feeling very lightheaded or dizzy: This could be a sign that your blood pressure is dropping.
• Having trouble breathing: This could include difficulty catching your breath, wheezing, or feeling like you can't get enough air.
• Losing consciousness: Passing out is a very serious symptom.

Don't delay getting help if you think you're having a severe allergic reaction. Every second counts in a situation like this.

Peanut allergies happen when your body's immune system mistakenly sees peanut proteins as dangerous. Your body's defense system then releases chemicals into your blood to fight these "invaders." These chemicals trigger the symptoms of an allergic reaction.

There are several ways you can be exposed to peanuts and have a reaction:

• Eating peanuts or foods containing peanuts: This is the most frequent cause. If you have a peanut allergy, eating even a tiny amount of peanuts or peanut butter can cause problems. This includes foods that might seem unrelated, like certain sauces, snacks, or even some processed foods, which might contain hidden peanuts.

• Cross-contamination: This happens when peanuts accidentally get mixed into other foods. It's often a problem during food processing or handling. Imagine a machine used to make cookies. If it was previously used to process peanuts, there could be peanut residue left behind. This residue could mix with the cookie dough, resulting in a dish that someone with a peanut allergy could react to.

• Breathing in peanut particles: Inhaling dust or tiny particles (aerosols) containing peanuts, like peanut flour, can also trigger a reaction in some people. This is less common than eating peanuts or cross-contamination, but it's important to be aware of.

Why some people get peanut allergies and others don't is still a mystery. But certain things can increase your chances.

Several factors make you more likely to develop a peanut allergy:

• Age: Peanut allergies are very common in young children, especially toddlers and babies. As a person gets older and their digestive system develops, they are less likely to react to things that cause allergies. But even if you seem to have outgrown it, it's still possible for the allergy to return.

• Previous peanut allergy: While some kids grow out of peanut allergies, it's not always permanent. Even if you think you've outgrown it, you should still be cautious.

• Other allergies: If you're allergic to one thing, you might be more likely to be allergic to other things. Having other allergies, like hay fever (allergic rhinitis), can also increase your risk of food allergies like peanut allergy.

• Family history: If allergies run in your family, especially food allergies, you're more likely to have a peanut allergy yourself. This means if your parents, siblings, or other close relatives have allergies, you may be at a higher risk.

• Eczema (atopic dermatitis): People with eczema, a skin condition that causes dry, itchy patches, often have a higher chance of developing food allergies, including peanut allergy. This is likely because of similar underlying immune system factors.

Severe peanut allergies can be dangerous. A serious peanut allergy can cause a life-threatening reaction called anaphylaxis. This means that people with very strong peanut allergies are more likely to experience this potentially dangerous response. Anaphylaxis is a sudden, severe allergic reaction that can affect many parts of the body and needs immediate medical attention.

Research consistently shows that exposing babies and young children to peanuts early can significantly decrease their chances of developing a peanut allergy later in life. These studies involved introducing peanuts to babies and children who were considered high-risk for allergies, starting as early as four months old and continuing up to three years of age. In these cases, the risk of developing a peanut allergy was reduced by up to 80%. High-risk children include those with skin conditions like eczema (ranging from mild to severe) and/or an egg allergy.

If you're concerned about your child's risk of peanut allergy, it's crucial to talk to their doctor about the best way to introduce peanuts to their diet. This is especially important for children with eczema or an egg allergy. Your doctor can provide personalized guidance based on your child's specific situation.

Understanding if you have a peanut allergy involves a conversation with your doctor and a series of tests. First, you'll discuss your symptoms and medical history. This helps your doctor get a complete picture of your health.

Next, your doctor might perform a physical exam. After that, several specific tests can help determine if you have a peanut allergy or something else:

• Food Diary: You might need to keep a detailed record of what you eat, any symptoms you experience, and any medicines you take. This helps your doctor connect your symptoms to possible triggers.

• Skin Prick Test: A tiny amount of a suspected allergen (like peanut) is placed on your skin. A small needle pricks the skin near the substance. If you're allergic, a raised bump or reaction will appear at the spot where the allergen was placed. This is a common and relatively quick way to identify potential allergies.

• Blood Test: A blood test can measure the level of allergy-fighting antibodies in your blood called immunoglobulin E (IgE) antibodies. High levels of these antibodies can suggest an allergic reaction to certain foods, but don't always confirm an allergy.

• Elimination Diet: If your doctor suspects you may be allergic to more than just peanuts, they might recommend an elimination diet. This involves removing suspected foods (like peanuts) from your diet for a period of time (like a week or two). Then, you slowly add them back one at a time, carefully watching for any reactions. This helps link specific foods to symptoms. However, if you've had a severe allergic reaction in the past, this method may not be safe and other methods will be used instead.

