How are peanut allergies managed? What is the treatment for a peanut allergy?
Strict avoidance of peanuts and prompt treatment of accidental ingestions are the mainstays of management of peanut allergy. The goals of treatment are to minimize the risk of accidental ingestion while maintaining adequate nutrition and an acceptable quality of life.
Although there is significant research focused on oral immunotherapy and desensitization protocols for peanut allergy, these treatment options are still not ready for widespread clinical use. There is also significant research involving a peanut patch, also known as epi-cutaneous immunotherapy.
Early studies of this patch have shown that by applying a patch containing peanut protein to the skin, it may be possible to make peanut allergic individuals less sensitive to peanut protein and it may protect certain peanut-allergic individuals from experiencing a reaction to an accidental peanut exposure. There are still many questions regarding this possible form of therapy and it is still not ready for widespread clinical use.
Peanut is a common food in the Unites States, and strict avoidance requires constant awareness of food labels and food ingredients. United States legislation requires all food companies to identify on labels whether their products contain the most common food allergens, including peanuts.
Advisory labeling practices, such as those stating "may contain peanut," "manufactured on shared equipment with peanut," or "manufactured in the same facility as peanut," are not regulated. The potential risk of ingesting peanut from foods labeled with advisory labeling is unknown, so peanut-allergic individuals should also avoid these foods.
Despite attempts at strict avoidance, accidental ingestions occur in up to 15% of patients per year, as evidenced by a British study. All individuals with a peanut allergy should have an emergency action plan outlining the treatment plan for an acute reaction. Since epinephrine injection is the only treatment for a significant allergic reaction, all individuals with a peanut allergy should carry an epinephrine auto-injector (Auvi-Q, Epipen, Twinject) at all times.
Although antihistamines such as diphenhydramine (Benadryl) may also be used in the management of acute allergic reactions, epinephrine generally remains the treatment of choice. Individuals who experience an acute allergic reaction to an accidental peanut exposure should also notify a health care professional. It is very important to note that the severity of acute reactions is variable and cannot be predicted by diagnostic testing or previous reactions. Risk factors for poor outcomes from peanut allergy include asthma and delayed treatment with epinephrine.
There are important additional considerations in managing and counseling individuals with peanut allergy. Research has shown that reactions due to skin contact are typically limited to the site of contact and unlikely to cause a systemic reaction or anaphylaxis. Similarly, the vast majority of peanut-allergic individuals will tolerate being around peanuts and the smell of peanut, since peanut protein is not airborne.
The majority of peanut-allergic individuals will also tolerate peanut oil, since the peanut protein is not present in the highly purified oils, except in the rarer cold-pressed oils. Although peanut is a legume, most peanut-allergic individuals will also tolerate other legumes, such as soy, peas, and green beans. Exposure to peanut through another person's saliva (such as from kissing) has been shown to trigger a reaction. All peanut-allergic individuals should discuss these considerations and other questions with their health care provider.