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.  

Avoidance Basics
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:

  • Arachis
  • 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
  • Peanuts
  • Peanut butter
  • Peanut flour
  • Satay

These foods may contain peanuts:

  • Baking mixes
  • Candy
  • Cereals
  • Chili
  • Chinese food
  • Chocolate
  • Cookies
  • Egg rolls
  • Hydrolyzed plant protein
  • Hydrolyzed vegetable protein
  • Indonesian food
  • Marzipan
  • Mexican food
  • Nougat
  • Pastries
  • Pesto
  • Praline
  • 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

Sources
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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