Peanut and Tree Nut Allergies: What to Know and Do (Premium)

 

Michelle Berriedale-Johnson

Michelle Berriedale-Johnson, editor of Foods Matter, explains what you need to do when you or your child have been diagnosed with a tree nut or peanut allergy. As your allergist will tell you, even a tiny amount can cause a serious reaction in sensitive people so it’s important to be fully informed on what you can do to avoid and treat allergic reactions. Though often referred to as a nut, peanuts are actually legumes that grow underground. Please note the special section on staying safe with peanut and tree nut allergies at the end of this article.

After the diagnosis, the first things to do

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• You need to be sure whether you or your child are allergic to peanuts or to tree nuts (e.g. almonds, cashews, pine nuts). They are quite different and can appear in different foods.
• Get as much guidance from your doctor or allergist as you can, and either download a “care plan” or ask your allergist for one. (You can download one from the BSACI site here.) The plan contains instructions on what to do if someone is suffering from anaphylaxis, and has been designed to be used by people with no medical training.
• You need to learn the different names that peanuts and tree nuts may be called. This is quite simple for some nuts, but more complicated for peanuts, which can have lots different names.
• Go through your kitchen and get rid of any products that include peanuts or tree nuts. You may decide later that some members can continue to eat these in the home but, especially if your children are young, it is much safer not to have them in the house.
• You need to be sure that you have your Adrenaline/Epinephrine Auto-injector pen (Epipen, Jext, Emerade) and that you know how to use it. You can get “trainer pens”  from all the suppliers. It is very important that you practice and know what to do. In the unlikely event that someone does have a serious reaction, it will be much easier not to panic and to use the pen properly if you have already practiced with the trainer pen.
• Depending on the age of your child, he or she should also practice with the pen even if they do not use it themselves, so that they are familiar with what should happen.
• Make sure that you or your child always carries the auto-injector pen at ALL times.
• Join the Anaphylaxis Campaign in the UK, FARE in the US, and/or a local support group. The Anaphylaxis Campaign has an excellent help-line and both have lots of local support groups.

Who do I need to tell?

The family

• Tell everyone in the family, not just your immediate family, but grandparents, uncles, aunts and cousins, especially if there are lots of children. You do not want to cause panic, but you do need everyone to know that the condition is serious and that they must be vigilant and ensure that the child does not come in contact with peanuts or tree nuts.

Child-minders, caregivers or nurseries and more

It is very important that you talk to the nursery or child-minders/caregivers if your child goes to either. Caregivers may not be prepared to accept the responsibility of a peanut allergic child, but nurseries should be able manage the situation. A care plan will be of great help, but you still need to discuss the child’s needs in detail with them. You also need to be sure that they know how to use an auto-injector and are prepared to do so if needed – and that they have a proper emergency procedure.

If you ever leave your child in the care of another organization (e.g. a piano teacher, a Scout pack or Sunday school), it’s also vital that they know your child’s allergy needs, and that they know what to do in the event of an emergency.

Schools

• Make sure that you talk to the school about your child’s allergy and, if there is a school nurse, talk to him/her. A pre-existing care plan will be very helpful.
• Be sure they know how to use an auto-injector and are prepared to do so; ask about their emergency procedure.
• What happens when a child plays a sport or goes on an outing? Does the school have a generic pen and who among the staff may have been trained, or is prepared to use it?
• Schools have different policies about whether nuts or peanuts should be excluded from the school (there are arguments on both sides) and you need to discuss this with them.
• Ask about the school’s policy on bullying, as when kids have a food allergy this can be an excuse for bullies to pick on their victims.
• Once you have learned more about peanut allergy encourage the school to involve the other students in the management of your child’s allergy.
• There is a brilliant free school video pack created by Allergy Adventures which will teach not only children but the teachers about the management of food allergy in a fun and exciting way, all tied into curriculum subjects.
• Karen Waggott  has put together an excellent management plan for schools. For the background to the plan click here; for a summary of the plan, click here; for the full plan click here.

