Nut Allergy Guidelines Help Manage Peanut, Tree Nut Allergies

Learn how experts recommend diagnosing and treating these allergies

Peanut butter toast
Tanja Giessler/Getty Images

Most doctors and other clinicians caring for people with peanut allergies and tree nut allergies don't have any formal training in managing these types of allergies, and so the care they provide can be inconsistent: You may get different advice depending on which doctor you ask, and the advice provided may not be based on the latest medical research.

Fortunately, nut allergy guidelines published by the British Society for Allergy and Clinical Immunology seek to bring guidance to the health care professionals providing hands-on care to people who are allergic to peanuts and tree nuts.

The guidelines, developed by an expert panel and published in the medical journal Clinical & Experimental Allergy, also provide plenty of self-care tips for people living with these allergies.

Peanut and tree nut allergies require "skilled management and advice," says Dr. Shuaib Nasser, president of the medical society that developed the guidelines. "The guidance has been written by experienced allergy experts and should provide a valuable resource for all those managing people with nut allergy, both in the U.K. and worldwide."

Although the nut allergy guidelines are written for doctors, anyone can read them and use them to improve their own management of severe nut and peanut allergies.

Nut Allergy and Peanut Allergy Often Lifelong Problem

Tree nut allergy and peanut allergy are common in the U.S. and worldwide: Researchers estimate that somewhere between 0.6 percent and 1.3 percent of people in the U.S. are allergic to peanuts and around 0.4 percent to 0.6 percent of people in the U.S. are allergic to tree nuts (which include walnuts, almonds, pistachios, and pecans).

These types of allergies also have been on the rise since the early 1990s.

While some people do outgrow their allergies, most people who develop a nut or peanut allergy in childhood bring it with them into adulthood. That means the number of people affected by this condition will continue to rise.

Even though it's very rare to die from an allergy, it does happen, and nut and peanut allergies are the most common cause of severe and fatal allergic reactions.

Around 165 people died from food allergies in the U.S. between 1999 and 2010. In addition, anaphylactic reactions to peanuts and tree nuts are responsible for thousands of visits to the emergency room every year.

In addition, the near-constant fear of having a bad reaction also causes significant stress for people with nut allergies and their families. That's why having the most up-to-date guidance on how to manage your allergy is so important.

Nut Allergy Guidelines Lead Through Diagnosis, Treatment

The guidelines, which were created by a panel of British physicians but apply to people worldwide, note that nut allergies most often appear in young children—before the child's fifth birthday—and usually occur the very first time a child eats nuts.

Babies have a higher risk of developing peanut allergy when they also have severe cases of eczema, an itchy skin condition that can be associated with food allergies, or when they are allergic to eggs. It's not clear which children may be at higher risk for developing tree nut allergy—the studies haven't been done to show who's at risk—but many people who are allergic to peanuts also are allergic to tree nuts, according to the guidelines.

The best way for doctors to diagnose peanut and tree nut allergies, the guidelines say, is by talking to the patient (and the patient's family, in the case of a child) about reactions to foods, and by using specific medical tests for allergies, the expert guidelines state.

These medical tests can involve skin pricks—your doctor will prick your skin with a tiny amount of the nut or peanut protein thought to cause your allergy—and look for a reaction. The tests also can involve blood tests that look for your immune system's reaction to nuts or peanuts.

As part of your diagnosis, your doctor also may want to perform what's called a food challenge to gauge your reaction to nuts or peanuts. The guidelines say food challenges usually aren't necessary, but may shed more light on the situation if the blood or skin prick test results are inconclusive or conflict with your history of reactions to nuts or peanuts.

If your doctor does want to you to undergo a food challenge, the guidelines say you should make sure it's conducted in the presence of medical professionals who will know how to handle severe allergic reactions.

How to Best Manage Nut and Peanut Allergies

First and foremost, the nut allergy guidelines say people with tree nut and peanut allergies need clear guidance from their doctors on how to avoid nuts and on what they should do if they are exposed to them accidentally.

You need to know how to recognize specific nuts, both in and out of the shell, and learn which types of foods commonly contain nuts or are at risk for cross-contamination from nuts that are processed on the same equipment or in the same facility.

For example, you might be surprised to learn that nuts such as almonds and hazelnuts can be used to thicken soups and sauces, and Thai food commonly contains peanuts and peanut sauce. Dining out can be particularly problematic if you're at risk for a severe allergic reaction, while certain snack foods, such as candy bars, and cereals, such as granola, are at higher risk for nut cross-contamination even if they don't contain nuts.

One way the guidelines recommend to learn about where peanuts and tree nuts can hide is to talk to a skilled dietitian—consider asking your doctor for a referral. A dietitian who specializes in food allergies can teach you how to read food labels and coach you on how to order in restaurants.

In addition, you should understand how to use emergency medications such as adrenaline self-injectors like Epi-Pen and Auvi-Q if you are exposed to tree nuts or peanuts, the guidelines state.

The nut allergy guidelines also stress keeping your asthma under control, since poorly controlled asthma is associated with severe allergic reactions. If you do have asthma, talk with your doctor about controlling it, and make sure to take any prescribed medications regularly.

Nut Allergies Involve the Whole Family

For children who are allergic to tree nuts or peanuts, the whole family needs to be involved in keeping the allergic child safe, the nut allergy guidelines say. This means everyone in the family—including grandparents and any other relatives who spend time with the child—needs to know what foods the child can't have, plus how to handle a reaction.

You'll need to make sure your child's preschool or school understands the allergy, as well. Many schools are well-versed in handling potentially severe allergies like peanut and nut allergies—many ban nuts altogether, in fact—but you can't count on that happening, so always double-check on your own school's policy. The guidelines recommend establishing links with your school's nurse and other health professionals.

Anyone who fixes food for a child who's allergic to peanuts or tree nuts should know how to read food labels and to avoid those foods with a high risk of nut cross-contamination, the nut allergy guidelines say.

A Word From Verywell

The guidelines from the British Society for Allergy and Clinical Immunology are the first to spell out the best ways to diagnose and manage peanut and nut allergies. They apply to care in the U.S. as well as in the U.K.

Although the document is written for physicians, it can help both doctors and patients who have been confused about how to handle these potentially severe allergies. In fact, if you're allergic to tree nuts or peanuts, you should consider reading the guidelines thoroughly and using them to improve your own self-management of your condition.

You also should double-check the guidelines to make sure your doctor is following the most up-to-date treatment recommendations, since the panel that wrote the document reports that many physicians are not up-to-date on severe allergy diagnosis and treatment. And if it's your child who has the allergy, you can use the guidelines to help keep her safe.

Sources:

Cianferoni A, Muraro A. Food-Induced Anaphylaxis. Immunology and allergy clinics of North America. 2012;32(1):165-195. doi:10.1016/j.iac.2011.10.002.

Jerschow E, Lin RY, Scaperotti MM, Mcginn AP. Fatal Anaphylaxis in the United States, 1999-2010: Temporal Patterns and demographic Associations. Journal of Allergy and Clinical Immunology. 2014;134(6). doi:10.1016/j.jaci.2014.08.018.

Melville N, Beattie T. Paediatric Allergic Reactions in the Emergency Department: A Review. Emergency Medicine Journal. 2008;25(10):655-658. doi:10.1136/emj.2007.054296.

Stiefel G, Anagnostou K, Boyle RJ, et al. BSACI Guideline for the Diagnosis and Management of Peanut and Tree Nut Allergy. Clinical & Experimental Allergy. 2017;47(6):719-739. doi:10.1111/cea.12957.

Continue Reading