What Else Should I Know
If you find out you have a nut or peanut allergy, don’t be shy about it. It’s important to tell your friends, family, coaches, and teachers at school. The more people who know, the better off you are because they can help you stay away from the nut that causes you problems.
Telling the server in a restaurant is also really important because he or she can steer you away from dishes that contain nuts. Likewise, a coach or teacher would be able to choose snacks for the group that don’t contain nuts.
It’s great to have people like your parents, who can help you avoid nuts, but you’ll also want to start learning how to avoid them on your own.
Who Gets A Peanut Allergy
In the United Kingdom, the prevalence of peanut allergy is reported to be in 0.22.5% in children and in 0.30.5% in adults . A rise in the prevalence was reported in the United States, with 1.4% of children having a peanut allergy in 2008 compared to 0.4% in 1997 .
There is a greater risk of peanut allergy in children who have:
- Egg allergy
- Severe atopicdermatitis
- Used topical preparations containing peanut oil.
Having a peanut allergy results in a low risk of allergy to another legume with the exception of lupin. However, one-third of those with a peanut allergy will have a concurrent reaction to a tree nut .
Peanut allergy is more prevalent in the Western world than in China, possibly due to the greater consumption of roasted peanuts rather than raw peanuts .
The Learning Early About Peanut Allergy study found that infants at risk of a peanut allergy who have eczema or an egg allergy were less likely to develop a peanut allergy if they had early and sustained consumption of peanuts .
Non-allergic mothers are now encouraged to eat potentially allergenic foods such as peanuts regularly during pregnancy and not to delay introducing their babies to them .
Oral Immunotherapy For Peanut Allergy
If your 4-17-year-old has a peanut allergy, a new treatment using peanut protein powder may offer additional protection. Palforzia is the only oral immunotherapy product currently approved by the FDA for treatment of peanut allergy. This type of treatment is called oral peanut immunotherapy. It slowly exposes an allergic child to peanuts so their immune system is less likely to react after an accidental ingestion of peanut product. That means if your child accidentally eats something containing peanuts, the treatment may protect them from a severe reaction. Even with this treatment, your child must continue to avoid peanuts and carry two epinephrine auto-injectors.
Its important to understand:
- The treatment is not a cure your child will still be allergic to peanuts and must avoid them.
- It will not enable your child to eat peanuts or peanut products anytime they wish.
- It works only while your child is taking it on a daily basis.
- Your child will need to continue to carry two epinephrine auto-injectors and you and your child will still need to read food labels.
- Reactions can occur due to the treatment itself.
For children with peanut allergy and their parents, the benefits may be worth the drawbacks. Discuss peanut oral immunotherapy with your allergist if your child is interested.
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How Can I Take Care Of Myself If I Have A Peanut Allergy
If you have a peanut allergy, you need to pay close attention to what you eat. Food manufacturers must clearly state on their ingredient label whether a food contains peanuts.
Prepackaged foods that dont contain peanuts can be contaminated during the manufacturing process. Watch for phrases like may contain peanuts and made in a factory on machinery that also may have been used to process peanut products.
When you go out to eat, ask questions about ingredients. For example, peanut butter may be in certain marinades or sauces. Ice cream or yogurt shops could be places of accidental exposure because peanuts are common ice cream toppings.
Eating Out With Peanut Or Tree Nut Allergy
The risk of accidental exposure to food allergic trigger/s can never totally be removed, but some simple precautions will reduce or minimise the risk:
- Contact the restaurant, cafe or home cook that you plan to visit in advance, and let them know of the food allergy.
- On arrival at arestaurant or cafe, ask to talk to the manager about any dishes that should be avoided,. Also ask them to let the chef know so they can take extra care in preparing your meal, to reduce the risk of cross contamination.
- Don’t rely on the menu descriptions of what is in the food. For example, pesto and dips may have nuts in them, and many salads have nuts or seeds added for texture. Sometimes nuts can be added to gravies and sauces too.
- Think about the cooking methods, possible cross contamination and the likelihood of shared utensils and cookware.
- Teenagers or adults who are eating out can cautiously touch test a small amount of the food on their outer lip before putting it in their mouth. Tell-tale warnings such as a burning, chilli-like reaction, and tingling or swelling, should alert you to the possibility that food allergen is present.
- If an adrenaline autoinjector has been prescribed, always have it and your ASCIA Action Plan for Anaphylaxis with you. For people who are not thought to be at risk of anaphylaxis and therefore have not been prescribed an adrenaline autoinjector, an ASCIA Action Plan for Allergic Reactions should be provided by a medical doctor.
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Avoidance Is The Only Proven Treatment For Peanut Tree Nut Or Seed Allergy
The only proven treatment for peanut, tree nut or seed allergy is avoidance of the allergen. Omitting peanuts, tree nuts or seeds from the diet has no adverse nutritional consequences for most people. Children with food allergy should take their own food with them to school and be taught not to swap or share food. In common eating and food preparation areas, where there are children with severe peanut or tree nut allergy, nut-containing foods are best avoided.