Your and your children’s friends

• Your friends and your children’s friends are the best guardians of your safety. Without making a big deal of it, try to make sure that your children tell their friends about their allergy and the importance of always having their auto-injector with them. It is important that while your children remain safe they can, as far as is possible, lead a “normal” life – which includes visiting friends’ houses.

• Telling their friends becomes even more important if they are teenagers. Check here for the Anaphylaxis Campaign’s hugely successful video on this very subject and check into the AC’s site and into this section of the FM site for more help on managing serious allergy for teenagers and students.

Very important:

Make sure that everyone has your phone number and knows that if they think you or your child might be having a serious reaction, they should always call for emergency help (999 in the UK;  911 in the US) and tell the operator that someone is suffering from anaphylaxis (pronounced ana-fill-axis). The emergency services would much rather be called out unnecessarily than get there too late!

What do I tell my child?

If very young:

• They need to know that if they eat something and then ‘feel funny’ – tickly throat or lips, short of breath – they must tell an adult immediately.
• They need to know that they must not eat peanuts and that, unless they know the person offering them food very well (parents or close family members), they should always ask if the food contains any peanuts.

Once they go to school:

• They need to know that if they eat something and then ‘feel funny’ – tickly throat or lips, short of breath – they must tell an adult immediately.
• They need to know that they must always carry their Epipen/adrenaline auto-injector or know who has got it and where to find it. (Some schools may prefer it be kept in a safe place rather than the child keeping it on them, as it could get lost or damaged.)
• Teach them that they should never swap foods with their friends or eat anything that their friends offer them!
• They should learn to recognize the word ‘peanuts’ (or the relevant tree nut) even if they cannot read, so that they can check foods themselves wherever they are before they eat them.
• If they are not sure about a food they should always ask an adult to check it for them.
• If they are worried about a food they should never eat it.
• Kids need to know that they never need to be ashamed of their allergy. Lots of other children have problems with foods. Children with celiac cannot eat any bread or cakes, for example, and many diabetic children need to give themselves an injection. So while having a food allergy is serious and they must be careful, it should in no way stop them having a fun and exciting life.

Teenagers

While perhaps you cannot “tell” teenagers very much, you can “encourage” them…so:

• Encourage them to get involved with a support group such as the Anaphylaxis Campaign or FARE.
• Encourage them to learn and read up about their allergy.
• Encourage them to tell their friends and explain to them what having a peanut or tree nut allergy means.
• Encourage them ALWAYS carry their adrenaline autoinjector. (See #Take the kit)
• Encourage them to learn to cook and enjoy it. Cooking – the safest way for them to eat!
• Encourage them to be firm and assertive when they go out. By law in the UK, any eaterie has to be able to tell their customers whether there are any of the 14 major allergens in their food, and peanuts and tree nuts are both “major allergens.” (See the Freefrom Eating Out Awards for award winning allergen-aware eateries and CanIEatThere? for listed ‘freefrom’ eateries all round the country.)
• Remind them that while no one wants to stop them having a good time, drinking too much alcohol can impair one’s judgement and make one take silly risks. This is where good friends who are aware of your allergy can be very useful.

 What do I do if I someone accidentally eats something containing peanuts or tree nuts?

• If you are sure that peanuts have been eaten, watch very carefully and at the least sign of a reaction (feeling sick, tingly mouth, difficulty in breathing, wheezing or anything else out of the ordinary) call for emergency help. Tell them you think someone is suffering from an anaphylactic reaction.
• Be very clear when you give instructions to the emergency services on how to find you. Getting lost wastes crucial time. Have someone waiting at the door to take them to where the person is.
• If you have an Adrenaline auto-injector (Epinen, Emerade etc) then use it, being careful to read the instructions carefully.  (The pens are easy to use but it really pays off to have “trained” with a trainer pen as using it is then so much less scary.) Even if the reaction is not a bad one, you will not do any harm in using the pen; it is perfectly safe to inject adrenaline/epinephrine even if you do not need it.
• Even if you have used the pen and you/your child feels better, always go with the ambulance, as sometimes there can be a delayed reaction.

