h3. www.kidshealth.org/parent/growth/feeding/nut_peanut_allergy.html

h3. Reviewed by: William J. Geimeier, MD
Date reviewed: September 2003

h3. What Are Nut and Peanut Allergies?

The most common allergy-causing foods are peanuts, tree nuts, milk, eggs, fish, shellfish, wheat, and soy. Half of those allergic to peanuts are also allergic to tree nuts, such as almonds, walnuts, pecans, cashews, and often sunflower and sesame seeds. Food allergies occur when a person’s immune system mistakenly believes that something he or she ate is harmful to the body. In an attempt to protect the body, the immune system produces antibodies called immunoglobulin E (IgE). Those antibodies then cause mast cells (which are allergy cells in the body) to release chemicals into the bloodstream, one of which is histamine. The histamine then acts on a person’s eyes, nose, throat, lungs, skin, or gastrointestinal tract and causes the symptoms of the allergic reaction. Future exposure to that same allergen (things like nuts or pollen that you can be allergic to are known as allergens) will trigger this antibody response again. This means that every time that person eats that particular food, he or she will have an allergic reaction.

Unlike allergies to other foods like milk and eggs, children generally don’t outgrow allergies to peanuts or nuts. But over time, they should become experienced at avoiding the foods that make them ill.

h3. Signs and Symptoms

You may not even recognize an allergic reaction, depending on the severity, the age of the child, and previous exposure to the allergen. The first signs of a reaction could be a runny nose, a skin rash all over the body, or a tingly tongue. Symptoms can quickly become more serious – including difficulty breathing, swelling of the throat or other parts of the body, rapid drop in blood pressure, and dizziness or unconsciousness. Other possible symptoms include hives, vomiting, abdominal cramps, and diarrhea. Symptoms usually appear within a few seconds to 2 hours after ingesting or being exposed to the allergen.

A sudden, potentially severe allergic reaction, called anaphylaxis, can involve various systems in the body (such as the skin, respiratory tract, gastrointestinal tract, and cardiovascular system) and can be fatal. Anaphylaxis can cause a person’s blood pressure to drop, airways to narrow, and tongue to swell, resulting in serious breathing difficulty, loss of consciousness and, in some cases, even death.

Obviously, babies can’t tell their parents when their tummies hurt or their throats itch, so diagnosing food allergies early in a child’s life can be difficult. Doctors therefore generally recommend that parents refrain from giving their children peanut butter or other peanut or nut products until after they’re 2 years old. If there’s a family history of food allergies, parents should wait until the child is 3. And many doctors recommend that their pregnant patients – especially those with food allergies – keep the lid on the peanut butter jar until after the baby’s born and they’re done nursing.

h3. Treating a Nut or Peanut Allergy
Unfortunately, there’s no cure for food allergies; the only way to help kids who have them is to stay away from the foods that will cause a reaction.

If your child has been diagnosed with a nut or peanut allergy, learn everything you can about what to watch out for and the type of reaction your child will have if you come into contact with a nut or peanut (or nut and peanut ingredients in other foods).

In case of an emergency, doctors recommend that adults and children 12 years and older who have a nut or peanut allergy keep a shot of epinephrine with them in an easy-to-carry container that looks like a pen. If a nut- or peanut-allergic person accidentally eats nuts or peanuts and has an anaphylactic reaction, a shot of epinephrine can be given to help counteract it. Your child’s doctor can give you instructions on how to use and store the epinephrine injection pen; it’s essential that you familiarize yourself with the procedure.

If your child is 12 years or older, make sure he or she keeps the pen readily available at all times. If the child is younger than 12, talk to the school nurse and your child’s teacher about keeping one on hand in case of an emergency. Also make sure that epinephrine pens are available at your home, as well as at the homes of friends and family members.

Your child’s doctor may also encourage your child to wear a medical alert bracelet. It’s also a good idea to carry an over-the-counter antihistamine, which can help alleviate allergy symptoms in some people. But antihistamines should be used in addition to epinephrine and not as a replacement for the shot.

Kids who have had to take an epinephrine shot should go immediately to a medical facility or hospital emergency department, where additional treatment can be given if needed. Up to one third of anaphylactic reactions can have a second wave of symptoms several hours following the initial attack, so the child might need to be observed in a clinic or hospital for 4 to 8 hours following the reaction.

h3. Feeding a child with a nut or peanut allergy
Parents who suspect or know that their child has a nut or peanut allergy must read every food label on every item and educate their children to do the same. Beginning in 2006, food makers are required to clearly state whether a product contains nuts or peanuts. But that only applies to foods labeled after 2006, so there may be some products still on store shelves, which don’t have the label.

The problem with peanuts, unlike tree nuts, is that they’re used in many, many foods, posing a threat to unwitting consumers. The Food and Drug Administration requires food manufacturers to list every ingredient in a product, with several exceptions – flavors, colors, or spices, and those in insignificant amounts. In addition, ingredient lists still don’t cover possible cross contamination when the same equipment that’s used to process peanuts for another product is also used to make foods that don’t have peanuts as ingredients.