In early childhood education/care, with very young children where the risk of food contamination of common eating areas or toys is higher, it may be requested that parents do not send nut containing foods in lunch boxes to reduce the risk. This is not a policy that is considered necessary when caring for older children, although the use of nut or seed containing foods in cooking classes and science experiments is discouraged if there are students with peanut or tree nut allergy in that class.
Research into food allergy is ongoing
The increased frequency of peanut and tree nut allergy is driving research into areas trying to find out why it has become more common, and how to treat and prevent it. Research has shown that early exposure to peanut reduces the risk of allergy developing in high risk infants. Allergen immunotheprapy studies are trying to see if peanut allergy can be switched off once the allergy has developed.
Pressure Or Delayed Pressure
This type of hives can occur right away, precisely after a pressure stimulus or as a deferred response to sustained pressure being enforced to the skin. In the deferred form, the hives only appear after about six hours from the initial application of pressure to the skin. Under normal circumstances, these hives are not the same as those witnessed with most urticariae. Instead, the protrusion in the affected areas is typically more spread out. The hives may last from eight hours to three days. The source of the pressure on the skin can happen from tight fitted clothing, belts, clothing with tough straps, walking, leaning against an object, standing, sitting on a hard surface, etc. The areas of the body most commonly affected are the hands, feet, trunk, abdomen, buttocks, legs and face. Although this appears to be very similar to dermatographism, the cardinal difference is that the swelled skin areas do not become visible quickly and tend to last much longer. This form of the skin disease is, however, rare.
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Risk Factors For Peanut Allergy
It is always advisable to understand yourself or rather your body in relation to the type of food you ingest or prepare for your family. Some foods produce orders that might react with your external skin, your respiratory track or even eyes. In such cases, one should take precaution to avoid such kind of foods in order to prevent the disaster.
This in most cases have to start with a medical examination to identify such kind of foods or ingredients. The national institute of allergy and infections has established guide lines that can comfortably guide the masses on ways of determining safe foods from dangerous ones basing on the reaction of individual body to this foods.
Skin prick testing in such scenarios can be used to determine the risky factors that should be put into consideration when planning for a meal.
Another methods that can be applied is the oral challenge although it has been proved to pose grave risk but still can be used in desperate situation.
First How Do Peanut Allergies Work In General
The molecular basis of peanuts allergenicity is a relevant topic, personally and societally. Peanuts contain various proteins, but the ones shown to be relevant to allergic reactions are Ara h 1, Ara h 2, and Ara h 34. Research into the immunological activity of these proteins shows that Ara h 2 is one of the more harmful proteins and is relatively resilient in the face of gastrointestinal digestion thus weve chosen Ara h 2 as our protein to explore.
Figure 2 selection of peanut protein for study
Allergic reactions in general are considered a type of hypersensitivity reaction, specifically a Type I response. In these responses, the body acts as if the allergen is a harmful pathogen5. This is due to the production of IgE antibodies that respond to peanuts, an otherwise innocuous antigen.
Figure 3 summary of immune response generation
Various therapies are currently being used or developed to mitigate food-related Type I hypersensitivity. Those that apply specifically to the bodys response to peanuts and Ara h 2 protein include those that inhibit IgE production or the effector pathways initiated when Ara h 2 protein and IgE interact, those that desensitize an individual to the allergens effect, and those that compete for IgEs active site5. The most common treatment is peanut oral immunotherapy, which aims to reduce, if not eliminate, the patients adverse reaction to peanuts.
Figure 4 general therapeutic methods for combating allergic responses to peanuts
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A Severe Reaction: Anaphylaxis
This is a life-threatening allergic reaction and needs emergency treatment. Peanuts are one of the most common causes of anaphylaxis, which can affect several parts of the body all at once.
Your risk may be higher if you have allergies or asthma, a family history of anaphylaxis or if its happened to you before. The FDA has recently approved the medication Palforzia for children aged 4 to 17 with peanut allergiies to help minimize any reaction. While they should still avoid contact with peanuts, it helps reduce the risk of them being life threatening.
Certain people with known peanut allergies should carry an injector. You can get one from your doctor. If the symptoms strike, use your epinephrine injector, such as Auvi-Q, EpiPen, Symjepi or a generic version of the auto-injector..
The signs of an attack can include:
- Swelling of the throat that makes it hard to breathe
- Dizziness or fainting
- A big drop in blood pressure
- A rapid pulse
- Blocked airways
Preventing A Nut Allergy Reaction
- Ask your server. Foods that don’t have peanuts or tree nuts in them can still get contaminated if theyâre made in the same place or with the same equipment as food that has the nuts. It can also happen in restaurants that use lots of ingredients, and even in ice cream parlors if equipment, like scoops, are shared.
- Check the label each time you buy a product. Food makers sometimes change the recipe.
- Look outside the kitchen. Nuts can also be in lotions, shampoos, and pet food. Check labels before you buy or use them.
