NUT AND PEANUT ALLERGIES—DIFFERENT FOODS, SIMILAR PROBLEMS

The U.S. Food and Drug Administration estimates that 6% of children younger than 3 years old have some kind of food allergy; among the most common is peanut allergy. Peanuts are actually legumes (not nuts) that grow in the ground. However, the proteins in peanuts are similar to those in tree nuts so people who are allergic to peanuts could also be allergic to the nuts that grow on trees.

Tree nuts are the nuts of hard-shelled fruit and include almonds, walnuts, pistachios, macadamias, Brazil nuts, hickory nuts, pine nuts, pecans, and cashews. You should be tested for both types of allergies to determine if you need to avoid both groups.

The Allergic Response

Since the body erroneously identifies the proteins in peanuts or tree nuts as hostile invaders, it mounts an immune response by creating specific antibodies to those proteins. These antibodies trigger the release of certain chemicals into the body such as histamine. Allergic reactions differ from person to person, from mild to severe. Some people outgrow certain food allergies as they get older but for most people, peanut and tree nut allergies are for life.

Peanut reactions can be very severe, even with minimal exposure to peanut protein. In general, most reactions to food allergies last less than a day and may affect:

1. Skin. Itchy, red, bumpy rashes (hives), eczema, or redness and swelling around the mouth or face.
2. Gastrointestinal system. Belly cramps, nausea, vomiting, or diarrhea.
3. Respiratory system. Runny or stuffy nose; itchy, watery eyes; sneezing to the triggering of asthma with coughing and wheezing. In severe cases, anaphylaxis may occur; this sudden, potentially life-threatening reaction causes airways to swell and blood pressure drop. The person may have trouble breathing and could lose consciousness.
4. Cardiovascular system. Feeling lightheaded or faint, can lose consciousness.

How the Reactions are Triggered

Typically, an allergic reaction to nuts occurs through ingesting nuts or peanuts or products containing them, or from cross-contact from cooking/food prep—but it could occur from breathing in airborne particles or handling them. Therefore, keep the offenders out of your home and ask questions before visiting or dining at other people’s homes.

The obvious sources for peanuts and tree nuts is peanut butter and nut butters extracts, and flours, but you might be surprised to discover nuts used in a wide range of other products as thickeners, emollients, and flavoring agents: baked goods, candy, frozen desserts, cereals, soups and chili, breads, meatless burgers, sauces (such as pesto and mole), and salad dressings, plus shampoos and soaps.

KidsHealth (www.kidshealth.org) has a great instruction sheet regarding peanut/nut allergic reactions:

Taking Precautions

·         Read every label and if you have any questions, call the manufacturer to confirm the presence of absence of any nuts in the manufacturing plant or process. Check the ingredient lists of international foods which use nuts extensively in their recipes.

All packaged food products sold in the U.S. that have tree nuts as an ingredient must list the specific tree nut on the label. Some manufacturers use advisory labels (“May contain …”) but this is voluntary and without specific guidelines. However, the FDA—which just announced regulations for labeling gluten-free packaged goods—is said to be developing a long-term strategy to help manufacturers use these statements clearly and consistently; that way, consumers can be informed about the potential presence of the eight major allergens (peanuts, tree nuts, soybeans, milk, wheat, shellfish, eggs, fish). 

·         Avoid them all? Food Allergy Research & Education notes that someone who is allergic to one type of tree nut has a higher chance of being allergic to other types; therefore, many experts advise patients with a tree nut allergy to avoid all nuts. Individuals may be advised to also avoid peanuts (and vice versa) because of the higher likelihood of cross-contact with tree nuts during manufacturing and processing. 

·         Talk to school/camp. Schools and camps are well aware of the dangers of nut allergies and the concerns parents have for their children’s well-being. Separate dining tables or instructions to other parents about what is allowed for lunch or snack are often offered. However, we recommend you speak with your school administrator and school nurse about steps to create a safe, allergen-free environment for your child.

·         Carry medication. As we noted in last month’s post about wheat allergy, many families carry injectable epinephrine for emergencies away from home. For people with milder reactions, an oral antihistamine might be all you need. Consult your doctor!

As with any food allergy, your best course of action is to research and become as well-informed as possible. Be sure to let others know about your child’s allergy to avoid any unpleasant situations or upsets.