Nut and Peanut Allergy

Tuesday, December 25, 2007

Oh, nuts! They sure can cause you trouble if you're allergic to them — and a growing number of kids are these days. So what kind of nuts are we talking about? Peanuts, for one, though they aren't truly a nut. (They're a legume [say: leh-gyoom] like peas or lentils.) A person could also be allergic to nuts that grow on trees, such as almonds, walnuts, pecans, and cashews.


When you think of allergies, you might picture lots of sneezing and loads of runny noses. But unlike a mild allergy to spring flowers, a nut or peanut allergy can cause difficulty breathing and other very serious health problems. That's why it's very important for someone with a nut or peanut allergy to avoid eating nuts and peanuts, which can be tough because they're in lots of foods.

Why Does the Body Go Nuts Over Nuts?
When someone has a food allergy, his or her body sort of misfires. Instead of treating a nut or peanut like any old food, the body reacts as if the nut or peanut is harmful. In an attempt to protect the body, the immune system produces antibodies (special chemicals designed to fight infections) against that food.

The antibodies then cause mast cells (which are a type of immune system cell in the body) to release chemicals into the bloodstream, one of which is histamine (say: his-tuh-meen). The histamine then causes symptoms in a person's eyes, nose, throat, lungs, skin, or gastrointestinal tract.

A person with nut or peanut allergies could have a mild reaction — or it could be more severe. An allergic reaction could happen right away or a few hours after the person eats it. Some of the first signs that a person may be having an allergic reaction could be a runny nose, an itchy skin rash such as hives, or a tingling in the tongue or lips. Other signs include:

tightness in the throat
hoarse voice
wheezing
cough
nausea
vomiting
stomach pain
diarrhea
In the most serious cases, a nut or peanut allergy can cause anaphylaxis (say: ah-nuh-fuh-lak-sis). This is a sudden, severe allergic reaction in which several problems occur all at once and can involve the skin, breathing, digestion, the heart, and blood vessels. A person's blood pressure can drop, breathing tubes can narrow, and the tongue can swell. People at risk for this kind of a reaction have to be very careful and need a plan for handling emergencies, when they might need to get special medicine to stop these symptoms from getting worse.

How Is a Nut or Peanut Allergy Diagnosed?
If your doctor thinks you might have a nut or peanut allergy, he or she will probably send you to see a doctor who specializes in allergies. The allergy specialist will ask you about past reactions and how long it takes between eating the nut and getting the symptom, such as hives. The allergist also may ask about whether anyone else in your family has allergies or other allergy-related conditions, such as eczema or asthma. Researchers aren't sure why some people have food allergies and others don't, but they often run in families.

The allergist may also want to do a skin test. This is a way of seeing how your body reacts to a very small amount of the nut that is giving you trouble. The allergist will use a liquid extract of the nut that seems to be causing you trouble. (A liquid extract is a liquid version of something that usually isn't liquid.) He or she also may use liquid extracts of other common allergy-causing foods or substances.

The doctor will make a little scratch on your skin (it will be a quick pinch!) and drop a little of the liquid extract on the scratched spot or spots. Different extracts will go on the different scratch spots, so the doctor can see how your skin reacts to each substance. If you get a reddish, raised spot, it shows that you are allergic to that food or substance.

Some doctors may also take a blood sample and send it to a lab. That's where it will be mixed with some of the food or substance you may be allergic to and checked for certain antibodies.

It's important to remember that even though the doctor tests for food allergies by exposing you to a very small amount of the food, you should not try this at home! The best place for an allergy test is at the doctor's office, where they are specially trained and could give you medicine right away if you had a serious reaction.

How Is It Treated?
There is no special medicine for nut or peanut allergies and most people don't outgrow them. The best treatment is simply to avoid the nut. That obviously means not eating that nut, but it also means avoiding the nut when it's mixed in foods. (Sometimes these foods don't even taste nutty! Would you believe chili sometimes contains nuts to help make it thicker?)

