Allergy to Peanuts

Peanuts are one of the most allergenic foods, and peanut allergy is one of the most common food allergies. Peanuts are probably the most common cause of death by food anaphylaxis in the United States, and about one third of peanut-sensitive patients have severe reactions to peanuts.

What Is Allergy to Peanuts

Peanut allergy is an immune-mediated hypersensitivity reaction to proteins found in peanuts, which are legumes belonging to the Arachis genus. This allergic response involves the immune system perceiving peanut proteins as harmful and subsequently mounting an exaggerated immune reaction. Immunoglobulin E (IgE) antibodies play a crucial role in this process, triggering the release of histamines and other chemicals that cause the symptoms associated with peanut allergy.

Causes of Peanut Allergy

The precise etiology of peanut allergy remains intricate and involves a combination of genetic and environmental factors. Genetic predisposition is evident in individuals with a family history of allergies, particularly peanut allergies. Additionally, exposure to peanuts early in life, during a critical period of immune system development, may influence the development of peanut allergy. It is postulated that a disrupted immune tolerance to peanut proteins may contribute to the development of hypersensitivity.

Signs and Symptoms of Peanut Allergy

Peanut allergy symptoms can manifest across multiple organ systems and range from mild to severe. Cutaneous symptoms include pruritus, urticaria (hives), and angioedema. Respiratory symptoms may involve rhinorrhea, sneezing, coughing, wheezing, and dyspnea. Gastrointestinal symptoms such as abdominal pain, nausea, vomiting, and diarrhea can occur. Severe reactions may progress to anaphylaxis, characterized by a rapid onset of symptoms affecting multiple systems, including cardiovascular collapse and respiratory distress.

Risk Factors of Allergy to Peanuts

Several factors increase the risk of developing peanut allergy:

  • Genetic Predisposition: Family history of allergies, especially peanut allergies, increases the likelihood of developing a peanut allergy.

  • Other Allergic Conditions: Individuals with existing allergic conditions, such as atopic dermatitis, allergic rhinitis, or asthma, may be more susceptible to peanut allergy.

  • Early Exposure: Contrary to previous beliefs, delayed introduction of peanuts into an infant's diet may contribute to an increased risk of peanut allergy. However, recommendations now include careful, controlled early introduction in certain high-risk infants.

Foods that May Contain Peanuts

Peanuts and peanut-derived products can be found in various foods, making it imperative for individuals with peanut allergies to be vigilant. Common sources include:

  • Peanut Butter: A staple in many households, peanut butter is a concentrated source of peanut proteins.

  • Processed Foods: Snack bars, baked goods, and cereals may contain peanuts or peanut flour.

  • Asian Cuisine: Some Asian dishes, sauces, and curries may contain peanuts or peanut oils.

  • Chocolates and Confections: Certain chocolates and candies may use peanuts or peanut butter as ingredients.

  • Ice Cream: Some ice cream flavors, especially those with mix-ins, may contain peanuts.

List of Foods That May Contain Peanut or Peanut Oil

  • Baked goods

  • Baking mixes

  • Battered foods

  • Biscuits

  • Breakfast cereals

  • Candy

  • Cereal-based products

  • Chili

  • Chinese dishes

  • Cookies

  • Egg rolls

  • Ice cream

  • Margarine

  • Marzipan

  • Milk formula

  • Pastry

  • Peanut butter

  • Satay sauce and dishes

  • Soups

  • Sweets

  • Thai dishes

  • Vegetable fat

  • Vegetable oil

How is Allergy to Peanuts Diagnosed?

Accurate diagnosis is crucial for effective management of peanut allergy. Diagnostic approaches include:

  • Medical History: A detailed history, including the timing and nature of allergic reactions, family history, and presence of other allergic conditions, is obtained.

  • Skin Prick Tests: This involves applying a small amount of peanut extract to the skin and pricking the skin underneath. A positive reaction, indicated by a wheal and flare, suggests sensitization.

  • Serum IgE Testing: Measurement of peanut-specific IgE antibodies in the blood can indicate sensitization but is not conclusive evidence of clinical allergy.

  • Oral Food Challenge: Considered the gold standard, an oral food challenge involves gradually introducing peanuts in a controlled environment to assess the patient's reaction. This is performed under strict medical supervision due to the risk of severe reactions.

Treatments for Allergy to Peanuts

While there is currently no cure for peanut allergy, management strategies aim to mitigate the risk of reactions and provide prompt intervention when needed:

  • Avoidance: Strict avoidance of peanuts and peanut-containing products is the primary strategy. This involves meticulous label reading and communication with food service providers.

  • Epinephrine: An epinephrine auto-injector is prescribed to individuals with peanut allergy for emergency use in case of anaphylaxis. Proper training on its use is essential.

  • Allergen Immunotherapy: This experimental treatment involves exposing individuals to increasing amounts of peanut allergens under controlled conditions to induce tolerance. It is still in the research phase and not widely available.

Preventive Measures to Avoid Peanut Allergy

Prevention and ongoing management of peanut allergy involve a comprehensive approach:

  • Early Introduction: Recent guidelines recommend controlled introduction of peanuts in the diet of high-risk infants, particularly those with severe eczema or egg allergy.

  • Education: Patients and caregivers must receive education on recognizing symptoms, proper use of epinephrine, and the importance of strict peanut avoidance.

  • Regular Monitoring: Periodic follow-ups with an allergist are crucial for assessing the patient's allergy status, making adjustments to management plans, and providing ongoing education.

  • Allergen-Free Environments: Creating allergen-free zones in educational and public settings can enhance the safety of individuals with peanut allergies.

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