What to Do if Your Child Has a Peanut Allergy: A Doctor's Guide

As healthcare professionals, we are constantly reminded of the rising prevalence of food allergies among children, with peanut allergies standing out as one of the most common and dangerous. A peanut allergy is not just a mild inconvenience—it can be life-threatening. This guide will offer a comprehensive, evidence-based approach to managing peanut allergies in children, outlining the necessary steps to create a tailored protection plan for your patients.

Understanding Peanut Allergies

A peanut allergy is a type of food allergy that occurs when the immune system mistakenly identifies proteins in peanuts as harmful. Upon exposure to peanuts, the immune system overreacts, releasing chemicals like histamine, which leads to symptoms that range from mild (itching, hives) to severe (anaphylaxis). For some children, even trace amounts of peanuts can trigger a reaction, making vigilance essential.

Symptoms of a Peanut Allergy

Peanut allergies manifest differently depending on the individual. Reactions can range from mild to severe, and it's crucial for both parents and healthcare providers to be aware of the signs. Common symptoms include:

• Mild reactions: Hives, itching, swelling, and nausea.
• Moderate reactions: Abdominal pain, vomiting, diarrhea, wheezing, and coughing.
• Severe reactions (anaphylaxis): Difficulty breathing, swelling of the throat, rapid heartbeat, dizziness, and loss of consciousness.

Given that anaphylaxis can be fatal without prompt treatment, all families should have a clear emergency plan in place.

Diagnosis of Peanut Allergy

Accurate diagnosis is key to managing peanut allergies. Doctors can confirm a peanut allergy through various tests:

1. Skin Prick Test (SPT): In this test, a small amount of peanut protein is applied to the skin, and a tiny prick is made. If a child is allergic, a raised bump will appear at the site within 15-20 minutes.
2. Blood Tests (specific IgE test): Blood tests measure the level of IgE antibodies specific to peanut allergens. Elevated levels suggest a peanut allergy.
3. Oral Food Challenge (OFC): This test involves giving the child small amounts of peanuts under close medical supervision. It is the gold standard for diagnosing food allergies but carries risks and should only be performed in a clinical setting.
4. Component-Resolved Diagnostics (CRD): A more advanced method of testing, CRD can identify specific peanut proteins that trigger allergies, helping to predict the severity of the reaction.

Immediate Steps After Diagnosis

When a peanut allergy is diagnosed, parents often feel overwhelmed by the lifestyle changes required to keep their child safe. As healthcare providers, it is essential to guide them through these steps:

1. Create an Emergency Action Plan (EAP): This document outlines what to do in case of an allergic reaction, who to contact, and which medications to administer. It should be distributed to everyone involved in the child's life, including school staff, caregivers, and babysitters.
2. Prescribe and Train on the Use of Epinephrine Auto-Injectors: Epinephrine is the first-line treatment for anaphylaxis. Every child diagnosed with a peanut allergy should have access to at least two epinephrine auto-injectors at all times. Ensure that parents, caregivers, and older children understand how to use them correctly.
3. Education and Awareness: It's vital to teach families how to read food labels, recognize hidden peanut ingredients, and communicate the allergy to schools, daycare centers, and social settings.
4. Carry Medical Identification: A medical ID bracelet can be lifesaving in an emergency, providing immediate information about the child’s allergy to first responders.

Dietary Management and Avoidance

The most effective way to manage peanut allergies is through strict avoidance of peanuts and peanut-containing products. However, peanuts are often found in foods where families may not expect them, so diligence is critical.

Reading Food Labels

The FDA requires that peanut-containing products list "peanuts" as an ingredient. Parents must be trained to read labels thoroughly, including advisory warnings like "may contain peanuts" or "processed in a facility that handles peanuts." These warnings indicate cross-contamination risk and should be avoided.

Common foods to watch for include:

• Baked goods: Cookies, cakes, and pastries often contain peanuts or peanut oil.
• Candies and chocolates: Many candies, especially those made in shared facilities, may contain peanuts.
• Processed foods: Some sauces, cereals, and snacks contain hidden peanut ingredients.

