PEANUT ALLERGY
Peanuts are one of the most frequently cited causes of life-threatening anaphylactic reactions. Because of the intense fear among sufferers, parents, and doctors about the risks associated with anaphylactic reactions, peanuts have become the bete noire of food allergy practice. In reality, peanuts have caused very few deaths; deaths from anaphylactic reactions to antibiotics and other medications, injected radio-contrast dyes used in X-ray diagnostic tests, and insect venom from wasp and bee stings vastly outnumber deaths from peanuts. Even when we consider the number of deaths from anaphylactic reactions to foods, tree nuts and shellfish seem to be more frequent culprits than peanuts. However, because of their bad reputation, peanuts have been banned by many airlines, in classrooms from kindergarten onward, and from most places where young children congregate. It is indisputable that whenever that is a risk for anaphylaxis, all possible precautions need to be taken, especially when the victim may be a young child. So, it is probably safer to err on the side of caution, and whenever there is even a slight risk of anaphylaxis, careful avoidance of exposure to even a minute quantity of peanuts is justified. The first thing we need to do, therefore, is to understand the nature of peanut allergy and to be informed about where we can expect to encounter peanuts in the normal diet. That’s what this chapter is all about.
Allergic Reactions to Peanuts
The most important, and most severe reaction to peanuts is anaphylaxis. An anaphylactic reaction involves all systems of the body (is systemic) and, in its severest form, can rapidly progress to anaphylactic shock and death.
Other symptoms of peanut allergy include hives, angioedema (tissue swelling), wheezing, asthma, nausea, vomiting, nasal congestion, itching, and allergic conjunctivitis (itchy/watery eyes). An allergy to peanuts is often lifelong.
People who have been diagnosed as anaphylactic to peanuts must avoid all sources of peanuts. Even when the reaction has been mild on previous occasions, if you have had any reaction at all to peanuts, the potential for a severe allergy exists. Therefore, most doctors advise treating all peanut allergies as if they were life-threatening.
Peanut Allergens
Peanuts are unrelated botanically to nuts that grow on trees, and most people are able to eat a variety of tree nuts, such as walnuts, pecans, Brazil nuts, almonds, cashew nuts, hazelnuts, macadamia nuts, and so on, without difficulty. However, because tree nuts are highly allergenic foods, they are also frequent causes of strong allergic reactions and anaphylaxis. An allergy to nuts should be distinguished from an allergy to peanut and other legumes, otherwise the diet can become stressful and cumbersome if the allergic person avoids all traces of peanuts and all other nuts.
In order to be sure that all sources of peanuts have been identified, especially in manufactured foods, the peanut-allergic person must become familiar with terms on ingredient labels that indicate the presence of peanuts and must be aware of the foods most likely to contain peanuts or peanut protein (Table Terms on food labels that indicate the presence of peanut protein).
A cautionary note here is that sometimes no differentiation is made in the marketing of peanuts and nuts, and the two are often found together in “nut mixtures.” When nuts and peanuts are sold in bulk, a utensil used to handle nuts has often been previously used with peanuts without cleaning in between. In the manufacture of candies, confectioneries, and ice cream, there is frequent cross-contamination between nuts of different species and peanuts, so a person with severe peanut allergy is advised to avoid any product containing “nuts” because of the danger of encountering peanuts inadvertently.
“Mandalona” nut is one of the names given to a manufactured product made from deflavored, decolored peanut meal that is pressed into molds, reflavored and colored and sold as a cheaper substitute for tree nuts such as almonds, pecans, and walnuts. People with peanut allergy must be cautious when consuming any food that may contain such a product.
Table Terms on food labels that indicate the presence of peanut protein
Ingredients That Indicate the Presence of Peanut
| Peanut protein | Peanut flour | Beer nuts |
| Hydrolyzed peanut protein | Mandalona nuts | Mixed nuts |
| Peanut oil | Artificial nuts | Goober nuts |
| Cold-pressed peanut oil | Nu-nuts flavored nuts | Goober peas |
| Peanut butter |
Products That May Contain Peanut
| Marzipan (almond paste) | Chinese dishes | Prepared and frozen desserts |
| Prepared soups | Satay sauces | Ice cream with nuts |
| Dried soup mixes | Baked goods | Chocolate ice cream |
| Chili | Cookies | Vegetable oil |
| Egg rolls | Candies | Hydrogenated vegetable oil |
| Thai dishes | Chocolate bars | Vegetable shortening |
Peanut Oil
Research studies have indicated that peanut-allergic adults can tolerate pure peanut oil without any clinical reactions. This is true of oils from any source, including soy. The allergic reactivity occurs to the protein that may contaminate the oil, not to the oil itself. However, people who are anaphylactic to peanut, nuts, or a grain are usually cautioned to avoid the oil derived from the allergenic plant because there may be traces of plant protein in the oil.
Research indicates that refined peanut oil is safe for peanut-hypersensitive people. However, there is no guarantee that any peanut oil is completely free from peanut protein. A person who is anaphylactic to peanut is strongly advised to avoid peanut oil entirely. Cold-pressed oils (also labeled “pure-pressed,” “expeller pressed,” or “unrefined”) in particular should be avoided.
