The good news is that more than 98 percent of Americans can enjoy peanuts without any issue.* According to the National Institute of Allergy and Infectious Diseases (NIAID) Expert Panel, peanut allergies affect just 0.6 percent of us – and fall behind milk and eggs in children and behind shellfish among adults in prevalence.*
For those with a true food allergy, however, reactions can be unpredictable – from person to person and episode to episode. That’s why they must be taken seriously. If you suspect you or a loved one has a food allergy, it’s important to get a diagnosis from a trained allergist. And if it turns out you have an allergy, work to develop an emergency action plan and be proactive about educating yourself.
Food Allergy 101
- Eight foods are responsible for 90 percent of food allergic reactions in the U.S.: milk, egg, shellfish, fish, peanuts, tree nuts, soy and wheat.*
- According to NIAID, four percent of adults and five percent of children ages 5-17 in the U.S. have food allergies.**
- Anyone can develop a food allergy during their lifetime.
- You should always consult an allergist if you have concern about a food allergy. Working with an allergist who is familiar with your health history would assist in managing a food allergy risk.
What’s with all the peanut allergies?
Though it’s increasingly in the national discourse, the fact is less than 1% of Americans have a peanut allergy,* and food allergies only affect about 5% of children and 4% of teens and adults.** Peanut allergies are not the most common, but they are among the top eight food allergens, and reactions to food allergens can be serious and sometimes life-threatening.
*Prevalence of Peanut and Tree Nut Allergy in the US Determined by a Random Digit Dial Telephone Survey. J Allergy Clin Immunol. 1999 APR;103(4):559-62.
** WAO. White Book on Allergy. Available at http://www.worldallergy.org/UserFiles/file/WhiteBook2-2013-v8.pdf
What causes food allergies?
Researchers believe that food allergies are on the rise, but no one knows what causes food allergies in some people and not in others. While several hypotheses are being investigated, certain conditions in infants, including severe eczema and egg allergy, are known to be risk factors for developing a peanut allergy.* Vaccines are not considered a cause of peanut allergy, and the Center for Disease Control and Prevention clearly states that peanut oil is not used in vaccines.**
* NIAID. Guidelines for the Diagnosis and Management of Food Allergies in the U.S. Available at http://www.jacionline.org/article/S0091-6749%2810%2901566-6/pdf
** CDC. Available at https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf
Can peanut allergy be prevented?
Yes. Research shows that introducing peanut foods to infants reduces their likelihood of developing peanut allergies.* Guidelines from the National Institute of Allergy and Infectious Diseases recommends that parents introduce infant-appropriate peanut foods starting as early as 4-6 months, depending on their risk for developing peanut allergy.** Discuss questions about food allergies and introducing peanut foods with your pediatrician or healthcare provider.
*NEJM. Randomized trial of peanut consumption in infants at risk for peanut allergy. Available at http://www.nejm.org/doi/full/10.1056/NEJMoa1414850
** NIAID. 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States. Available at https://www.niaid.nih.gov/diseases-conditions/guidelines-clinicians-and-patients-food-allergy
Should pregnant and breastfeeding women avoid peanut foods?
No. The American Academy of Pediatrics explicitly states that research does not support avoiding any food as a means of preventing food allergies. They also state that there’s no need for women to avoid peanuts while pregnant or breastfeeding, unless they are allergic.*
*AAP. Available at http://pediatrics.aappublications.org/content/121/1/183
How are peanut allergies diagnosed?
Diagnosing a food allergy is complex, and should be conducted by a board-certified allergist. Blood and skin-prick tests are valuable tools for identifying an allergy, but are not conclusive in diagnosing food allergies on their own. Oral food challenges are the gold standard for food allergy diagnosis.*
*NIAID. Guidelines for the Diagnosis and Management of Food Allergies in the U.S. Available at http://www.jacionline.org/article/S0091-6749%2810%2901566-6/pdf
How can peanut allergic individuals prevent a reaction?
Avoiding a food allergen is the only way for allergic individuals to prevent a reaction.* Those who are food allergic should always check labels on packaged foods, ask about ingredients in meals at restaurants, and have an emergency action plan in place in case of accidental exposure.
What are the signs and symptoms of an allergic reaction to food?
Identifying and treating a reaction quickly is paramount for safety. Common signs and symptoms of food allergy reaction include:*
– itching and swelling of the mouth, throat and eyes
– vomiting and diarrhea
– difficulty breathing
– reduced blood pressure, weakness, and fainting
What is the treatment for someone who is suffering from an allergic reaction?
Anaphylaxis is a life-threatening allergic reaction, and can occur when only a small amount of the allergenic protein is eaten. Epinephrine is the approved treatment for anaphylaxis and should be administered without delay.* Individuals should seek medical help when a reaction occurs, including calling 911 anytime epinephrine is administered.
Will smelling or touching peanuts or peanut butter cause anaphylaxis?
No. Research does not support skin contact or airborne peanut butter exposure as a source of anaphylaxis, though hay fever type reactions may occur.* Most instances of anaphylaxis are the result of accidental ingestion of peanut proteins, or exposure through the eyes or mouth.
*JACI. Simonte, S, et al. Relevance of casual contact with peanut butter in children with peanut allergy
How can peanut proteins be cleaned from surfaces and skin?
Common household cleaners have been demonstrated to be effective in removing peanut proteins from surfaces and eating areas. Soap and water remove peanut proteins from skin, but sanitizer alone does not.*
*JACI. Perry, Tamara T., et al. Distribution of peanut allergen in the environment
Do bans on peanut products reduce the risk of accidental exposure?
No. To the contrary, research has shown that banning peanuts in schools may increase the risk for reactions and does not reduce the frequency of epinephrine use.*,** Bans give a false sense of security, and are not recommended by healthcare professionals. Best practices for managing food allergies in foodservice include using basic food safety techniques, separating allergens, clearly labeling allergens and avoiding cross contact in kitchens and serving areas. Most importantly, allergic customers should use caution when dining out, be sure to notify staff of their allergy and be prepared in case of accidental ingestion.
* AACI. Accidental exposure (AE) to peanut in a large cohort of Canadian children with peanut allergy. Available at https://aacijournal.biomedcentral.com/articles/10.1186/1710-1492-10-S1-A32
** JACI. Impact of School Peanut-Free Policies on Epinephrine Administration. Available at http://www.jacionline.org/
It seems like peanut allergies are more common than they used to be. Is that the case?
From 1997 to 2007, the prevalence of all reported food allergies has increased by 18 percent among children, according to Food Allergy Research & Education (FARE). A FARE-funded study found the number of children in the U.S. with peanut allergy more than tripled between 1997 and 2008. No one knows the real reason why, but scientists have a variety of theories.