Nut and Peanut Allergy in Children

Nut and peanut allergy are common causes of food allergy.

Peanuts are actually a legume, so from the same family as peas and lentils, rather than true nuts (such as cashew, walnut, almond, pecan) also known as tree nuts. So your child may be allergic to peanuts but not cashew and vice versa.

This page answers these questions:

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What symptoms do peanut and nut allergy cause?

They cause similar allergy symptoms to other food allergies, so:

  • skin reactions with urticaria (an itchy skin rash) - this is the most common reaction. Read more
  • tummy upset and vomiting
  • anaphylaxis - this is the most severe type of allergic reaction and nuts and peanuts are a common cause. Read more

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How do you test for nut and peanut allergy?

First of all, there would be a history of problems after eating nuts or peanuts. Then, allergy could be confirmed with:

  • skin prick tests- if these show very strong reactions, it is likely your child is allergic
  • RAST, EAST blood tests - if these show very high levels, it is likely your child is allergic

The gold standard test is a food challenge - read more. The symptoms appear with the food every time.

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What is the treatment for peanut and nut allergy?

1. Exclusion of peanuts and/or nuts from the diet.

Children with peanut allergy are usually advised to exclude all peanuts and nuts from the diet.

If your child tolerates peanuts but has a tree nut allergy (eg. cashew nuts, walnut etc) or allergy to sesame or poppy seeds then you only need to exclude nuts (and seeds if they are responsible) not peanuts.

You will need to read the labels on food, but the following foods should be avoided in children with peanut allergy:

  • artificial nuts, ground nuts, monkey nuts
  • cold pressed peanut oil or arachis oil
  • peanuts, peanut butter, peanut flour

It is very important whatever reaction your child has had to peanuts or tree nuts, that they avoid eating peanuts or tree nuts completely. There is always the chance of having a severe reaction even though the first reaction may have been mild. Most children will not have an anaphylactic reaction but we can't predict what few children will, so extreme caution and vigilance is required for all children with nut and peanut allergy.

2. If your child has had an anaphylactic reaction in the past or has asthma that requires preventative treatment and has allergy, then your child will need Epinephrine (Adrenaline) that can be injected. There are auto-injector devices, such as EpiPen and AnaPen, that are easy to use in an emergency.

You will also need to have a written action plan, developed with your doctor.

Click here for an example of an anaphylaxis emergency plan

3. For children who do not have anaphylactic reactions but have an itchy skin rash, the treatment will depend on the symptoms but if your child gets an skin rash, an anti-histamine, like Cetirizine, will be useful - read more.

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Will my child grow out of his peanut (or nut) allergy?

Unlike other food allergies in children, most children with nut or peanut allergy will not grow out of the tendency and will have to avoid nuts and or peanuts for life.

I often repeat the skin prick tests at about 4 years of age and if there is not a strong reaction, I would try a peanut (or tree nut) challenge in a hospital setting to check if the allergy persists.

If there is a previous history of peanut (or nut) allergy and there remains a strong skin test, I would just advise continuing avoidance of peanuts (or nuts).

If you have a child who has previously been peanut allergic and he now can tolerate peanuts, it is best to make sure he has a regular "dose" of peanuts as if there is a long period between eating nuts, an allergic reaction may occur again.

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Is casual exposure to peanut butter dangerous?

No. If your child has a peanut allergy and has casual contact with peanut butter, such as when it touches the skin or is close enough to inhale, there should not be a serious reaction.

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Is there any danger if my peanut allergic child travels on a plane where they serve peanuts?

There has been some work on this problem as on an airplane there are potentially hundreds of people opening packets of nuts (or peanuts) at the same time, and the air is recirculated. The consensus is that the chance of an allergic reaction is low, and is more likely to occur because the child has ingested (eaten) a nut, rather than any casual contact, such as being touched by nuts or inhaling any nut (or peanut) protein.

So, as long as you are careful to ensure your child doesn't eat any nuts (or peanuts) or any food containing them, then travel on commercial airlines should be safe.

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I have heard of new research where children are given a peanut mixture to reduce allergy -is this something I can do?

There are some very exciting research studies underway looking at desensitization where children are given peanuts by mouth in increasing doses over time with a view to reducing their peanut allergy. The initial results are very promising but this technique is not widely available yet. However, this is not something that can be undertaken without medical supervision, so you should not try this at home.

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When is the best time to introduce peanuts if my child has not had a reaction but there is allergy in the family?

The most recent advice is that peanut should be introduced relatively early even if your child has eczema and egg allergy.

  • For severe eczema and egg allergy, introduce peanut-containing foods in the first 4 to 11 months of life
  • For mild to moderate eczema, introduce peanut-containing foods in the first 4 to 6 months of life when you wean your baby
  • For those babies who have no eczema or risk of allergy, introduce peanut-containing foods in the first year

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References

  • Australasian Society of Clinical Immunology and Allergy
  • NIAID. Guidelines for the Diagnosis and Management of Food Allergy in the United States. 2016 addendum
  • Sicherer S et al. Self-reported allergic reactions to peanut on commercial airlines. J Allerg Clin Immunol 1999; 103:186-9
  • Simonte S et al. Relevance of casual contact with peanut butter in children with peanut allergy. J Allerg Clin Immunol 2003; 112:180-2

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Last reviewed 18 March 2016

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Dr Maud MD

Dr Maud MD (MBChB, FRACP, FRCPCH), a specialist pediatrician, provides health information and medical advice for parents of babies and toddlers. Read more about Dr Maud.



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