Peanut Allergies 101

by pblovers

Peanut Allergies

About 0.6 percent of the American population has a peanut allergy, according to the National Institute of Allergy and Infectious Diseases (NIAID) Expert Panel. More children are allergic to milk and eggs than to peanuts and more adults are allergic to shellfish than to peanuts.

For those with a true food allergy, as opposed to an intolerance or sensitivity, reactions can be unpredictable and serious and must be taken seriously. It is important to get a diagnosis from a trained food allergist and work with them to develop a plan. Diagnosing a food allergy is complex, and should be conducted by a board-certified allergist. Blood and skin-prick tests can be valuable tools for identifying a food to which a person is sensitized, but are not conclusive in diagnosing food allergies on their own. Oral food challenges are the gold standard for food allergy diagnosis. (1)

For an allergic individual, strictly avoiding the consumption of the offending food is the only sure way to avoid an allergic reaction. Those who are food allergic should always check labels on packaged foods, ask about ingredients in meals at restaurants, and have an emergency action plan in place in case of accidental exposure. The real danger for a person with a peanut allergy is accidental consumption of peanut products by mouth or by being rubbed into mucous membranes like the eyes. Mild reactions may occur if peanuts come into contact with the skin. There is no evidence to suggest that skin contact or airborne exposure can cause an anaphylactic reaction. (2)

Refined peanut oil does not contain the peanut protein and does not pose a risk to people with peanut allergies. The vast majority of peanut oil available to consumers and foodservice is highly refined oil and presents no risk. There is a specialty market for unrefined peanut oil, which may also be called ‘gourmet’, ‘aromatic’ or ‘cold pressed’. These unrefined peanut oils may contain peanut proteins, so they should be avoided.

Peanut Allergy Treatments

It is critical for a person with a food allergy to be diagnosed by a board-certified allergist and to work with that doctor to develop a treatment plan in case of accidental consumption. Epinephrine is the approved treatment for anaphylaxis and should be administered without delay. Individuals should seek medical assistance when a reaction occurs, including calling 911 any time epinephrine is administered.

The most promising strategy to reduce an existing allergy seems to be oral immunotherapy (OIT), which seeks to desensitize the patient to their allergen by providing small, daily doses of the allergen. In theory, the body will eventually recognize the daily dose of allergen as no longer foreign.

In August 2016, a study was conducted to test the safety and effectiveness of OIT. Dr. Brian P. Vickery, assistant professor of pediatrics at University of North Carolina at Chapel Hill, led the study, which included 40 infants and toddlers (9 to 36 months old) with peanut allergy. They received low doses (300mg) or high doses (3,000 mg) of peanut protein each day for at least one year. By the end of the treatment, 81 percent of children were desensitized to peanut protein, including 85 percent of the low-dose group and 76 percent of the high-dose group. More OIT studies are underway, this study suggests OIT may be more easily and durably corrected in young children with peanut allergies. (3)

In January of 2020, the first oral immunotherapy drug for peanut allergy – Palforzia – was approved by the FDA. Many food allergists now offer OIT in their office either with Palforzia or with daily micro-doses of peanut protein which they increase over time.

Peanut Allergy Prevention

In 2017, the National Institute of Allergy and Infectious Disease (NIAID) released recommendations about the early introduction of peanut foods to prevent peanut allergy.(4) The new guidelines recommend introducing peanut foods to infants as early as 4-6 months of age, especially if they are at higher risk for food allergy. This is based on research that showed that early introduction significantly reduced peanut allergy among children at high risk due to severe eczema or egg allergy.(5) The good news is that most babies are not at risk for developing a peanut allergy. The 2020 Dietary Guidelines for Americans (6) recommend that all babies should be introduced to peanut within the first year of life. For more information and recipes on how to introduce peanuts to babies click here. The window to prevent peanut allergy is early and small so ‘early and often’ is key!

1 NIAID. Guidelines for the Diagnosis and Management of Food Allergies in the U.S. Available at
2 JACI. Simonte, S, et al. Relevance of casual contact with peanut butter in children with peanut allergy
3 Vickery, B, et al. Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective. J Allergy Clin Immunol. 2016. Dos:
5 (LEAP) DuToit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372:803-13.