Frequently asked peanut allergy questions - peanuts

Understanding peanut allergies helps those friends or family members who have allergies feel more included and understood. Most importantly, understanding peanut allergies is important in keeping everyone safe. We’ve answered the most frequently asked peanut allergy questions so you can help support those you know with peanut allergies.

Can someone with an allergy have a little bit of peanut?

No. In most cases, a person who is allergic can’t have any peanuts or foods that have had cross-contact with peanut. However, until recently, little clinical data or studies were available to understand the true thresholds for how much peanut does cause a reaction. The golden standard for being tested for a food allergy today is an oral food challenge (OFC). A food challenge typically takes place at a doctor’s office and can last between 4 and 6 hours. Over the course of that time, the person being tested receives increasing doses of food. The test is double-blind such that both the doctor or nurse administering the food and the subject do not know whether the food contains the allergen. However, over the course of the challenge the person will be subjected to the food. The double blind test helps eliminate potential false or emotionally triggered reactions. If a person gets a reaction it is typically mild such as a slight rash. It’s important to note that most reactions are not severe during OFCs. If the person doesn’t develop any symptoms during the challenge, it can be determined that they are not allergic to the food. For peanut, many clinics challenge the person to consume 5 mg to 6 mg of peanut to determine an allergy.

Are most allergic reactions to peanut anaphylactic?

No. A recent study has shown that the breakdown of reactions to peanut in children is mostly non-severe. Reactions to peanut vary widely from stomach aches, skin reactions, and in some extreme cases anaphylaxis. The threshold study used predicted elicit dose that is believed to affect 95% of all patients – for peanut is 1.5 mg of peanut protein (6 mg of whole peanut).

  • 245 (65%) children experienced no reaction to the single dose of peanut.
  • 67 (18%) children reported a subjective reaction without objective findings.
  • 58 (15%) children experienced signs of a mild and transient nature that did not meet the predetermined criteria.
  • Only 8 (2.1%; 95% CI, 0.6%-3.4%) subjects met the predetermined criteria for an objective and likely related event. No child experienced more than a mild reaction, 4 of the 8 received oral antihistamines only, and none received epinephrine.

Note: none of the subject’s reactions levels were known beforehand. 378 children completed the study. All of the children had only a minor amount to test for threshold but with their known allergy a larger dosage of peanut may have affected them adversely.

Reactions can vary based on which peanut protein one is allergic to. For example, someone who might be allergic to Arh 1 might have peanut anaphylaxis while someone who is allergic to Arh 8 might experience an oral reaction such as mouth itches.

There are many factors that affect the reactions individuals have. The most notable ones known today is asthma as well as general seasonal allergies. For example, Sicherer et al. (1998) observed that mild reactions to peanut in childhood tend to become more severe and unpredictable in later childhood and adulthood. However, this was later found to be due to the fact that these children tend to develop asthma later in life (Sampson, 2005). Links have been found between tree pollen and the incidence of peanut allergies such as a study done in South Korea that showed “the increase in Fagales pollen allergy can influence the prevalence of peanut allergies” (Park 2016).

Is someone with a peanut allergy allergic to all peanuts?

In most cases, but not always. There are many varietals of peanuts – the most common peanut varieties in the U.S. are Runner, Virginia, Spanish and Valencia, with Runner claiming about 80 percent of production. Each peanut varietal contains different quantities of peanut proteins. There are some interesting new startups and university laboratories that are working on removing some of the allergenic peanut proteins from peanuts, creating potentially new and safe peanuts!

Will peanut oil cause a reaction for someone with a peanut allergy?

It depends. Reactions depend on how the oil is processed. Peanut oils, if refined are safe! All allergenic proteins are removed in the process. However, if the oil is crude, then the proteins might still present and a person can react to them. About 10% of individuals in one study reacted to crude peanut oil (Hourihane 1997). According to the FDA: “Studies show that most individuals with peanut allergy can safely eat peanut oil (but not cold-pressed, expelled or extruded peanut oil – sometimes represented as gourmet oils).”

Unsure if oil is crude or not? You should always ask the restaurant about their practices and ingredients, but Nima can be there for you as that additional help to test ingredients such as peanut oil and help you have one more data point to know if the sample is peanut-free.

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Resources:

  • Sicherer, S. H., Burks, A. W., Sampson, H. A. (1998). Clinical features of acute allergic reactions to peanut and tree nuts in children. Pediatrics, 102:1-6.

Frequently asked peanut allergy questions