Some people who are very sensitive may need to avoid foods just because they are made in the same factory that also makes nut products. And a kid may have to sit at a special table in the school cafeteria because just smelling or touching someone else's peanut-butter sandwich could cause a reaction. But most kids with peanut allergy just need to avoid eating nuts or foods containing nuts.

Have an Emergency Plan
If you have a serious nut or peanut allergy, you and a parent should create a plan for how to handle a reaction, just in case one occurs. That way your teachers, the school nurse, your basketball coach, your friends — everyone will know what a serious reaction (anaphylaxis) looks like and how to respond.

To immediately treat anaphylaxis, doctors recommend that people with a nut or peanut allergy keep a shot of epinephrine (pronounced: eh-puh-neh-frin) with them. This kind of epinephrine injection comes in an easy-to-carry container that looks like a pen. You and your parent can work out whether you carry this or someone at school keeps it on hand for you. You'll also need to identify a person who will give you the shot.

You might want to have antihistamine medication on hand as well, though if anaphylaxis is occurring, this medicine is not a substitute for epinephrine. After receiving an epinephrine shot, you would need to go to the hospital or a medical facility, where they would keep an eye on you and make sure the reaction is under control.

Handling Your Nut or Peanut Allergy
If you find out you have a nut or peanut allergy, don't be shy about it. It's important to tell your friends, family, coaches, and teachers at school. The more people who know, the better off you are because they can help you stay away from the nut that causes you problems. Telling the server in a restaurant is a good idea because he or she can steer you away from dishes that contain nuts. Likewise, a coach or teacher would be able to choose snacks for the group that don't contain nuts.

Here are some to avoid:

peanut butter, peanuts, and peanut oil
mixed nuts, candied peanuts, beer nuts, and peanut brittle
crushed nuts in sauces
Asian foods (for example, satay and pad thai)
pesto (an Italian sauce made with nuts)
marzipan (a paste made from ground almonds and sugar)
health food bars, energy bars, and sports bars
all cakes and pastries with unknown ingredients, particularly carrot cake, pumpkin cake or pie, and fruit and nut rolls
bouillon and Worcestershire sauce
praline and nougat
muesli and fruited breakfast cereals
vegetarian casseroles prepared with nuts and some veggie burgers or soy burgers
prepared salads and salad dressings
gravy mixes
candy with nuts (M&Ms, Snickers, Hershey bars with nuts, Hershey almond kisses, salted nut rolls, and others)
It's great to have people, like your parents, who can help you avoid nuts, but you'll also want to start learning how to avoid them on your own.

It will help you when reading food labels because there are some ingredients that contain nuts, but have names that sound nothing like nuts — hydrolyzed vegetable protein, for instance. The good news is that many food companies are starting to note on their labels when the product could contain even a trace of peanuts or other nuts.

Here are some other tips that might make life a little easier when you have an allergy to peanuts or nuts:

If you're staying at a friend's house, bring some of your own "safe" food.
Make your own lunches. Try veggie wraps, meat sandwiches, or fruit and cream cheese sandwiches.
Use — and encourage others to use — an antiseptic hand-wash after meals.
Avoid fried foods (especially in restaurants and fast-food places) that may be made with peanut oil.
Consult with a dietitian to come up with safe but delicious meals and snacks.
Carry a list of foods to watch out for in your backpack or bag.
Put some safe foods in your backpack for a quick snack that does not need to be checked.
Become an avid label reader. Check the ingredient list and any processing description such as "this product was manufactured alongside a product that contains peanuts."
Use the manufacturer's toll-free phone number if you have questions about the ingredients contained in your favorite foods.
Having a nut allergy can be a little frustrating, but it doesn't need to keep you from the activities you like to do. In time, you'll probably get very good at avoiding your problem nut. As long as your "problem nut" isn't your brother or sister!