The American Academy of Allergy, Asthma & Immunology (AAAAI) estimates that approximately 2.2 million school-age children suffer from food allergies. Of these, peanut allergy is believed to be the leading cause of severe or life-threatening food-induced allergic reactions, causing an estimated 15,000 emergency room visits each year and nearly 100 deaths. Only about 20 percent of children with peanut allergy will outgrow their allergy, making this a condition that most will have to manage well into adulthood.
Managing a peanut food allergy requires a concerted effort between parents, caregivers, educators and your child’s allergist, who is the best qualified medical professional to confirm the diagnosis. Reactions can occur at anytime, so it is important that everyone involved in the care of a child knows how to avoid, recognize and manage an allergic reaction.
Step 1: Avoidance
Avoidance of peanut allergens by reading food labels is the first step in management. Here are a few good tips to remember to avoid accidental exposure to peanuts:
- Avoid foods that contain ingredients such as beer nuts; cold pressed, expelled or extruded peanut oil; goobers; ground, mixed, monkey or artificial nuts; nut meat; nut pieces; peanut butter; or peanut flour
- Remember that certain ethnic foods such as Chinese, Indian, Thai and Vietnamese dishes, as well as many chocolate candies and baked goods are likely to include peanut as an ingredient
- Avoid foods that are made in facilities that process peanuts. For example, sunflower seeds are often produced on equipment shared with peanuts
- Many experts advise that tree nuts (almonds, pecans, etc.) should also be avoided due to risk of cross contamination
- Studies show that most peanut allergic individuals can safely eat peanut oil (other than cold pressed, expelled or extruded peanut oil)
- When eating out, always make a server aware that your child has a peanut allergy and ask about possible hidden ingredients or food contaminants.
Step 2: Recognizing the signs
Allergic reactions to peanuts typically begin within minutes to a few hours after eating the offending food. The frequency and severity of symptoms vary widely from one child to another. Mildly allergic children may only experience and itchy nose and sneezing, while highly allergic children may experience severe and life-threatening reactions, such as asthma or swelling of the tongue, lips or throat.
The most common symptoms of food allergy involve the skin and gastrointestinal tract. Skin rashes include hives and eczema. Intestinal symptoms typically include vomiting, nausea, stomach cramps, indigestion and diarrhea. Other symptoms can be asthma, with cough or wheezing; rhinitis, often including itchy, stuffy, runny nose and sneezing; and rarely, anaphylaxis, a severe allergic reaction that may be life threatening.
Because these symptoms can be caused by a number of different diseases other than food allergy, your child’s allergist/immunologist may want to examine your child to pinpoint the source of the problem.
Step 3: Managing a reaction
Children with a peanut allergy should have a clearly defined plan of action for handling emergency situations. Keep a list of symptoms and your child’s doctor's instructions for treatment posted in a prominent place in your kitchen, such as the refrigerator.
Oral antihistamines can be very effective in treating many of the early symptoms of a mild allergic reaction to food. Children with histories of severe reactions need to be instructed how and when to give themselves a shot of epinephrine in the event of a severe allergic reaction. Epinephrine can slow or reverse life-threatening reactions (anaphylaxis) before medical help can arrive. This medication is available in easy-to-use injectable devices and should be carried at all times by children with histories of severe allergic reactions. Bracelets or necklaces may be worn to quickly alert medical personnel or other caretakers to the food allergy.
Back to school
While parents can control the home environment to keep peanut-allergic children safe, cooperation between parents and school staff is necessary to extend that security to the classroom. The AAAAI recommends the following back-to-school strategies for parents of peanut-allergic children:
- Communicate with school staff Before the academic year begins, meet with your child’s teacher, principal, nurse and other staff to discuss allergy triggers and reactions. Prepare a food allergy action planto keep on file at the school (find a template at www.aaaai.org). Include a photo of the child with the form to simplify identification.
- Provide safe situations If necessary, work with school administrators to create allergy-free dining areas (such as a peanut-free table in the cafeteria). Send safe treats from home for classroom parties, fieldtrips and other special activities
- Explain the danger Have an age-appropriate conversation with your child about the risk of food allergies. Talk about safe and unsafe food and review the list . Remind your child not to share lunches or accept offers of food from classmates. Encourage your child to notify an adult immediately if he or she eats something that may cause a reaction or begins to experience symptoms.
- Keep medication available Work with school healthcare providers to keep physician-approved medications available. Mild reactions often require treatment with antihistamines. Children at risk of severe reactions should have injectable epinephrine within reach (older children can carry their medication with them; younger children should have it available in the classroom). Have your child’s physician provide written instructions for administering epinephrine and confirm that school staff members understand their responsibility to act quickly. Medications should also be brought to all off-campus school events.
The AAAAI offers food allergy fact sheets, educational brochures and other resources for patients and school staff online at
www.aaaai.org. The Web site also features a physician referral directory to help patients locate an allergist/immunologist in their area.
Cascya Charlot, MD, is an allergist/immunologist based in Brooklyn, New York.
The American Academy of Allergy, Asthma & Immunology is the largest professional medical association devoted to the research and treatment of allergic disease. The AAAAI offers educational materials for patients online at www.aaaai.org.
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