Peanut Allergy: Symptoms, Testing, and Treatment

Peanut allergy is incredibly common among children and adults. According to recent estimates, nearly 1.6 million children and teens in the U.S. have a peanut allergy. Approximately 20 percent will outgrow a peanut allergy over time, but the vast majority will have a persistent peanut allergy throughout their lives.

Cases of peanut allergy have been steadily increasing in recent history. This may be a result of many variables in our society from environmental changes to shifts in our diets over the generations, and even decades of recommendations to avoid peanut-based foods altogether. 

Regardless of the cause, since reactions to peanut allergies can be severe, it is essential to diagnose and treat peanut allergy as early as possible. A peanut allergy develops when the immune system reacts to major proteins found in peanuts as harmful invaders. The immune system fights off the proteins, resulting in a wide range of symptoms. See the sections below for an overview of common peanut allergy reactions and how to properly diagnose and treatment options for a peanut allergy.

Symptoms of a Peanut Allergy Reaction

Peanut allergy reactions are most often the result of accidental ingestion. Some patients may react from skin contact or, rarely, by inhaling dust or aerosols that contain peanuts. Even if a certain food or dish does not contain peanuts, cross-contamination (i.e., accidental contact with peanuts or related ingredients) can still result in an allergic reaction. 

An allergic reaction to peanuts can manifest in a wide range of skin, respiratory, gastrointestinal, and cardiovascular symptoms. These include:

    • Hives
    • Skin redness or swelling 
    • Itching or tingling in the throat or mouth
    • Runny nose
    • Red, watery eyes
    • Swelling of the tongue and/or the lips or around the eyes
    • Nasal congestion
    • Stomach cramps (and/or abdominal pain)
    • Diarrhea
    • Nausea or vomiting
    • Difficulty breathing and/or wheezing
    • A sense of impending doom

Peanut allergy is the most common allergy associated with anaphylaxis, a life-threatening allergic reaction that causes the body to go into shock. Children and adults who have a severe peanut allergy are at the highest risk of experiencing anaphylaxis. Signs of anaphylaxis can include:

    • Pale or bluish tint on the skin 
    • Throat constriction
    • Shortness of breath (and/or wheezing)
    • Difficulty breathing
    • Confusion and/or dizziness
    • Weak, rapid pulse

Fatalities are rare, however, allergy-related anaphylaxis cases do represent 63 to 99 deaths per year in the U.S. Should anaphylaxis occur, medical treatment must be sought immediately. Those with a peanut allergy should create an emergency anaphylaxis plan to minimize response time, including keeping two epinephrine auto-injectors accessible at all times.

Peanut Allergy Testing and Diagnosis

Peanut allergy testing in infants and young children can often bring false positives. Thorough testing can ensure that diagnoses are as accurate as possible, tracking progression over time to verify whether an allergy has been outgrown. And because peanut allergies can have severe or life-threatening reactions, failing to obtain a clinical diagnosis can present significant health and safety risks. 

The gold standard of testing encompasses four ways to clinically determine whether someone has a true peanut allergy.

Skin Prick Test

A safe and low-risk test in which the skin is lightly pricked with a suspected allergen. This often results in hives or rashes, with more significant reactions pointing to a greater likelihood of an allergy.

Blood Test

Measures the amounts of IgE antibodies that the immune system has deployed as an allergic response to peanuts. 

Component Test

A blood test that assesses whether a patient can tolerate certain components of an allergen. For peanut allergy, component testing is crucial to distinguish between a cross-reaction to a pollen or a potential life-threatening allergy. 

Oral Food Challenge

This is a gradual, step-by-step process in which the patient consumes small amounts of a suspected allergen over 3 to 4 hours. Because severe allergic reactions can become life-threatening, this should only be performed under the supervision of a trained clinician.  Moreover, the clinician must have determined that the patient is likely to successfully and safely pass the food challenge.

