Peanut Allergy

     In previous articles I have discussed food allergy in general, but of all food allergies in children, peanut allergy is one of the potentially most dangerous. Both peanut allergy and bee-sting allergy can be rapidly fatal and any child who is suspected of having either peanut or bee-sting allergy should be seen by an allergist – not just a pediatrician.

     About 1% of children under age 5 have a true peanut allergy. It was once thought that allergy to peanuts was a life-long allergy, but there have now been reports of some children who have “grown out of” peanut allergy. But, because it is so dangerous, only a qualified allergist should decide whether peanut consumption is safe for a child previously diagnosed as having peanut allergy.

    The serious reaction to peanuts involves hives, coughing, vomiting, change in voice, difficulty breathing and, finally, unconsciousness, shock and death. This is called anaphylaxis. It usually occurs immediately after peanut contact but can occur up to 2 hours after contact. In about 20% of cases of anaphylaxis, there is another reaction that occurs from 1 to 4 hours after the first – even if the first was treated. A child could be brought to the emergency room, treated and released only to die later at home. Even if a child had a mild reaction at his first contact with peanuts, later reactions can be more severe. A child with both a history of asthma and peanut allergy is at a greater risk for having a fatal reaction with peanut ingestion. Teenagers also have a greater risk for severe reaction than younger children.

     When a child has peanut allergy, the only way to avoid a reaction is to avoid peanuts. The child needs to be taught to only eat foods from home and never to share foods or eat anything else – especially “treat” foods someone has brought in for a special day. Labels need to be read carefully and the parents and the child need to be extra careful in restaurants where the waitress (even the cook) may not be aware of a peanut-product ingredient or peanut contamination from a work area. Most cases of peanut anaphylaxis come from ingestion of peanuts, but there are cases of reaction from contact with eating surfaces exposed to peanuts and there are also very rare cases of a reaction from inhaling peanut protein.

     Most cases of death from peanut allergy are a result of epinephrine not being given in time. Epinephrine is an injected medication and parents and children need to get over their initial fear of the injection. This takes practice along with a carefully written plan for schools and other caregivers stressing the importance of giving immediate epinephrine at the first sign of a reaction. Your allergist can supply an ”Action Plan” which outlines exactly what to do if an allergic child is exposed to peanut. The dose of epinephrine should be repeated if the child doesn’t rapidly improve after the first shot and 911 should be called immediately when epinephrine is given. There is no danger to giving an epinephrine injection. Waiting to give the injection can be fatal.