That’s why the responsibility falls on parents to make sure their child doesn’t eat and isn’t exposed to foods with nuts or peanuts.

When reading labels, avoid these ingredients:
* food additive 322 (also often listed as lecithins)
* arachis (an alternative term for peanut)
* hydrolyzed vegetable protein (which may be found in some cereals)
* arachis oil (peanut oil)
* emulsified or satay (which could mean that the food was thickened with peanuts)
* natural and artificial flavoring (which could contain tree nuts and are used in many foods, including barbecue sauce, cereals, crackers, and ice cream)

Foods to avoid include:
* peanut butter
* mixed nuts
* crushed nuts in sauces
* African, Chinese, Indonesian, Japanese, Mexican, and Vietnamese dishes (which often contain peanuts or are contaminated with peanuts during meal preparation)
* pesto (an Italian sauce made with nuts)
* marzipan (a paste made from ground almonds and sugar)
* mandelonas (peanuts soaked in almond flavoring)
* health food bars
* artificial nuts (which could be peanuts that have been deflavored and reflavored with a nut, such as pecan or walnut)
* all cakes and pastries with unknown ingredients, particularly carrot cake, pumpkin cake or pie, and fruit and nut rolls
* bouillon and Worcestershire sauce
* praline and nougat
* muesli and fruited breakfast cereals
* vegetarian dishes
* prepared salads and salad dressings
* gravy

Doctors also advise peanut-allergic patients to avoid chocolate candies, unless they’re absolutely certain there’s no risk of cross contamination during manufacturing. Many candy companies are very aware of nut and peanut allergy issues. Some even make sure they manufacture candies that contain nuts separately from those that don’t, so people with nut allergies can still enjoy their products. To be sure a candy is nut- and peanut-free, log on to the manufacturer’s website or call the toll-free number listed on the package. Most companies have customer-service representatives that can answer nut and peanut allergy questions accurately.

Even nonfood items can contain ingredients that could cause a reaction in a nut- or peanut-allergic child:
* Hackysacks, beanbags, and draft dodgers are sometimes filled with crushed nut shells.
* Bird feed, dog food and treats, hamster food and bedding, livestock feed, some cosmetics (especially moisturizers), secondhand toys and furniture, and ant traps and mousetraps could even contain nuts or peanuts.

It’s important to be vigilant about your child’s food allergies, even during simple, everyday activities. Here are some basic tips allergist Sandra Gawchik, MD, gives her patients:
* Read food labels. Beginning in 2006, food makers are required to clearly state whether a product contains peanuts or tree nuts that could trigger an allergic reaction. The statement should be in or adjacent to the list of ingredients. (Keep in mind though, this rule only applies to foods labeled after the start of 2006. So some of the products that were made before then and are still on the shelves may not say anything about allergens.)
* Avoid cooked foods you didn’t make yourself – anything with an unknown list of ingredients. Stay away from baking mixes, chilis, Asian dishes, and buffet restaurants where spoons go in and out of various bowls that may contain nuts or seeds.
* Avoid fried foods (especially in restaurants and fast-food places) that may be made with peanut oil or may contain hidden peanuts or nuts.
* Don’t be cavalier about food allergies – tell everyone who handles the food your child eats, from waiters and waitresses to chefs and bakers. If the manager or owner of a restaurant is uncomfortable about your request for peanut- or nut-free food preparation, don’t eat there.
* If you’re unsure about whether a food or candy is nut and peanut free, log on to the manufacturer’s website or call the toll-free number listed on the package. Most companies have customer service representatives that can answer nut and peanut allergy questions accurately.
* Encourage people not to feed your child. Make your own school lunches, as well as snacks and treats to take to parties, play dates, sleepovers, school functions, and other outings.
* Talk to the daycare supervisor or school principal before your child attends. Then talk to your child’s classmates or send home a note explaining that your child has a severe allergy to peanuts or nuts. Ask parents to refrain from sending in snacks that have peanuts.
* Keep epinephrine accessible at all times – not in the glove compartment of your car, but with you, because seconds count during an anaphylaxis episode. It’s a good idea to also keep epinephrine in your child’s classroom (not just in the nurse’s office), or with your child, depending on state laws.
* See a board-certified allergist or your child’s doctor regularly.

Here are some other tips that might make life a little easier for you and your nut- or peanut-allergic child:
* Use – and encourage others to use – an antiseptic hand wash after meals.
* Consult with a dietitian to come up with safe but delicious meals and snacks.
* Carry a list of foods to watch out for in your backpack or bag.
* Talk to your child’s teachers, relatives, caregivers, and close friends about the allergy. Teach them to recognize the signs of anaphylaxis and show them how to help your child.

Revised 3.23.09