FoodsMatter editor, Michelle Berriedale-Johnson, explains what you need to do when you or your child have been diagnosed with a treenut or peanut allergy.

I have (or my child has) been diagnosed with a peanut or treenut allergy – what do I need to do?

First things that you need to do

• You need to be sure whether you or your child are allergic to peanuts or to treenuts (e.g. almonds, cashews, pine nuts, etc.) – they are quite different things and appear in quite 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 treenuts can be called. This is quite simple for tree nuts but more complicated for peanuts which have lots of different names. (See below for more details.)
• You need to go through your kitchen and get rid of any products that include peanuts or treenuts. Depending on the size, age and shape of your family you may decide later that some members will continue to eat them 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 practise 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 practised with the trainer pen.
• Depending on the age of your child, they should also practise with the pen, even if they do not use it themselves, so that they know what should happen.
• Make sure that you or your child always carry their 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.
• Your child should also wear some sort of Medical Alert jewellery so that if he/she does have a reaction adn they are not with people who know what to do, others can easily find out what is wrong and what they need to do. Check here for MedicAlert in the UK and here for Medicalert in the US.

Who do I need to tell?

The family

• Tell everyone in the family – and 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 (especially if the child is small) and ensure that the child does not come into contact with peanuts or treenuts.
• Tell any close friends, and their children, with whom you or your child may spend time

Child-minders or nurseries

It is very important that you talk to the nursery or child-minder if your child goes to either.  Child-minders may not be prepared to accept the responsibility of 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 know 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.

Schools

• Make sure that you talk to the school about your child’s allergy and, if there is a school nurse, that you talk to him/her. Again, a pre-existing care plan will be very helpful.
• As in the nursery you need to know 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.
• You also need to know how the school will deal with your child’s injector pen when he/she is at school. What happens when they play sport or go on an outing? Does the school have a generic pen and who amongst the staff may have been trained, or be 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 food allergy can be an excuse for bullies to pick on their victims.
• Once you have learnt more about peanut allergy (see below) encourage the school to involve the other children 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 the children but the teachers about the management of food allergy in a really fun and exciting way – all tied into curriculum subjects.
• Karen Waggott, whose son Jamie has a severe nut allergy, 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.
• If your children are small you must also make sure that their friends’ parents know about your child’s allergy. 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.

Other care-givers

If you ever leave your child in the care of another organisation (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.

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 999 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?

This will depend very much on the age of the 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 to be kept in a safe place rather than the child keeping it on them as it could get lost or damaged.)
• They need to know that they should never swap foods with their friends or eat anything that their friends offer them.
• They should learn to recognise the word ‘peanuts’ (or the relevant treenut) even if they cannot read so that they can check foods themselves wherever they are before they eat it.
• 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.
• They need to know that they never need to be ashamed of their allergy. Lots of other children have problems with foods – coeliac children cannot eat any bread or cakes, for example, and diabetic children need to inject themselves. So while having a food allergy is serious and they must be careful, it in no way stops them having a fun and exciting life.

Teenagers

You cannot ‘tell’ teenagers anything very much, but 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 allergy means.
• Encourage them always to carry their adrenaline autoinjector. (See #Take the kit)
• Encourage them to learn to, and enjoy, cooking – the safest way for them to eat!
• Encourage them to be firm and assertive when they go out. By law 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 treenuts are both ‘major allergens’. So, they have a right to know.
  (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 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 eat or my child accidentally eats something containing peanuts or treenuts?

• If you are sure that they have eaten peanuts, watch them 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 999 and tell them that you think someone is suffering from an anaphylactic reaction.
• Be very clear when you give instructions to the emergency services how to find you. Getting lost wastes crucial time. Always provide them with a postcode or zip code to key into their SATNAV and have someone ready 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 very 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 you can get 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 of which 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 tree nut 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 tree nut 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

Why has this happened ?

No one really knows what has caused the massive rise in the incidence not only of peanut allergy (from almost unheard of 50 years ago to one in 70 today) but of allergy in general. But there are many theories.

• Some blame vaccinations (see Heather Fraser’s History of the Peanut Allergy Epidemic).
• Some blame the fact that we have eliminated parasites from our systems (see the helminthic section on our website).
• Some blame the overuse of antibiotics which has drastically upset the balance of the bacterial population of our guts.
• Some blame food processing, junk food and the use of food additives.
• Some blame monocultures and industrial farming which has starved the soil of nutrients.
• Some blame excessive hygiene which has meant that the immune system has become confused.
• Some blame the huge growth in the use of chemicals in the home and our personal care products.
• Some blame the massive growth in the amount of man-made electromagnetic radiation to which we subject ourselves.
• If you would like to investigate some of these theories for yourself we have a whole section of the FoodsMatter site devoted to possible causes of food allergy.

Is there any cure or will you or your child grow out of a peanut allergy?

People do grow out of peanut and nut allergy but it is far less common for a peanut or nut allergic child to grow out of their allergy than an egg or milk allergic child.

So you should assume that a peanut allergy will be with them for life.

However, some interesting work has been going on in research laboratories in both the UK and USA on peanut desensitisation or immunotherapy. In immunotherapy you give an allergy sufferer a tiny amount of their allergen and gradually increase the dose thus ‘educating’ their immune system not to see it as an enemy (never try this at home! It can be very dangerous, and is normally conducted at hospitals where resuscitation equipment is available). For more on immunotherapy see Linda Gamlin's article here.

Although desensitisation may never allow peanut allergy sufferers to eat peanuts freely, it would hopefully reduce their sensitivity to the point that they would be able to tolerate traces of peanuts in other foods, or peanut dust in the air, without ill effect – allowing for a massive improvement in their general quality of life.

This treatment is not yet widely available but may well become so over the next five years.

For lots more really useful information on peanut and tree nut 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.

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 (in brackets) 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.

Treenuts 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 treenut 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.

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