Avoiding Cross-Contamination

Even small amounts of peanut residue can trigger an allergic reaction. Cross-contamination occurs when peanut particles are transferred from one food to another via shared utensils, cutting boards, or cooking surfaces. Families should be mindful of this, especially when dining out or at social gatherings. Educating restaurants and catering staff about cross-contamination risks is also crucial.

Developing a Peanut-Safe Environment at Home and School

Creating a peanut-safe environment for a child involves both physical precautions and social awareness.

At Home

• Dedicated peanut-free areas: Consider designating areas of the home as peanut-free zones, particularly the kitchen.
• Safe meal preparation: Use separate utensils, cutting boards, and kitchen equipment to avoid cross-contamination.
• Check beauty and pet products: Some non-food items, such as pet foods or lotions, can contain peanut oils or derivatives.

At School

For school-aged children, implementing peanut-safety protocols in schools is crucial. Collaboration with school nurses and teachers can ensure that the child’s dietary restrictions are respected and emergency measures are in place.

• Peanut-free classrooms or lunch tables: Some schools have implemented peanut-free zones to protect allergic children.
• Training staff on allergies: School personnel, including teachers, cafeteria workers, and bus drivers, should receive training on recognizing allergic reactions and using epinephrine.
• Packing safe lunches: Advise parents to pack lunches and snacks from home to ensure food safety.

Coping with Emotional and Social Challenges

A peanut allergy doesn’t only affect a child’s physical health—it can also influence their emotional well-being. Feelings of isolation, anxiety, and fear are common in children with food allergies. Here are some strategies to help families cope:

1. Foster Communication: Encourage children to speak openly about their allergies with friends, teachers, and other trusted adults. Confidence in self-advocacy can reduce feelings of isolation.
2. Offer Psychological Support: Food allergies can cause significant anxiety for children and parents alike. Consider referring families to counseling or support groups to help them navigate the emotional landscape.
3. Normalize Inclusion: Help families find ways to safely include their children in social activities, such as birthday parties or sports events, by working with hosts to ensure allergen-free options are available.

Medical Treatment Options and New Therapies

While avoidance remains the gold standard in peanut allergy management, new treatments are emerging that may reduce the severity of reactions or even allow for desensitization to peanut allergens.

Oral Immunotherapy (OIT)

OIT involves administering small, gradually increasing amounts of peanut protein to an allergic child under strict medical supervision. Over time, this may help build tolerance to peanuts, reducing the risk of severe reactions. OIT is not a cure, but it can make accidental exposures less dangerous. However, it’s not appropriate for all patients, and families should discuss this option with an allergist.

Palforzia®: FDA-Approved Peanut Allergy Treatment

Palforzia is the first FDA-approved oral immunotherapy for peanut allergies. It's designed for children aged 4-17 and works by gradually desensitizing them to peanut protein. While it does not cure the allergy, it can reduce the severity of accidental exposures. It's important to note that children receiving this treatment must still avoid peanuts in their diet.

Other Therapies on the Horizon

• Epicutaneous Immunotherapy (EPIT): This approach uses a patch containing small amounts of peanut protein that is worn on the skin. Early studies suggest it could be another option for peanut allergy desensitization.
• Biologics: Drugs like omalizumab (Xolair) are being studied for their potential to block the allergic reaction by targeting IgE, the antibody responsible for allergic reactions.

Living with a Peanut Allergy: Long-Term Strategies

1. Annual Checkups: Regular follow-ups with an allergist are essential to monitor the child's condition, assess the risk of accidental exposures, and discuss new treatment options.
2. Stay Informed: Encourage families to stay up-to-date on peanut allergy research and management strategies. Reliable sources include the American Academy of Allergy, Asthma & Immunology (https://www.aaaai.org/) and Food Allergy Research & Education (https://www.foodallergy.org/).
3. Educate Friends and Family: It’s crucial to ensure that everyone in the child’s life understands the severity of the peanut allergy and knows how to respond in case of an emergency.

Conclusion

Managing a peanut allergy requires constant vigilance, clear communication, and a comprehensive protection plan. From diagnosis to emergency preparedness, families and healthcare professionals must work together to ensure the child’s safety. By educating parents, caregivers, and schools, we can empower children with peanut allergies to lead safe, fulfilling lives.