The Peanut-Free Diet (Table The peanut-free diet: foods allowed and foods restricted)
The peanut-free diet omits peanuts and foods containing peanuts. It is important that peanut-sensitive people avoid all sources of if there is even a moderate risk of an anaphylactic reaction to it. However, there is no evidence that even a severe allergy to peanut requires avoidance of all other legumes. Avoidance of legumes such as soy, lentils, dried peas, and beans is necessary only when allergy to the individual foods has been identified. It is also unnecessary to avoid tree nuts, which are botanically unrelated to peanuts. However, because of the risk of contamination of tree nuts, especially nut mixtures, to contain, or to be contaminated, by peanuts, a person who has demonstrated allergy to peanuts is usually advised to avoid nuts of all types in the interests of safety.
Nutrients in Peanut
Peanuts supply niacin, magnesium, vitamin E, manganese, pantothenic acid, chromium, and in smaller amounts vitamin B6, folacin, copper, and biotin. These nutrients are easily replaced by including meat, whole grains, legumes, and vegetable oils in the diet.
The Peanut-Allergic Baby
Protein from peanuts in the mother’s diet can pass into her breast milk and cause allergic symptoms in the breast-fed baby. If the breast-fed infant is allergic to peanut protein, the elimination of all peanut and peanut-containing products from the mother’s diet should be beneficial. If peanut elimination only partially eases the infant’s distress, carefully kept exposure diaries by the mother may isolate other possible dietary or medication irritants.
Table The peanut-free diet: foods allowed and foods restricted
| Type of Food | Foods Allowed | Foods Restricted |
| Milk and
Milk Products |
• Milk
• Cream • Plain yogurt • Ice cream made with allowed ingredients • Plain cheese • Sour cream • Quark • Dips made with allowed ingredients |
• Milk-based desserts and
confectioneries (e.g., ice cream) containing peanuts or nuts • Chocolate ice cream or other milk-based confectioneries unless labeled “peanut-free” • Cheese foods (e.g., slices, dips, spreads, cheese balls) containing nuts or undisclosed ingredients |
| Breads and
Cereals |
• Any breads, buns, or baked
goods that are known to be free from peanut and peanut oil • Plain cooked grains • Plain oatmeal • Regular Cream of Wheat® • Ready-to-eat cereals without added oil or nuts • Homemade granola without peanut • Dried pasta |
•Commercial or homemade baked
goods made with peanut oil or peanuts • Baked goods made with undisclosed sources of “nuts,” oil, or shortening • Baking mixes • Ready-to-eat cereals with added oils and nuts, such as granola |
| Vegetables | • All pure vegetables and their juices | • Vegetable dishes with sauces containing peanuts, peanut oil, or unknown nuts or oils
• Salads with dressings containing unknown oil or nuts • Vegetables canned in undisclosed oils |
| Fruit | • All pure fruit and fruit juices | • Fruit dishes containing peanuts or nuts
• Fruit dishes made with oil or shortening of unknown origin |
| Meat, Poultry,
and Fish |
• All pure fresh or frozen
meat, poultry, or fish • Fish canned in broth, water, or non-peanut oils |
• Meat, poultry, or fish dishes made
with peanut or undisclosed nuts or oils • Fish canned in undisclosed oils • Chinese dishes • Thai dishes • Egg rolls • Commercial chili • Vegetarian burgers unless labeled “peanut-free” • Peanut protein |
| Eggs | • All without restricted ingredients | • Egg dishes prepared with oils or nuts of unknown sources
•Egg rolls |
| Legumes | •All pure legumes except peanut
• Tofu |
•Peanut and peanut products
including -Artificial nuts - Goober nuts - Goober peas - Hydrolyzed peanut protein - Mandalona nuts - Mixed nuts - Peanut butter - Peanut flour - Peanut oil - Peanut protein • Legume dishes containing peanut or oils or nuts of undisclosed source |
| Nuts and
Seeds |
• All packaged plain, pure
nuts and seeds • All pure nut and seed oils and their butters, such as - sesame tahini - almond butter - almond paste - cashew butter |
• Mixed nuts
• Mandalona nuts • Artificial nuts • Nuts or oils of undisclosed origin • Goober nuts • Goober peas |
| Fats and Oils | • Butter
• Cream • Pure vegetable, nut, or seed oil with source specified (except peanut) • Lard • Meat drippings • Gravy made with meat drippings |
• Peanut oil
• Salad dressings that list “oil” without revealing source • Margarine, unless source of all oils is revealed and is peanut-free |
| Spices and
Herbs |
• All pure herbs and spices
• Blends of herbs and spices, without added oils |
• Seasoning packets with
undisclosed ingredients • Vegetables such as garlic or sun-dried tomatoes packed in oil, unless source of oil is disclosed and is peanut-free |
| Sweets and
Sweeteners |
• Plain sugar, honey,
molasses, maple syrup • Corn syrup • Pure chocolate • Pure cocoa • Artificial sweeteners • Homemade cookies and candies with allowed ingredients |
• Chocolates with unknown ingredients
• Chocolate bars • Marzipan (almond paste) • Cookies and candies • Any confectionery containing nuts unless specified to be peanut-free |
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