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Strategies for Managing Peanut Allergies

By Sherry Coleman Collins, MS, RD, LD

Food allergies have become a growing concern for healthcare professionals and their clients and patients who have them. It’s estimated that food allergy affects 5% of children under the age of 5 and 4% of teens and adults.1 But many more people suffer from food sensitivities and intolerances. Furthermore, about 0.6% of Americans have a peanut allergy.1

Like other food allergies, peanut allergy reactions may involve the skin, gastrointestinal tract, and respiratory and cardiovascular systems. Most reactions are mild, but severe ones can occur. Virtually any food allergy can cause life-threatening repercussions. Reactions are unpredictable from person to person and from reaction to reaction, and they may not worsen with subsequent exposures. Risk of the most severe reactions is highest in people with multiple allergies and asthma.

Taking the Right Precautions
Treating and managing food allergies, including a peanut allergy, requires individuals to avoid the allergen. So it’s important to inform parents and caregivers and those with allergies to read all product labels each time they buy or eat something since manufacturers may change formulations without notice. Thanks to the Food Allergen Labeling and Consumer Protection Act (FALCPA), peanuts and the other top food allergens (milk, eggs, tree nuts, crustacean shellfish, fish, wheat, and soy) must be listed on food labels. Precautionary statements such as “may contain” or “manufactured in a factory with” aren’t mandatory.

Peanuts may be in unexpected places such as protein bars, sauces, and cereals, so label reading is imperative. Other “danger zones” include foods containing unknown ingredients, mixed foods, baked goods, Asian foods (where peanuts are a staple ingredient), and buffets. When in doubt, people with peanut allergies shouldn’t take any chances eating these foods.

If clients accidentally eat a food they’re allergic to, their symptoms will determine the required medical treatment. Mild reactions may go away without the need for intervention, or an antihistamine such as Benadryl may be recommended. For severe reactions, called anaphylaxis, epinephrine (eg, EpiPen) should be administered, as it’s the only drug recommended for anaphylaxis. A delay or lack of administration can lead to death, so suggest clients who have severe food allergies always keep epinephrine on hand.

In a recent study, caregivers reported severe reactions in less than 12% of individuals, but only 29.9% of those administered epinephrine.2 Nevertheless, no deaths were reported.

Working With Schools
When it comes to managing food allergies in schools, it’s important for parents and caregivers to work closely with administrators. Life-threatening food allergies are considered a disability, and school officials are required to make reasonable accommodations.

While some fearful individuals want to ban peanuts in schools, bans aren’t recommended because they can lead to a false sense of security. Bans take the focus off education and place it on enforcement. Instead, schools should create a community of support where children can learn to manage their food allergies in an instructive environment with a safety net. Families should work with school nutrition staff, the school nurse, and teachers to develop a plan that will keep kids safe while minimizing the impact on nonallergic students. Within the plan, everyone should have a responsibility. Here’s what parents, students, and schools can do to successfully manage this issue:

• Give the school nurse current medical documents and emergency medication that hasn’t expired to use in case a child has an allergic reaction.

• Pack the child special snacks for unplanned special events that may involve food.

• Don’t share food with anyone or eat food with unknown ingredients.

• Send home a letter with classmates explaining there’s a child with a life-threatening food allergy in the class.

• Avoid involving the allergenic food during classroom activities.

• Send alerts to cafeteria cashiers that certain children have food allergies. Any questionable food should be removed from the student’s tray.

• Develop a no food/eating policy for buses.

• Provide an allergen-safe table in the cafeteria dining area where students with allergies can sit with friends.

Dispelling Myths
Individuals and families managing food allergies can connect with support groups around the country and across the world through the Internet. But it’s important to remember there are myths and misinformation out there of which clients must be aware. Here are some examples:

Myth: Peanuts are the most deadly food allergen.
Fact: Any food can cause anaphylaxis.

Myth: Peanuts are responsible for at least 100 deaths each year.
Fact: One survey showed no deaths out of more than 2,000 hospital admissions for anaphylaxis.3

Myth: The smell of peanuts can be deadly.
Fact: Research has shown that casual contact and airborne allergens pose a very small risk to people with a peanut allergy. Ingestion must occur to trigger anaphylaxis.

Myth: Peanut residue is harder to remove from surfaces than residue from other foods.
Fact: You can effectively remove peanut residue with soap and water.

Compelling Research Is Under Way
Exciting research continues to emerge for peanut allergy sufferers. Ongoing clinical trials are showing that oral immunotherapy can help those with peanut allergies develop tolerance. Researchers give subjects increasing amounts of peanuts over the course of months or years until they can safely eat a serving without an allergic reaction.

Sublingual immunotherapy, in which a tiny amount of allergen is placed under the tongue instead of immediately swallowed, also is making headway. Transdermal patches, which deliver small amounts of peanut protein through the skin, and Chinese herbal therapy also are being tested.

Since preventing food allergies altogether would be a monumental breakthrough, researchers are assessing how avoidance vs. early introduction affects their development. Populations in which peanuts are eaten early in life have lower rates of peanut allergy.

As new research emerges, education and preparation will be key to keeping those with food allergies safe. And dietitians can make all the difference as we continue to counsel our clients and patients.

— Sherry Coleman Collins, MS, RD, LD, has worked in clinical pediatrics and school foodservice, where she had hands-on experience working with students, families, and staff to manage food allergies. She currently is the senior manager of marketing and communications for the National Peanut Board.


1. NIAID-Sponsored Expert Panel, Boyce JA, Assa’ad A, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 Suppl):S1-S58.

2. Fleischer DM, Perry TT, Atkins D, et al. Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study. Pediatrics. 2012;130(1):e25-32.

3. Ross MP, Ferguson M, Street D, Klontz K, Schroeder T, Luccioli S. Analysis of food-allergic and anaphylactic events in the National Electronic Injury Surveillance System. J Allergy Clin Immunol. 2008;121(1):166-171.