Peanut Allergy in Children and Teens

Depending on how sensitive your child’s immune system is, any type of exposure to peanuts or peanut residue can trigger an allergic reaction, including:

• Eating peanuts or peanut butter
• Eating any food made with peanuts, which can happen accidentally
• Touching peanuts or peanut residue before putting their hands in their mouth or rubbing their eyes
• Breathing in peanut residue

If your child is having an allergic reaction to peanuts, you may notice:

• Hives
• Swelling of skin tissue
• Skin rash (redness or itching)
• Itching or tingling in or around the mouth and throat
• Diarrhea
• Stomach cramps
• Nausea or vomiting
• Tightening of the throat
• Shortness of breath or wheezing

Anaphylaxis is a severe, life-threatening allergic reaction that can affect the whole body. Call 911 immediately if your child shows signs of anaphylaxis, such as:

• Difficulty breathing
• Swelling or closing of the throat
• Sudden drop in blood pressure (shock)
• Turning pale
• Blue lips
• Dizziness or lightheadedness
• Fainting

An allergic reaction usually starts within minutes after a child has contact with peanuts. Although, in some cases, symptoms can happen in two phases — sometimes hours apart.

Like others, peanut allergy is most common in younger children, especially infants and toddlers. But, a peanut allergy can develop at any age — even in adulthood. Some children may have contact with peanuts multiple times without symptoms before their immune system responds with an allergic reaction.

Children can be tested for peanut allergy at any age. However, testing is generally recommended for children who:

• Have experienced an allergic reaction
• Have moderate to severe eczema

Yes, pediatricians can perform blood tests for food allergy. However, if the test result is positive, we recommend a consultation with one of our pediatric allergists or nurse practitioners to confirm the results and provide further evaluation.

Our specialists will review and discuss your child’s medical history, perform a physical exam, and possibly use a skin prick test and/or a blood test to find out whether your child has a peanut allergy. In some cases, we may recommend an oral food challenge to confirm your child’s diagnosis.

If allergy test results and medical history do not show for certain whether or not your child has (still has) a food allergy to a specific food, we recommend that your child have an oral food challenge test. 

The oral food challenge involves eating a serving of the allergic food in a slow, graded fashion under medical supervision.  The food challenge procedure is the most accurate test to determine whether a food needs to be avoided or will no longer need to be avoided.

The food challenge is undertaken when your child is in generally good health and can discontinue antihistamine for a brief period (usually three days) before the test.

During the food challenge, your child will be given very small amounts of the specific food being tested. If tolerated, increasing amounts of the challenge food will be given with close observation at each stage.

Your child will be observed for symptoms such as itching, rash, abdominal pain or difficulty breathing. If any symptoms develop, your child will be treated immediately. In most cases, this will involve the use of diphenhydramine and/or epinephrine to prevent any allergic reactions from getting worse. In studies of food challenges, many children develop mild symptoms during a food challenge that require these treatments. Very rarely, other treatments are needed for more serious reactions. 

In some cases, your doctor may decide to place an IV in your child’s arm before the challenge starts. This would be used to give medicine if needed. 

In some cases, the food challenge is performed by masking the food to hide the taste, and using food that looks/tastes the same but does not contain the food being tested. This is called a placebo. These procedures reduce the possibility that we would misjudge a reaction to the food that could occur from fear or distaste of the new food.

The discomforts associated with the food challenge are generally no more than those encountered when eating the food. Symptoms usually are short-lived (less than 2 hours). Symptoms may include an itchy skin rash, nausea, abdominal discomfort, vomiting, diarrhea, stuffy “runny” nose, sneezing or wheezing. 

The major risks involved include severe breathing difficulties and rarely a drop in blood pressure. While a severe outcome such as death is theoretically possible, this has not occurred from medically supervised oral food challenges. The risk of a reaction is reduced by starting the challenge with very small amounts of food, administering the food over a prolonged time period, stopping the challenge at the first sign of a reaction and by not giving any food suspected to cause a major reaction.

The best prevention plan is to avoid contact with peanuts. Our team can help you and your child learn helpful tips and practices for home, school, restaurants and other places.

In some cases, over-the-counter antihistamines (such as Benadryl or Zyrtec) are useful to treat mild allergic reactions in children.

An auto-injector, most commonly known as an EpiPen, delivers medication (epinephrine) to instantly treat symptoms of an allergic reaction when a child has contact with peanuts. You, your child and any other caregivers should keep the auto-injector accessible at all times in case your child accidentally comes in contact with peanuts. Our team will help you and your child learn how and when to use an auto-injector.

If your child has a severe allergic reaction and needs emergency care, specialists may suggest steroids to help treat inflammation and to keep symptoms from recurring or worsening.

If your child has asthma symptoms after a severe allergic reaction, specialists may suggest an inhaler or a nebulizer treatment to help your child breathe more comfortably.

Recovery is different for every child, especially depending on how mild or severe their symptoms are. An allergic reaction can clear up in minutes, hours or days.

Peanut allergy is often a lifelong health condition. However, there are children who outgrow it. In these cases, as the child grows up, their digestive system matures and becomes able to handle exposure to peanuts without having an allergic reaction. It’s also possible that the peanut allergy can recur.