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Shell shock: Peanut allergies

Peanut allergy affects a small number of people. But those who are allergic risk life-threatening reactions from even a small exposure.

A relatively small number of people (about 4% of adults and 4% to 6% of kids) have allergies to foods. Even fewer people have allergies to peanuts, says the American College of Allergy, Asthma & Immunology.

But peanuts can cause severe reactions in those with the allergy, even when the person has only eaten half a nut. Severely allergic people can even have a reaction after being kissed by someone who's eaten peanuts.

What's an allergic reaction?

When an allergic person eats a peanut, the body misinterprets the food as an invader and releases histamine and other chemicals to protect the body. The result can be hives, vomiting or diarrhea, says the U.S. Food and Drug Administration (FDA).

People with peanut allergies are prone to the most severe reaction—called anaphylaxis. This sudden allergic reaction can cause swelling of the lips and face, difficulty breathing and a dangerous drop in blood pressure. The symptoms can occur within minutes after the peanut is eaten. Anaphylaxis can lead to death.

Treatment means avoidance

The only way to treat a peanut allergy is to avoid peanuts. But for those with a peanut allergy, this can be difficult.

Peanuts are often included in foods at restaurants without being listed on the menu. They are also often included in small amounts in packaged foods, and it's easy to forget to read labels.

Children who may not be old enough to ask questions before eating something are the most likely to eat peanuts by accident, warns the American Academy of Pediatrics.  

Because reactions can be so severe and peanuts are so common, it makes sense to take some extra precautions if you or your child have a peanut allergy.

Protecting yourself

When you're shopping, read labels and understand the names of ingredients. Don't rely on the same brand to be safe each time. Manufacturers are constantly refining their products, and ingredients may change over time.

When you're eating out, ask about ingredients if you're unsure about a particular food.

If you're prone to anaphylactic reactions, you should wear an ID bracelet that describes your allergy, says the FDA. Also ask your doctor if you should keep a medicine called epinephrine with you at all times.

Injectable epinephrine is a synthetic form of adrenaline that can be placed directly into a thigh muscle or vein. It works directly on symptoms and can keep them under control until you get to the emergency room.

Protecting your child

Take the same precautions for an allergic child as you would for yourself, including asking about ingredients at restaurants and scrutinizing labels.

In addition, work closely with teachers, school nurses and other staff to make sure they understand the needs of your child and what they should do if he or she has a reaction at school.

Meeting with staff members and administrators before school starts and providing an action plan is also a good idea. Ask the teacher to require that all snacks come from a store, so ingredients are clearly labeled.

Make sure cafeteria workers know that your child has a peanut allergy. They should read labels of the foods they're cooking to ensure that peanut ingredients aren't included. It's also vital to ensure that food preparation and serving utensils aren't exposed to peanuts and then used on another food. You could also ask for menus in advance and select the foods that are safe for your child. Make sure your child understands that he or she shouldn't trade foods.

If your child has anaphylactic reactions, keep epinephrine in your child's classroom or with the nurse and have him or her wear an ID bracelet.

Can you prevent peanut allergy?

In 2017, the National Institute for Allergy and Infectious Disease (NIAID) issued updated guidelines aimed at preventing many new cases of peanut allergy.

NIAID recommends that infants at high risk of developing peanut allergy—those with severe eczema and/or egg allergy—be introduced to peanut-containing foods at about 6 months, if their doctor has determined it is safe and they've started solid foods.

Infants with low to moderate risk for peanut allergy—those with mild to moderate eczema—who have already started solid foods do not need an evaluation before being introduced to peanut-containing foods, also at around 6 months, according to NIAID.

Should you get tested?

If you or your child experiences discomfort after eating peanuts, that doesn't mean you're allergic, says the FDA. You may have a peanut intolerance—your body is missing an enzyme needed to break down the food.

The only way to be sure is to get tested. Your doctor or allergist will ask about your medical history, perform a physical exam and perform tests to rule out other conditions. Tests can include direct allergy skin tests, blood tests, or elimination and challenge tests, where peanuts are eliminated from the diet and then reintroduced to see whether they cause problems.

Reviewed 2/5/2021

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