Children affected by peanut allergy has doubled in the past 20 years. Interestingly, it is more common in the United
States than in Asian countries; although the consumption of peanuts there is at least as high, if not higher than in the
United States. The difference is that in the United States, we mostly consume dry roasted peanuts. In Asia, they
are usually boiled or fried. Studies demonstrate that roasting peanuts results in the generation of new proteins
which have a higher allergic potential, perhaps explaining the higher incidence of peanut allergies in the USA
compared to Asian countries.
What are Peanuts?
Peanuts, along with peas, lentil, and beans are legumes. It is extremely rare for someone to have a cross-reactivity
between peanuts and other legumes. It is therefore safe to eat other legumes (to the dismay of children
everywhere). While tree-nuts are not related to peanuts, about half of peanut allergic patients will also be allergic to
tree-nuts. Even if you are not allergic to tree-nuts, it is important to avoid them as there is a risk that trace amounts
of peanuts will be found on tree-nut products since most tree-nut processing plants also process peanuts.
Reading food labels is extremely important. As a rule of thumb, you should avoid anything with the word “nut” in
it. Studies demonstrate, however, that it is safe to eat foods cooked in peanut oil—unless this oil is cold processed
or labeled as gourmet peanut oil. It is thus safe to eat foods cooked in peanut oil, unless it is cold processed,
expelled, extracted, or gourmet oil. But looking for the word “nut” is not always enough! Hidden sources of
peanuts include Asian dishes (such as egg rolls or dishes with satay sauce, which is made with peanuts), nougat,
chocolate, baked goods such as cookies and cakes. While sunflower seeds do not cross-react with peanuts, they
are often processed on the same equipment used to manufacture peanuts, and thus should be avoided since they
could be contaminated with trace amounts of peanuts.
Avoid foods that contain:
- Artificial nuts
- Beer nuts
- Cold pressed peanut oil
- Expelled peanut oil
- Extruded peanut oil
- Gourmet peanut oil
- Ground nuts
- Mixed nuts
- No-Nuts flavored nuts
- Peanut butter
- Peanut flour
These foods may contain peanuts:
- Baking mixes
- Chinese food
- Egg rolls
- Hydrolyzed plant protein
- Hydrolyzed vegetable protein
- Indonesian food
- Mexican food
- Thai food
- Vietnamese food
Most peanut allergic individuals can consume peanut oil safely, unless it is cold pressed, expelled, extruded, or
gourmet peanut oil.
Nutmeg is safe to eat. Although the name of this spice would lead one to believe it is made from nuts, nutmeg is
actually made from the seed of the fruit that grows on a tropical evergreen called Myristica fragrans.
Is this For Life?
Peanut allergy appears to be a life long condition for the majority of people. However, it does go away in some, and
studies suggest that up to 20% of children outgrow their peanut allergy by age 6. Strict avoidance of peanuts,
including avoiding foods that contain trace amounts, may increase the likelihood that the allergy will disappear.
Several case reports have been published describing peanut allergic individuals who seemed to have outgrown their
allergy with negative tests and oral challenges in an allergy clinic, but then subsequently returned. While the cause is
unclear, it appears that these individuals ate peanuts infrequently. Experts thus recommend that patients who
appear to have outgrown their allergy (by evaluation with an allergist) eat peanuts frequently and continue to keep an
epinephrine injector on hand until they are able to eat peanuts safely for 1-2 years. Research is ongoing to
determine whether allergy shots or allergy drops (sublingual immunotherapy) may be of benefit for food allergies.
Make sure to check out the coping with food allergies page for school and traveling tips, and useful links including
sites that sell allergy safe foods, medic alert bracelets. There's even a link to a website that will translate food allergy
words in just about any language you can imagine!
updated 25 Aug 2010
Fleischer et al. The Natural Progression of Peanut Allergy: Resolution and the Possibility of Recurrence. J Allergy
Clin Immunol 2003;112:183-9.
Food Allergy: A Practice Parameter Annals of Allergy, Asthma, & Immunology 2006;96
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