How to Handle Peanut Allergies

Nicole Wetsman

Updated May 28, 2019 at 6:02 AM

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Peanuts often take center stage in conversations about food allergies. That's because the nuts are a common food that’s hard to avoid—and allergies to it are severe and usually lifelong, says Scott Sicherer, M.D., director of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York. Peanut allergies cause more cases of anaphylaxis—a severe allergic response that can restrict one’s airway and cause nausea, low blood pressure, and cardiac arrest—than any other food allergy in kids.

There’s no cure for this increasingly common condition. But Sicherer says researchers have been looking for ways to reduce its severity to make it less dangerous.

Peanuts often take center stage in conversations around food allergies, because the nut is a common food that’s hard to avoid—and allergies to it are severe, and usually lifelong, says Scott Sicherer, M.D., director of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York. Peanut allergies cause more cases of anaphylaxis than any other food allergy in kids, and currently, there’s no cure for this increasingly common condition. But in recent years, Sicherer says researchers have been looking for ways to reduce the severity of the allergy, in order to make it less dangerous.

A new study published last month revealed that one treatment researchers were trying, called oral immunotherapy—where patients take tiny doses of peanut protein in an attempt to “desensitize” them to the allergen—may help to reduce the severity of the allergy. However, the study also found that the treatment is risky, and can trigger an anaphylactic reaction—the severe allergic response that can restrict one’s airway and cause nausea, low blood pressure and cardiac arrest.

“It means that there could be limitations to pursuing peanut oral immunotherapy, and it might not be for everyone,” says study author Derek Chu, a clinical immunology and allergy resident at McMaster University in Ontario, Canada.

In the meantime, researchers have also been studying ways to prevent peanut allergies in the first place, prompting both The American Academy of Pediatrics and National Institute of Allergy and Infectious Diseases to issue new recommendations for parents on when to feed children peanuts to prevent the allergy from developing.

A new study published last month revealed that a treatment called oral immunotherapy—in which people take tiny doses of peanut protein to “desensitize” them—may help. But the study also found that the treatment is risky and can trigger an anaphylactic reaction.

“It means that there could be limitations to pursuing peanut oral immunotherapy, and it might not be for everyone,” says the study's author, Derek Chu, M.D., Ph.D., a clinical immunology and allergy resident at McMaster University in Ontario, Canada.

Researchers have also been studying ways to prevent peanut allergies in the first place. That has prompted the American Academy of Pediatrics and the National Institute of Allergy and Infectious Diseases to issue new recommendations for parents about when to feed children peanuts to prevent the allergy from developing.

Why the Peanut Problem?

In 1999 a study published in the Journal of Allergy and Clinical Immunology found that less than half of 1 percent of children under the age of 18 were allergic to peanuts. But by 2010 a follow-up study revealed that the number had risen to 2 percent, which translates to over 3 million adults and children in the U.S. Researchers don’t know why peanut allergies have become more common, though some speculate that the increased use of antibiotics or living in environments that don’t expose kids to enough germs and dirt might play a role.

At the moment, kids with peanut allergies generally must avoid foods that contain any trace of peanuts. To prevent accidental exposure, some schools in the U.S. have implemented peanut-free policies, and airlines such as Southwest and American Airlines have stopped serving packaged peanuts on flights. In case they do come into contact with peanuts, allergic people must always carry an auto-injector of the hormone epinephrine (such as the EpiPen or Auvi-Q) to use if an anaphylactic reaction occurs. Epinephrine reverses the symptoms of a reaction by constricting blood vessels (raising blood pressure) and relaxing the muscles in the airway (to help a person breathe).

However, even though many allergic people experience reactions at some point during their lives, very few die from one. People without allergies are more likely to suffer an accidental death than people with allergies are to die from a food allergy, according to a 2013 analysis. Only 11 people in the U.S. died from peanut or other food allergies in 2005, the last year data is available.

Reducing the Severity of the Problem

Allergists and researchers see immunotherapy as a promising way to reduce that dangerous reaction to peanuts. It has been used for years by people who are allergic to pollen or bee venom, Chu says. In those cases, they get shots that deliver tiny doses of the allergen.