These tests can help confirm a peanut allergy, or they might indicate a different problem, such as a food intolerance. Intolerance means your body has trouble digesting a food, but it's not a full-blown allergic reaction. Your doctor will use all this information to make an accurate diagnosis and recommend the best treatment plan.

Managing Peanut Allergies: Treatments and Preparedness

Peanut allergies are common, and the most important step is avoiding peanuts and peanut products. However, research continues to explore ways to reduce the severity of allergic reactions, including potentially life-threatening anaphylaxis. One approach is immunotherapy, which aims to retrain the immune system to not react to peanuts. This process, also called desensitization, works by gradually introducing small amounts of peanuts into the body, increasing the dosage over time until the highest tolerated amount is reached.

Oral Immunotherapy (OIT):

A specific type of immunotherapy for peanut allergies is oral immunotherapy (OIT). In OIT, a person with a peanut allergy, or someone at risk, is given gradually increasing doses of peanut-containing food. This process aims to help the immune system get used to peanuts, potentially reducing future reactions. One FDA-approved OIT treatment for children aged 4-17 with confirmed peanut allergies is Palforzia (Peanut Allergen Powder-dnfp). However, this treatment isn't suitable for everyone, especially those with uncontrolled asthma or certain other conditions like eosinophilic esophagitis.

Antibody Treatments:

Another method involves using antibody treatments. These medications are injected and work differently from OIT. They target a specific protein in the blood that triggers allergic reactions. The medication binds to this protein, making the immune system less sensitive to peanuts. One example of an antibody treatment is omalizumab (Xolair).

Important Considerations:

While these treatments can help reduce the risk of severe reactions, they don't eliminate the need for avoidance and emergency preparedness. Peanuts are present in many foods and products, and accidental exposure is possible. To prevent a severe allergic reaction, strict avoidance is crucial.

Emergency Preparedness:

If a severe allergic reaction (anaphylaxis) occurs, an immediate injection of epinephrine is necessary. Many people with peanut allergies carry an epinephrine auto-injector (like an EpiPen or Adrenaclick). This device is a pre-filled syringe with a needle that injects a dose of epinephrine when pressed against the thigh. It's vital to:

• Carry the auto-injector with you at all times. Keep extra injectors in your car and at work.
• Check the expiration date. Expired epinephrine may not work effectively. Ask your doctor for a backup injector in case one is lost or misplaced.
• Learn how to use the auto-injector. Have your healthcare team demonstrate the procedure and ensure that those close to you know how to use it, too.
• Know when to use the auto-injector. Consult with your doctor to understand the signs of a severe allergic reaction. If you're unsure, it's generally better to use the epinephrine.

By understanding the available treatment options and taking proactive steps for emergency preparedness, people with peanut allergies can manage their condition effectively and minimize the risk of severe reactions. Regular communication with a healthcare professional is essential for personalized guidance.

Protecting a Child with a Peanut Allergy: A Practical Guide

If your child has a peanut allergy, it's crucial to take steps to keep them safe. This involves everyone who interacts with your child.

Involve Caregivers:

Talk to all the adults who look after your child, including relatives, babysitters, and teachers. Explain the allergy clearly and teach them how to recognize the signs of a reaction. These signs can include hives, swelling, trouble breathing, or a racing heart. Crucially, emphasize that a peanut allergy can be very serious and requires immediate action. Make sure your child understands that if they have a reaction, they need to tell someone right away.

Create a Written Action Plan:

Write down a detailed plan for handling allergic reactions. This plan should include:

• Specific steps: The exact sequence of actions to take.
• Medications: The names of all allergy medications and the correct doses.
• Contact information: Phone numbers for family members and healthcare providers.

Give a copy of this plan to all caregivers, including teachers and family members.

Prevent Sharing:

Children often share food. If your child has a peanut allergy, encourage them not to share food with others, and remind them to be cautious when accepting food from others. This helps prevent accidental exposure.

Keep Emergency Supplies Accessible:

Ensure your child's epinephrine autoinjector (a device that delivers a dose of epinephrine) is always available and easily accessible to anyone who cares for them. Epinephrine is a crucial medicine for treating severe allergic reactions, also known as anaphylaxis.

Explain to everyone caring for your child how to use the autoinjector and where it is kept. They need to know when and how to use it.

School Policies are Important:

Work with your child's school to ensure they have a robust food allergy management plan. This plan should include procedures for recognizing and responding to allergic reactions. The school should have access to epinephrine autoinjectors and staff trained in their use.

Medical Alert:

Have your child wear a medical alert bracelet or necklace. This will help medical professionals quickly identify the allergy if communication is difficult during a reaction. The alert should clearly state the child's name and the allergy type (in this case, peanut allergy). It may also include brief emergency instructions.

Adult Actions:

If you have a peanut allergy, always carry your epinephrine autoinjector and wear a medical alert bracelet or necklace.

By taking these precautions, you can significantly reduce the risk of a serious reaction for your child and ensure they receive the prompt medical attention they need.