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What Will The Doctor Do
If your doctor thinks you might have a nut or peanut allergy, he or she will probably send you to see a doctor who specializes in allergies. The will ask you about past reactions and how long it takes between eating the nut or peanut and getting the symptoms, such as hives.
The allergist may also ask whether anyone else in your family has allergies or other allergy conditions, such as eczema or asthma. Researchers aren’t sure why some people have food allergies and others don’t, but they sometimes run in families.
The allergist may also want to do a skin test. This is a way of seeing how your body reacts to a very small amount of the nut that is giving you trouble. The allergist will use a liquid extract of the nut that seems to be causing you symptoms.
During skin testing, a little scratch on your skin is made . That’s how just a little of the liquid nut gets into your skin. If you get a reddish, itchy, raised spot, it shows that you may be allergic to that food or substance.
Skin tests are the best test for food allergies, but if more information is needed, the doctor may also order a blood test. At the lab, the blood will be mixed with some of the food or substance you may be allergic to and checked for antibodies.
A Positive Feedback Loop Reinforces The Allergic Immune Response In Human Peanut Allergy
Disclosures: E.D. Mellins reported grants from Glaxo-Smith-Kline and Novartis outside the submitted work. K.C. Nadeau reported grants from the National Institute of Allergy and Infectious Diseases, the National Heart, Lung, and Blood Institute, the National Institute of Environmental Health Sciences, and Food Allergy Research and Education “other” from World Allergy Organization, Cour Pharma, Before Brands, Alladapt, Latitude, IgGenix, Immune Tolerance Network, and the National Institutes of Health clinical research centers outside the submitted work. In addition, K.C. Nadeau had a patent to “inhibition of allergic reaction to peanut allergen using an IL-33 inhibitor” , a patent to “special oral formula for decreasing food allergy risk and treatment for food allergy issued, a patent to “basophil activation-based diagnostic allergy test” , a patent to “granulocyte-based methods for detecting and monitoring immune system disorders” , a patent to “methods and assays for detecting and quantifying pure subpopulations of white blood cells in immune system disorders” , a patent to “mixed allergen compositions and methods for using the same” , and a patent to “microfluidic device and diagnostic methods for allergy testing based on detection of basophil activation” . No other disclosures were reported.
X. Zhou and W. Yu contributed equally to this work as first authors.
E.D. Mellins and K.C. Nadeau contributed equally to this work as senior authors.
J Exp Med
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Test Family Members For Peanut Allergy
Between 5% and 9% of siblings of children with a peanut allergy will also have a peanut allergy. In individuals at high risk of an allergic reaction or in cases of parental anxiety, it is advisable to perform skin prick testing or specific IgE testing before the child introduces peanut into their diet. In individuals at low risk of an allergy, peanuts can be carefully introduced to test for any allergic reaction .
Severe Allergic Reaction Anaphylaxis
Peanuts and tree nuts are among the most common foods to cause severe allergic reaction which is life threatening. Symptoms of a severe allergic reaction include:
- difficult or noisy breathing
- persistent dizziness or collapse
- paleness and floppiness in young children.
If you, or someone in your care, have a severe allergic reaction , call triple zero for an ambulance.
- Do not stand or walk.
- Administer an adrenaline injector , into the outer mid-thigh, if available.
- Further adrenaline may be given if there is no response after 5 minutes.
- Give adrenaline first, then asthma reliever puffer, if required.
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What Tests Help Diagnose A Peanut Allergy
Your healthcare provider may use a blood test to diagnose a peanut allergy. A blood test called an immunocap radioallergosorbent checks the number of antibodies in your blood. A higher number of certain types of antibodies can indicate an allergy.
Your healthcare provider may also use a skin test to identify or rule out multiple types of allergies. During a skin test, your provider:
- Makes a few tiny needle pricks in your back or arm.
- Applies small doses of different types of allergens where you have needle pricks.
- Montiors your skin reaction and interprets them after 15 minutes.
Skin patches that become red and itchy indicate an allergic response. Your provider can use this information to diagnose allergies.
You may also have an oral food challenge. During an oral food challenge, you eat tiny, increasing amounts of a peanut-based product in your healthcare providers office. Your healthcare provider has emergency medication and equipment on hand in case you have an allergic reaction.
Is There A Cure For Peanut Allergies
There is no cure for peanut allergies. But children can outgrow peanut allergies. As children get older, an allergist may perform another blood or skin test to measure a childs sensitivity to peanuts. If a peanut allergy appears to be decreasing, allergists may recommend an oral food test.
There are new treatments available called Oral Immunotherapy and early OIT. This is where carefully selected patients undergo therapy to help develop a tolerance to the food they have an allergy to. Palforzia®, a treatment for peanut allergies, is the first FDA approved treatment for food allergies. Although it doesn’t cure peanut allergies, it can make it possible for people to tolerate accidental peanut exposure without having a reaction.
If your child has a peanut allergy, it’s important to not give your child peanuts unless an allergist has directed you to do so.
As an adult, you can manage a peanut allergy by carefully avoiding peanuts. You may need to carry epinephrine if you have severe allergies that could lead to anaphylaxis.
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