Peanut allergy: a guide for parents

Peanut allergy in the United States has more than quadrupled in recent years, and peanuts are the leading cause of food allergy–related anaphylaxis and death in the U.S. 

Researchers don’t know why there’s been such a dramatic increase in peanut allergies, but they’ve found several risk factors, including severe eczema, egg allergy, and a family history of asthma and allergies.

Reducing the risk

In the past, the American Academy of Pediatrics recommended that parents wait until their children were 3 years old before introducing peanuts. Despite this recommendation, peanut allergy continued to become more common, suggesting that delaying introduction of peanuts may not help. In fact, new information shows that waiting might make the problem worse. 

Current guidelines on peanut introduction are based on results of a large study that explored the idea that a delay in peanut introduction could be increasing the nation’s peanut allergy problem. Early exposure was actually shown to reduce the incidence of peanut allergy later in life.

For parents who wish to reduce their child’s risk of peanut allergy, experts recommend the following:

  • If the infant has no known risk of peanut allergy (no eczema, no diagnosed food allergy), or has only mild-to-moderate eczema, parents can talk with their infant’s pediatrician about introducing peanut-containing foods at around 6 months of age.
  • If the infant has risk factors like severe eczema or an egg allergy, the pediatrician may recommend skin-prick testing before introduction of peanut-containing foods. Infants with no reaction may be started on a diet that includes small amounts of peanut. Those with a mild reaction may try a “food challenge,” with a pediatrician or allergist giving the infant a small amount of a peanut-containing food and watching closely for any reaction. Children without a reaction may be started on peanut-containing foods.

Introducing peanuts

Below are several tips for introducing peanut-containing foods as safely as possible. However, always follow the plan recommended by your child’s pediatrician.

  • A peanut-containing food shouldn't be the first food your child tries.
  • Peanut-containing foods may include crackers or puffs. Whole peanuts aren’t recommended for children under 5 years of age since they pose a choking hazard. Spoonfuls of peanut butter are also too sticky for a young child (under 4 years of age) to handle.
  • Feed the peanut-containing food only when your child is healthy and not having an illness.
  • Give the first taste at home, not at day care or at a restaurant.
  • Begin with a small taste the first time—not a full serving.
  • Make sure that at least one parent can give his full attention to the child for several hours the first time a peanut-containing food is given.
  • If your child has any reaction to a peanut-containing food—rash, difficulty breathing, etc.—stop and seek immediate medical attention. See more below on symptoms of food allergy.
To avoid unplanned exposure to peanuts, parents should always read ingredient labels since products unrelated to nuts, or that don't advertise nuts on the packaging, can still contain nut flours.

Recognizing symptoms of food allergy

Any time a new food is introduced, parents should be alert for signs of food allergy, which are usually evident within the first 5 minutes after ingestion but may take up to 2 hours to develop. With peanut-containing foods, parents should be especially vigilant due to the severity of reactions that may occur. Symptoms may include the following:

  • hives (red and itchy welts)
  • difficulty breathing and swallowing 
  • wheezing 
  • red, itchy eyes 
  • swelling of the tongue and/or lips 
  • swelling of the hands and face 
  • hoarseness
  • stomach upset, nausea, or vomiting
  • itchy or runny nose and sneezing 
  • coughing 
  • light-headedness 
  • feeling something bad will happen, anxiety and confusion

If any allergy symptoms occur, contact your child’s pediatrician immediately or call 911. Allergic reactions can progress rapidly, and quickly seeking treatment is essential.

Last updated July 11, 2017

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