When your child is allergic to nuts or peanuts, any food - even a Valentine's Day chocolate or the hot dog you serve at your Memorial Day picnic - needs to undergo an exhaustive ingredient analysis. And, as any parent who has a child with a nut or peanut allergy knows, Halloween can be an absolute nightmare.
But you don't have to be a chemist to know which foods are OK and which ones could cause a potentially dangerous allergic reaction in your child. Reading labels and just knowing what the hidden ingredients are can go a long way toward keeping your child safe.
What Is a Nut and Peanut Allergy?
About 1.5 million adults and children in the United States have an allergy to peanuts, and 50% of these people also are allergic to nuts or tree nuts. There's no typical age of diagnosis, although research indicates that the median age of first exposure is 14 months. And although many children outgrow allergies to milk, soy, and eggs, those with allergies to peanuts and nuts rarely outgrow their reactions.
Although peanuts aren't true nuts but legumes (in the same family as peas and lentils), the reaction in people allergic to them is similar to the reaction in people who are allergic to tree nuts, such as walnuts, cashews, and pecans.
An allergic reaction is when the immune system mistakenly believes that a harmless substance, in this case a nut or peanut, is harmful. It creates specific antibodies to that food to protect your body. The next time you eat that food, your immune system releases huge amounts of chemicals and histamines to protect your body, triggering an allergic reaction.
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.
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.
Feeding a Child With a Nut or Peanut Allergy
Doctors advise parents to keep their children away from foods linked to severe allergies - such as eggs, fish, shellfish, peanuts, and nuts - until they're 2. The Food Allergy and Anaphylaxis Network (FAAN) recommends that children not eat eggs before age 2 or any sort of nuts or fish until age 3.
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
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:
- Avoid baked goods you didn't make yourself - anything with an unknown list of ingredients. Stay away from baking mixes, chili mixes, etc.
- Be careful when eating at Asian or buffet restaurants - spoons often go in and out of various bowls that may contain nuts or seeds and could easily cross contaminate foods.
- 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. Don't take food from strangers. Make your own snacks and treats to take to parties, play dates, 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 contain peanuts. If your child's school doesn't already have one, talk to the school principal, your child's teacher, or cafeteria personnel about setting up a nut- and peanut-free table in the cafeteria.
- 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 in your child's backpack, depending on your state's laws on carrying medicine in classrooms.
- See a board-certified allergist or your child's doctor regularly.
A little bit of knowledge and an ounce of prevention can go a long way in ensuring that your nut- or peanut-allergic child stays free of allergic reactions.
Reviewed by: William J. Geimeier, MD
Date reviewed: September 2003