PEANUT ALLERGY

Peanut allergy

Peanuts are eaten in large quantities due to its flavour and high protein content.  There are numerous proteins in peanut and when you are allergic to peanut you react to some of these.

 

How common is peanut allergy

The prevalence of peanut allergy has been increasing over the last two decades and at present affects about 4% of school children in the UK.  In majority of individuals peanut allergy is a lifelong condition.

 

What are the symptoms?

Symptoms can be mild such as itchy sensation and tingling sensation of mouth or throat.  But serious reactions can occur these include choking sensation due to swelling of throat, asthma attack, widespread rash and faint and collapse which is termed “anaphylaxis”.

 

How to avoid peanut in food

For manufactured foods, ingredient labelled needs to be checked for presence of peanut.  Peanut may also be called groundnut, earthnut or monkey nut.  Food most likely to contain peanut include: breakfast cereals, cereal bars, chocolates, cakes and biscuits.  Chinese, Indian, Indonesian and Thai foods are often cooked with ingredients containing peanut therefore one needs vigilance when eating food prepared away from home environment.  Nuts are often ground up so you cannot see them.  Meals are not always prepared the same way so just because you have eaten a dish before it does not guarantee it would be safe next time.

 

Certain food additives (E471 and E472) and some lecithins contain peanut protein hence should be avoided.  We recommend that peanut allergic individuals should not eat food labelled “contains trace amounts of nuts” or “may contain trace amount of nuts”.

 

Peanut oil may be present in food in a refined or unrefined form.  It is a fact that refined peanut oil does not pose a risk for people with peanut allergy.  However, cold-pressed (unrefined) peanut oil has been shown to contain peanut protein and could potentially pose a problem with peanut allergic people.  Peanut oil also can become contaminated when used for cooking foods containing nut products.

 

 

Where you may come across peanut

Raw peanut (nuts in pods, peanuts sold for birds, peanuts in muesli, flaked nuts) may cause more serious reactions.  Usually peanuts are easily identifiable, however peanut may be hidden flaked nut, ground-up nuts, nut paste, praline, nougat, chocolate – e.g. Snickers bar, some biscuits and cakes.  Always be aware of food that may be cross contaminated with other food containing peanuts e.g. Chinese, etc takeaway.  When eating out in restaurants it is not always guaranteed that the staff would know if the food contains peanut.  The usual warning sensation in the mouth such as tingle or sore throat may be masked by the spices in the food.  Therefore it is advisable not to eat spicy foods in restaurants.

 

Is it safe to eat other nuts?

It is common for people allergic to peanut to react to other nuts as well.  Sometimes these reactions are worse than the reaction to peanut, therefore you must be very careful unless you know you can eat a particular type of nut without any problems.   Sometimes the reactions to other nut may be caused by cross-contamination of small amount of peanut.  Very rarely some peanut allergic people are also allergy to peas, chickpeas, beans, lentil and soya.

 

Are there any issues when travelling abroad?

If you are travelling abroad it would be useful to learn words and phrases in order to enquire as to whether a nut/ peanut is a food product.  On arrival at the destination it is advisable to familiarise yourself with the nearest medical emergency department.  Before you go on holiday, it may be advisable to discuss with your general practitioner whether any additional medication will be required e.g. adrenaline pen (EpiPen, Jext).

 

Is there a test to assess the severity of future peanut allergic reactions?

There are no conclusive tests available to assess the severity of future reactions.  A subsequent reaction may be less severe or on the other hand it could be potentially life threatening.  Therefore vigilance is needed at all time.  The size of skin test reaction or blood IgE level have no correlation to the severity of future reaction.  There is a new test where IgE to recombinant peanut antigen is tested.  This is useful in population based trials to identify individuals with severe reaction but may not be useful in any one individual.

 

Can I eat other nuts?

If you have not eaten other nuts be very careful the first time you try them, a piece of nut the size of a pin head could cause a severe reaction e.g. almond, cashew, pistachio, Brazil, walnut, hazelnut, macadamia and pine nuts.  Rarely a reaction may occur with pea, chickpea (channa, hummous, falafel), lentil (dhal), bean, butterbean and baked bean, soya and bean curd and hydrolysed vegetable protein.  Green beans and mange tout are not likely to cause a reaction.

 

Is desensitisation treatment available for peanut allergy?

There are currently clinical trials showing improvement in allergic reaction when children have been given increasing doses of peanut.  This does not cure their allergy and they have to continuously take this treatment.  This treatment is not yet available widely in the clinics and has not been trialled in adults.

 

If you know of anything of use to other peanut allergy sufferers please let us know.