Peanut allergies in children
Generally, children younger than five years old should steer clear of nuts because they pose a choking hazard, but nuts – and peanuts in particular – can pose a real danger for those with allergies, lspecially when ingested unknowingly as pastes, butters or oils concealed in other foods.
Although the exact cause of nut allergy remains unclear, it is on the increase. And while genetic factors raise susceptibility, even children with no family history of allergies are at risk of developing it.
Peanuts form part of the legume family and have strong antioxidant properties. And while most can benefit from this highly nutritious food type, some people’s immune systems can be hypersensitive to the protein component.
What exactly is a food allergy?
A food intolerance is a hypersensitivity that usually causes gastrointestinal problems. A food allergy, on the other hand, is an immune system response that forms a line of defence by means of antibodies. The distinction between the two is critical, because allergies can range from mild to severe and even life-threatening in some cases.
Food allergies are divided into two categories:
- Immediate type (IgE-mediated)
- Delayed type (non-IgE-mediated)
Peanuts belong to the IgE-mediated allergy group. Reactions can occur anywhere from a few minutes to a couple of hours after ingesting, and are characterised by these symptoms:
- Itchy skin
- Swollen or itchy eyes
- Swollen lips or tongue
- Anaphylaxis, a severe allergic reaction that is life-threatening. It is distinguished by sudden and severe onset, can affect breathing and heart rate, and requires immediate emergency medical treatment.
How does one deal with a peanut allergy?
As with food allergies in general, there is no cure for peanut allergies. Avoidance and awareness of foods containing peanuts is critical, so always read product labels and especially watch out for these:
- Peanut butter
- Cereal bars
- Vegetable fats and oils
- Biscuits and rusks
- Certain sweets, including chocolates and nougat
For children with a peanut allergy, schools and daycare centres are perhaps two of the most important places where awareness and prevention should be observed. Many schools encourage healthy eating and washing of hands before and after eating, with some even enforcing peanut-free policies. Communal and supervised eating times are becoming more commonplace, which help to eliminate the chance of accidental ingestion through food sharing. If your child has a known peanut allergy, make sure you inform their teachers and carers.
Milder reactions to peanuts can be treated with antihistamine medications, but severe reactions such as anaphylaxis requires muscle-injected adrenaline. In such cases, it is mandatory for sufferers to carry an EpiPen adrenaline auto-injector prescribed by a specialist.
Can children outgrow a peanut allergy?
The answer in some cases is an encouraging yes – studies indicate that approximately 20% of children with a peanut allergy eventually outgrow their allergy. This can be determined by a doctor specialising in allergies through standard skin, blood and food tolerance testing. Younger siblings of children allergic to peanuts may be at increased risk, so consult your doctor about testing them.
When can I safely introduce nuts in my child’s diet?
The American Academy of Pediatrics suggests you wait until your child is at least four years old before offering nuts – and to chop them into small pieces if you give it earlier to prevent choking. Since peanut butter and other nut butters aren’t a choking hazard if spread thinly, you can offer spreads on bread or crackers after the age of 12 months, but pay close attention for any signs of a reaction. If you have a family history of allergies, or your child has other known food allergies, first consult with your doctor or paediatrician, who may suggest that you wait longer.
Reviewed by Dr Mike Levin, Head of Division of Asthma and Allergy at the University of Cape Town.