What is Peanut Allergy?

Your primary doctor will likely come across patients with food allergies. Foods that cause 90% of allergy reactions include cow’s milk, eggs, soy, wheat, peanuts, tree nuts, fish, and shellfish. Peanuts are one of the most common food allergens and can cause deadly reactions when eaten. An allergic reaction to peanuts usually happens in the first few years of life. Most of the time, a peanut allergy lasts for a person’s entire life and could potentially be fatal.

While staying away from peanuts can be a solution, it can be challenging because peanuts are often found in trace amounts in many foods, making it almost impossible to avoid them completely, particularly for children. This passage provides information about vaccinations and immune-enhancing treatments which could help in preventing peanut allergies.

What Causes Peanut Allergy?

Several studies have focused on how exposure to peanuts at different ages can affect the chances of developing a peanut allergy. In one study, the rate of peanut allergies in Israeli Jewish children was compared to that of Jewish children living in the United Kingdom (UK). The amount of peanuts included in the diet of these two groups varies. In Israel, foods containing peanuts are commonly eaten, while in the UK, children usually don’t start eating such foods until they’re two years old. The results showed that the children in Israel developed peanut allergies less frequently compared with those from the UK. This implies that eating peanuts at an early age might help prevent peanut allergies in the future.

Another key study, called the Learning Early About Peanut Allergy (LEAP) study, looked at two groups of children from 4 to 6 months old until they were 5 years old. In one group, the children avoided peanuts altogether, while in the other group, they were frequently exposed to peanuts. This study aimed to see whether there was a difference in the rate of peanut allergies between the two groups five years later. The children in this study had a high risk of developing a peanut allergy because they either had severe eczema or an allergy to eggs. The results showed that early peanut consumption among these high-risk kids could keep a peanut allergy from developing.

Current guidelines suggest introducing peanuts into the diets of infants who have a high risk of developing a peanut allergy as early as 4 to 6 months old.

There are several factors that can increase the risk of developing a peanut allergy, including:

* A personal history of allergies (atopy)
* The child’s family having a history of peanut allergies
* The child’s mother eating a lot of peanuts while pregnant
* Using certain types of oil to cook peanuts.

Risk Factors and Frequency for Peanut Allergy

Food allergies are quite common, affecting between 4% to 8% of children, and 1% to 2% of adults. A common food allergy is an allergy to peanuts, which tends to show up early in one’s life, sometimes even as early as 4 months old and usually within the first two years. Interestingly, about 20% of kids outgrow this allergy and can eat peanuts without any problem when they get older.

In recent years, it seems like peanut allergies have become more common. Usually, signs of this allergy appear when the child is between 12 to 24 months old. Unlike some other allergies, like those to eggs or milk, a peanut allergy often persists as the child grows older. Some research also suggests that the reactions to peanuts can become more severe as a person ages.

Food allergies are common, affecting 4% to 8% of children and 1% to 2% of adults.
A common type of food allergy is the peanut allergy, which typically starts showing symptoms as early as 4 months of age, usually within the first two years of life.
About 20% of children that have a peanut allergy outgrow it and can then tolerate peanuts later in life.
Peanut allergies have become more frequent over the past two decades.
The first signs of a peanut allergy often show up when a child is 12 to 24 months old.
Unlike some other allergies, such as those to milk or eggs, a peanut allergy usually does not decrease as a person ages.
According to some studies, the severity of reactions to peanuts can intensify as a person ages.

Signs and Symptoms of Peanut Allergy

Diagnosing a peanut allergy involves understanding the patient’s history and conducting a physical examination. Key factors to consider include the type and quantity of food eaten, when symptoms started and how long they lasted, and what helped to alleviate these symptoms. It’s also significant to note if the patient has a history of eczema, as this can increase the risk of developing a peanut allergy. Typical symptoms of a peanut allergy can involve skin reactions such as hives, redness, or swelling. More severe symptoms could include a tingling sensation in the mouth and throat, swelling of the lips, and difficulty breathing. In some cases, these symptoms could worsen and lead to a severe allergic reaction known as anaphylaxis.

Type and quantity of food eaten
When symptoms started and how long they lasted
What helped to alleviate these symptoms
History of eczema
Typical skin reactions: hives, redness or swelling
Severe symptoms: tingling sensation in the mouth and throat, swelling of the lips, difficulty breathing
Possibility of symptoms progressing to anaphylaxis

Testing for Peanut Allergy

If your doctor suspects that you might be allergic to peanuts based on your symptoms, they will likely use skin testing. This is the most preferred way to test for food allergies. During this test, a drop of peanut extract is put on your skin, usually on your arm or back. Then, your skin is gently pricked where the extract lies. After around 20 minutes, your doctor will observe your skin for any reactions, like redness or swelling, which is also known as a wheal/flare response. This test can show if you are sensitive to peanuts and can indicate how likely it is that you may experience a reaction if you eat peanuts.