A peanut allergy diagnosis does not mean that all nuts must be avoided. Because peanuts are legumes, other types of nuts are often safe to eat, such as walnuts, almonds, hazelnuts, and cashews. However, since it is possible to be both allergic to peanuts and to tree nuts and seeds, a clinical evaluation and diagnosis is crucial. Once a diagnosis is given, patients should freely eat the foods that they are not allergic to.

Ingredients to Avoid for Peanut Allergy

Allergic reactions from accidental ingestion of peanuts are often the most severe. In addition to peanuts, peanut oil, peanut butter and peanut flour, peanut protein may be listed as an ingredient on a food label in several different ways:

    • Arachic oil 
    • Arachis 
    • Arachis hypogaea 
    • Artificial nuts 
    • Beer nuts 
    • Crushed nuts
    • Earth nuts 
    • Goober peas 
    • Goobers 
    • Ground nuts 
    • Hydrolyzed peanut protein
    • Hypogaeic acid 
    • Mandelonas 
    • Mixed nuts 
    • Monkey nuts 
    • Nu nuts flavored nuts 
    • Nut pieces 
    • Nutmeat

Foods That Commonly Contain Peanut

Peanuts can be present within numerous types of foods. It is important to always check the ingredients for these common foods:

    • Cakes
    • Cookies
    • Pastries
    • Doughnuts
    • Cereals
    • Frozen yogurt
    • Ice cream
    • Sundae toppings
    • Soup mix
    • Chili
    • Gravy
    • Candy
    • Chocolate
    • Dried fruits
    • Granola bars
    • Marzipan
    • Nougat
    • Dried salad dressing
    • Fried foods (i.e., foods fried in peanut oil)

Those with a peanut allergy must carefully read all ingredient labels, as even a non-threatening vegetarian meat substitute or a bowl of chili may include peanuts. Additionally, foods that have been fried in peanut oil encompass a wide range of household staples, such as potato chips, popcorn, or foods that contain hydrolyzed plant/vegetable protein.

An allergic reaction may even be triggered by non-food items. Peanut proteins can be present in vitamins, skin creams, cosmetics, sunscreen, craft materials, toy stuffing, pet food, bird feed, and even ant baits or mouse traps.

Peanut Allergy Treatment Options

At Latitude Food Allergy Care, we provide oral immunotherapy (OIT) to help patients improve their quality of life. OIT is approximately 85 percent effective for single or multiple food allergies and is safe for all ages. 

The goal of oral immunotherapy is to continually expose the patient to increasing amounts of an allergen. As OIT progresses, the body is gradually desensitized and learns to adapt to the allergen. This allows for fewer dietary restrictions, and protects against severe or life-threatening reactions due to accidental exposure. 

To determine whether a patient may be a candidate for OIT, our expert clinical team will evaluate existing conditions, collect full medical history, and discuss lifestyle. Latitude Food Allergy Care patients may also choose to include Palforzia in their treatment plan, an FDA-approved drug for peanut allergy treatment. 

Recent research into peanut allergy treatment shows promising advancements for future therapies. New treatments may include sublingual immunotherapy (SLIT), where small amounts of an allergen is held under the tongue for small periods of time, and epicutaneous immunotherapy (EPIT), where an adhesive patch allows for minute amounts of an allergen to penetrate the skin.

In 2017, the National Institute of Allergy and Infectious Diseases (NIAID) published updated guidelines for early introduction of peanuts to infants for prevention of food allergies. Early introduction of peanut is especially recommended for infants with eczema who have a higher risk of developing a food allergy and families that have a history of food allergies. Assessment of risk for an infant should be done by a skilled clinician. 

Do you or a loved one have a suspected peanut allergy? Take the next step toward better health, safety, and quality of life with Latitude Food Allergy Care. Our expert clinicians are happy to discuss your testing, prevention, and treatment options. Contact us today to schedule a no-obligation conversation with one of our Patient Care Coordinators.

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