• Peanuts
• Tree nuts
• Egg
• Milk
• Wheat
• Soybeans
• Fish
• Crustacean shellfish.34
Treatment for Anaphylaxis
In pediatric patients, administration of epinephrine is the definitive treatment for anaphylaxis; both the child and parents should carry an epinephrine self-injection device at all times in the event of accidental peanut ingestion. These devices are available in two strengths, based on the child’s weight, and expiration dates should be noted with care. Correct use of the epinephrine self-injection device should be reviewed at each office visit.6
Early-stage allergic reactions can be managed by oral antihistamines, such as diphenhydramine (1 mg/kg body weight up to 75 mg) and an intramuscular injection of epinephrine.1 Prompt transport to the ED should follow (see “Management of Anaphylaxis in the ED”1,9).
PREVENTION
A 2010 expert panel on diagnosis and management of food allergy sponsored by the NIAID, NIH,3 does not advise women to restrict their diet during pregnancy and lactation. Similarly, the United Kingdom’s Department of Health and the Food Standards Agency (DHFSA)36,37 does not support the belief that eating peanuts and peanut-containing foods during pregnancy correlates with a child’s potential for developing a peanut allergy.
The DHFSA does recommend breastfeeding infants for the first six months, if possible, and that mothers refrain from introducing peanut-containing foods during that time. They also recommend that foods associated with a high risk for allergy be introduced into a child’s diet one at a time, to make it easier to identify any allergenic substance.36,37
Lastly, the DHFSA advises parents with a family history of peanut allergy to introduce peanuts only after consulting with their health care provider. The same consideration is advised if a child has already been diagnosed with another allergy.34 According to the American Academy of Pediatrics,6,38 children at high risk for food allergy (eg, atopic disease in both parents or one parent and one sibling) should be breastfed or be given hypoallergenic formula until age 1 year, with no solid foods before age 6 months; peanut-containing foods should not be given before age 3 or 4 years.
CONCLUSION
Peanut allergy can present a lifelong battle for affected patients. Eating one peanut or being exposed even to minute amounts of peanut protein could mean life or death without appropriate management. Reading food labels carefully, preparing peanut-free foods, recognizing the signs and symptoms of anaphylaxis, and obtaining the necessary treatment when allergic reactions occur are essential for peanut-allergic patients and their families.
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