But when it comes to peanuts, immunotherapy treatment is still experimental, he stresses. Chu and his colleagues analyzed 12 studies of the treatment to gauge its effectiveness and safety, and published their findings in The Lancet.

The good news is that their analysis found that immunotherapy could successfully desensitize patients to peanuts—meaning they could begin to include peanut products in their diet without a reaction after treatment. But during immunotherapy treatment, there were risks: While those with allergies who just avoided peanuts had a 7 percent risk of having an allergic reaction over the course of the trial, that number jumped to 23 percent for those who were receiving immunotherapy.

At the moment, the National Institute of Allergy and Infectious Diseases doesn't recommend oral immunotherapy for peanut allergies, and the therapy isn't approved by the Food and Drug Administration. However, it's offered by some allergists in the U.S.

“Patients considering immunotherapy should first know the facts, not just the claims or anecdotes,” Chu says. “The unfortunate reality is that there is some predatory behavior out there targeting patients seeking guidance.” Carefully review the claims made by doctors, particularly if they claim to have a “foolproof” oral immunotherapy method, he says, and determine if they have any financial conflicts of interest.

There are clinical trials of oral immunotherapy, Chu says. They're carefully controlled, and the results might benefit people with allergies. You can find a list of clinical trials at clinicaltrials.gov. Doctors may know of others than aren't publicly posted.

If you're considering oral immunotherapy, make decisions in partnership with your allergist and other health professionals, says Michael Pistiner, M.D., director of food allergy advocacy, education, and prevention in the Food Allergy Center at Massachusetts General Hospital. “We need this shared decision-making because we’re at a time of uncertainty,” he says.

There’s much more to learn about oral immunotherapy. “We need to understand its safety, we need to know what is the best dose, who is the best candidate, why do some kids do better than others, and what’s the best age,” Pistiner says.

Can You Prevent Peanut Allergies?

While researchers aren’t sure what causes peanut allergies, they have identified a few risk factors and are studying how to prevent allergies in the first place in people at high risk. For example, infants who suffer from eczema, a skin condition thought to be caused by a combination of genetic and environmental factors, may be more likely to develop a peanut allergy. And infants who are allergic to eggs are also at an increased risk, according to the National Institute of Allergy and Infectious Diseases (NIAID).

For these babies at high risk, the American Academy of Pediatrics now recommends that parents begin feeding them peanut products by 4 to 6 months of age to reduce their chances of developing a peanut allergy.

The recommendations are based on a 2015 study known as the LEAP trial, or Learning Early About Peanut Allergy. The theory is that eating peanut products early on helps the body learn that it’s a food that’s safe. “The immune system sees it, but doesn’t attack it,” Sicherer says.

NIAID used the LEAP study to develop guidelines, endorsed by the American Academy of Pediatrics, on the best way to prevent allergies. There are different recommendations for babies at high and moderate risk of allergies and those who aren’t at an elevated risk.

High-risk infants should be tested for peanut allergies before the first introduction of food, either with a blood test or skin-prick test, to see whether they have already developed the allergy. If the tests don’t show a peanut allergy, the nuts can be introduced either at home or—if a parent is concerned—in a doctor’s office. If a skin-prick test shows that the infant might have an allergy, the guidelines recommend that he or she should still be fed peanuts, but only in a doctor’s office.

Infants who have mild or moderate eczema and therefore have some risk of developing a peanut allergy—but not as high—should start eating peanut-containing foods around 6 months of age. If an infant doesn’t have eczema, peanuts should be treated like any other food; they can be added to a diet when the family prefers.

And last, babies shouldn't be fed whole peanuts or plain peanut butter straight from the jar, because they're choking hazards for those younger than 1 year old, Sicherer says. Instead, they can be fed foods cooked with peanuts, such as peanut butter mixed into oatmeal.

Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. CR does not endorse products or services, and does not accept advertising. Copyright © 2019, Consumer Reports, Inc.

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How to Handle Peanut Allergies

Why the Peanut Problem?

Reducing the Severity of the Problem

Can You Prevent Peanut Allergies?