Another way to evaluate if you might have a peanut allergy is by measuring specific peanut antibodies in a blood sample. These antibodies, known as peanut-specific IgE antibodies, can also help predict the chance of you experiencing an allergic reaction in the future.

However, it’s important to note that neither skin tests nor blood tests can predict how severe your reaction to peanuts might be. Also, these tests aren’t always perfectly accurate; they might not always pick up on an allergy, despite its presence. So, if these tests come back negative, it means there’s a good chance you don’t have a peanut allergy, which is definitely comforting.

The most reliable method to diagnose a peanut allergy is through something called an “oral food challenge.” This test is carried out under medical supervision, where you’re given small amounts of peanut to eat and observed for any reactions. The results of the skin and blood tests can help your doctor decide if this challenge should be done. An oral food challenge can also confirm if you’re actually allergic to peanuts, especially if your history of reactions to peanuts is unclear, or you’ve never actually eaten peanuts despite showing a sensitivity toward it.

Treatment Options for Peanut Allergy

Currently, the best way to manage a peanut allergy is to completely avoid eating peanuts. However, severe allergic reactions known as anaphylaxis might still occur despite doing your best to avoid peanuts. The first medication to be used in such situations is epinephrine, which can be given by injecting it into a muscle or through a vein. This injection is usually given in the thigh, and although it can be done via a vein, this is usually reserved for when a patient is in the hospital and can be monitored. Other medications like antihistamines, corticosteroids, and bronchodilators can be used to help manage anaphylaxis but they don’t actually treat the condition. To prevent tissue damage due to poor blood circulation, fluids may be given through a vein. In rare cases, a tube might have to be inserted into a patient’s airway for protection. If anaphylaxis is severe, the patient may need to be observed in the hospital overnight because sometimes, symptoms can return up to 8 hours after the initial reaction. For milder cases, the patient can be monitored in the emergency department and then sent home once they’ve improved.

While avoidance is the primary method of managing a peanut allergy, there are promising new strategies on the horizon. One of these is peanut immunotherapy, which involves gradually eating small amounts of peanuts over a period of time to make the body tolerant of peanuts. This could either help a person avoid a reaction if they accidentally eat peanuts or it could allow them to safely eat peanuts on a regular basis.

An alternative to eating peanuts is a method called epicutaneous immunotherapy, where a patch containing peanuts is applied to the skin to help build tolerance. Other experimental treatments include immunization with genes from peanut allergens, using altered peanut proteins, or a technique called sublingual immunotherapy. Sublingual immunotherapy involves holding a purified peanut protein under the tongue for a couple of minutes and then swallowing it. Research shows that this could also help prevent peanut-related allergic reactions with time.

When you experience symptoms like hives and itching, it might not be a simple allergy. There could be other possibilities causing these symptoms. Here are few possibilities:

Acute urticaria (sudden hives)
Food intolerance (like lactose intolerance)
Toxic reaction (such as scombroid poisoning)
Oral allergy syndrome
Eosinophilic esophagitis (inflammation in the esophagus)

These are just a few possibilities to consider. It’s important to consult with a physician if you’re experiencing symptoms, for an accurate diagnosis.

What to expect with Peanut Allergy

About 1 in 5 people with a peanut allergy may naturally become tolerant to peanuts as time passes. Sadly, a peanut allergy tends to be lifelong and can potentially be life-threatening.

Possible Complications When Diagnosed with Peanut Allergy

After consuming something that triggers an allergic reaction, symptoms can appear within seconds and reach a peak within 30 minutes. However, in some cases, these signs can take up to two hours to show. The most affected areas of the body include the skin, stomach and guts (gastrointestinal), and the lungs (respiratory tracts).

The reaction could manifest on the skin as hives, swelling, or a worsening of already existing eczema. Symptoms affecting the gastrointestinal system include stomach pain, vomiting, and diarrhea. Respiratory symptoms may involve persistent coughing, noisy breathing, and wheezing. In severe cases, the reaction might lead to a life-threatening allergic reaction called anaphylaxis, which can cause low blood flow to organs (diminished tissue perfusion), heart failure (cardiac arrest), and fainting (syncope).

However, it’s important to note that these symptoms can only be linked to a food allergy when they occur within the time frame usually expected for food-induced allergic reactions. Here are some common symptoms:

Hives
Swelling
Worsening of eczema
Stomach pain
Vomiting
Diarrhea
Persistent coughing
Noisy breathing
Wheezing
Anaphylaxis (severe allergic reaction) that can lead to low blood flow to organs, heart failure, and fainting.

Preventing Peanut Allergy

It’s important for both patients and their parents to understand that they need to avoid peanuts and any food or product containing peanuts. Everyone who takes care of the patient, including teachers, should also be aware of this allergy. For safety, patients should always have a special medicine called injectable epinephrine with them. This can be used for immediate treatment if they accidentally consume or come into contact with peanuts.