What else can I do to keep myself or my child safe?

• If you or your child  are asthmatic, make sure that your asthma is well controlled. Asthma and serious allergy are closely linked, and it is thought that many of the deaths apparently from asthma might in fact have been allergic reactions. Keeping your asthma well under control greatly reduces the risks.
• If you don’t already know how, learn to cook and teach your child to cook! The safest – and the healthiest – way for an allergic person to eat is to cook for themselves!
• We have over 800 recipes in our ‘freefrom’ recipes section, most of which are free from peanuts and tree nuts – but all are coded for what they are free from.
• We also have huge directories of ‘free from’ foods (including ace products like peanut-free ‘peanut butter’!)  – and you can check out our FreeFrom Food Awards site for award-winning peanut and nut-free products.
• Learn more about peanut and  allergy. On the FoodsMatter site we have hundreds of articles and research reports about peanut allergy and allergy in general. Follow the links below to find:

• • Articles and research reports specifically on peanut and  allergy
  • Articles and research reports on anaphylaxis
  • Articles and research reports on the management of food allergy in children and young people
  • Articles and research reports on the management of food allergy in general
  • Articles and research reports on the possible causes of food allergy

For lots more really useful information on peanut and  allergy see the peanut and treenut allergy section of the FoodsMatter site, the Anaphylaxis Campaign site in the UK, the FARE site in the US or Allergy & Anaphylaxis Australia in Australia or New Zealand.

 Additional information on staying safe with peanuts and tree nuts

Other names for peanuts:

• Arachide
• Arachis oil
• Beer Nuts
• Cacahuete
• Earth nuts
• Goober Nuts/Peas
• Groundnuts
• Mandalona nuts
• Monkey nuts

Where will you find them?

• Peanuts are used as an ingredient in some processed/manufactured foods (such as satay sauce) although not in very many. However, they can also be substituted for more expensive ingredients (such as ground almonds) so do be sure to check labels very carefully.
• Because peanuts are a major allergen they should always appear after the ingredient of which they are a constituent part but if that ingredient has not been properly labelled, or comes from outside the EU, it may not be.

Some unexpected places in which you might find peanut or peanut products:

• Almond powder & chopped almonds can contain peanuts
• Bakery products sold loose
• Chinese & Indonesian dishes in general
• Chocolate from Poland
• Curry sauces
• Hydrolysed vegetable protein (occasionally)
• Medicines and supplements (peanut oil*)
• Oil in which peanut products have previously been fried
• Sweets such as jelly babies
• Worcester sauce

NB * Research would suggest that peanut allergic people do not react to refined peanuts oils although very sensitive people should still be careful.

Tree nuts and where you might find them (not an exhaustive list…)

• Almonds
• Brazil nuts
• Cashews
• Chestnuts
• Hazelnuts
• Macadamias
• Pecans
• Pine nuts (pine nuts are a seed not a nut so although you can be allergic to pine nuts, it is not a ‘nut’ allergy – although those who are nut allergic can, occasionally, also be allergic to pine nuts. See here for more. )
• Pistachios
• Shea nuts (very rarely allergenic – see here for more)
• Walnuts

Common tree nut based products to be aware of: (not an exhaustive list…)

• Gianduja
• Marzipan
• Nut butters (e.g. cashew butter)
• Pesto (look out for treenut free pestos!)
• Praline
• They also frequently appear in cereal, sweets, biscuits, desserts – always check the label!

If you found this article interesting, you will find many more articles on peanut and tree-nut allergy here, and reports of research into the conditions here.
You can also find articles on anaphylaxis here, cow’s milk allergies here, egg allergy here, histamine intolerance here and articles on a wide range of other allergic and intolerance reactions to a wide range of other foods here.

Note: Information on this site is not a substitute for medical advice and no liability can be assumed for its use.

Editor’s note: This article has been condensed and adapted with permission from the original.

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