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).

What symptoms do peanut and nut allergy cause?

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

• skin reactions with urticaria - this is the most common reaction

• tummy upset and vomiting

• anaphylaxis - this is the most severe type of allergic reaction and nuts and peanuts are a common cause

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

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

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, 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.

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 challenge in a hospital setting to check if the allergy persists.

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

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.

Is causal 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.

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 airline 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.

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 and at least one is looking at desensitization where children are given increasing doses of peanuts over time with a view to reducing their peanut allergy. The final results are not out yet, but it is something to keep an eye out for. However, this is not something that can be undertaken without medical supervision, so you shouldn't try this at home.

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