Peanut Allergy

Peanuts can cause a severe, potentially life-threatening allergic reaction (anaphylaxis). Allergic reactions can be unpredictable, and even very small amounts of peanut can cause a serious allergic reaction. 

Casual skin contact is less likely to trigger a severe reaction, and can become a problem if the affected area then touches the eyes, nose or mouth. For example, if a child with peanut allergy gets peanut butter on her fingers and rubs her eyes, she can have an allergic reaction.

If you have a peanut allergy, keep an epinephrine delivery device with you at all times. Epinephrine is the first-line treatment for anaphylaxis.

To prevent a reaction, it is very important that you avoid peanut and peanut products. Always read food labels to identify peanut ingredients.

Peanuts and tree nuts often touch one another during manufacturing and serving processes, and may cause an allergic reaction due to cross-contact. Discuss with your allergist whether you need to also avoid tree nuts.

Peanut is one of the eight major allergens that must be listed in plain language on packaged foods sold in the U.S., as required by federal law, either within the ingredient list or in a separate “Contains” statement on the package. This makes it easy to see if peanut is present in a food item. 

Avoid foods that contain peanuts or any of these ingredients:

• Arachis oil (another name for peanut oil)*
• Artificial nuts
• Beer nuts
• Cold-pressed, expelled or extruded peanut oil*
• Ground nuts
• Lupin (or lupine)—which is becoming a common flour substitute in gluten-free food. A study showed a strong possibility of cross-reaction between peanuts and this legume, unlike other legumes.
• Mandelonas (peanuts soaked in almond flavoring)
• Mixed nuts
• Monkey nuts
• Nut meat or nut meal
• Nut pieces
• Peanut butter
• Peanut flour
• Peanut protein hydrolysate

*Highly refined peanut oil is not required to be labeled as an allergen. Studies show that most people with peanut allergy can safely eat this kind of peanut oil. If you are allergic to peanuts, ask your doctor whether you should avoid highly refined peanut oil.

Everyone with peanut allergy should avoid cold-pressed, expelled or extruded peanut oils—sometimes called gourmet peanut oils. These oils are not highly refined and may contain small amounts of peanut protein.

Other Possible Sources of Peanut

Peanuts can be found in surprising places. While allergens are not always present in these food and products, you cannot be too careful.

Remember to read food labels and ask questions about ingredients before eating a food that you have not prepared yourself. If in doubt about the ingredients, do not eat the food. 

• African, Asian (especially Chinese, Indian, Indonesian, Thai and Vietnamese), and Mexican restaurant food—even if you order a peanut-free dish, there is high risk of cross-contact
• Alternative nut butters, such as soy nut butter or sunflower seed butter, are sometimes produced on equipment shared with other tree nuts and, in some cases, peanuts. Contact the manufacturer before eating these products.
• Candy (including chocolate candy)
• Chili
• Egg rolls
• Enchilada sauce
• Glazes and marinades
• Grains (such as Museli cereal)
• Granola
• Ice creams
• Marzipan
• Nougat
• Pancakes
• Pet food
• Sauces such as chili sauce, hot sauce, pesto, gravy, mole sauce and salad dressing
• Specialty pizzas
• Sunflower seeds (which are often produced on equipment shared with peanuts)
• Sweets such as pudding, cookies, baked goods, pies and hot chocolate
• Trail mix
• Vegetarian food products, especially those advertised as meat substitutes

Also, peanut hulls (shells) can sometimes be found in compost, which can be used as lawn fertilizer. Before you hire a contractor, ask whether they use peanut hulls in their compost so you can make an informed decision.

1 Sicherer SH, Munoz-Furlong A, Burks AW, Sampson HA. Prevalence of peanut and tree nut allergy in the US determined by a random digit dial telephone survey. J Allergy Clin Immunol 1999; 103(4):559-62; see also Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol 2003; 112(6):1203-7.
2 Sicherer SH, Munoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 2010; 125(6):1322-6. [LINK to ADVANCING A CURE>FARE Research Grants>Selected Completed Studies > Sicherer, Prevalence of Peanut and Tree Nut Allergy in the United States]

Allergy to peanuts appears to be on the rise in children. According to a FARE-funded study, the number of children in the U.S. with peanut allergy more than tripled between 1997 and 2008.⁴ Two studies in the United Kingdom and Canada also showed a high prevalence of peanut allergy in school-aged children.

Peanut allergies tend to be lifelong, although studies show that about 20 percent of children with peanut allergy do eventually outgrow their allergy.¹

Younger siblings of children who are allergic to peanuts may be at higher risk for allergy to peanuts.⁵ Your doctor can provide guidance on  food allergy testing for siblings. Recent research shows that introducing infants to peanuts early on may help prevent them from developing this food allergy. FARE provides additional resources on this on babyfirst.org.