What is the management for peanut allergy?

Management of Peanut Allergy

The cornerstone of peanut allergy management is strict avoidance of peanut-containing products combined with immediate access to intramuscular epinephrine for emergency treatment of accidental exposures. 1, 2

Strict Avoidance Strategy

• Complete elimination of peanut and peanut-containing products from the diet is the primary management approach, as there is currently no cure for established peanut allergy 3, 2
• Carefully read all food labels, as peanut proteins can inadvertently contaminate foods during manufacturing and preparation 4
• Be aware that accidental ingestion through cross-contamination is the primary risk, with 60% of peanut-allergic children experiencing unintentional exposures over 5 years 5
• Avoid kissing someone who has recently consumed peanuts, as this has been reported to cause reactions 5
• Practice proper hand washing after any potential peanut contact, especially before touching mucous membranes (eyes, mouth) 5

Emergency Medication Management

All patients with peanut allergy must carry an epinephrine auto-injector at all times and know how to use it. 1, 4

Epinephrine Dosing for Anaphylaxis

• Adults and children ≥30 kg (66 lbs): Administer 0.3 to 0.5 mg (0.3-0.5 mL) intramuscularly into the anterolateral thigh, up to maximum 0.5 mg per injection 1
• Children <30 kg (66 lbs): Administer 0.01 mg/kg (0.01 mL/kg) intramuscularly into the anterolateral thigh, up to maximum 0.3 mg per injection 1
• Repeat injection every 5-10 minutes as necessary if symptoms persist or recur 1
• Inject through clothing if necessary, and hold the child's leg firmly to minimize injection-related injury 1

Recognition of Allergic Reactions

Mild symptoms include: 6

• New rash
• Few hives around mouth or face

Severe symptoms requiring immediate epinephrine include: 1

• Respiratory distress, airway swelling, laryngospasm, or bronchospasm
• Cardiovascular symptoms: syncope, tachycardia, hypotension
• Gastrointestinal symptoms: vomiting, diarrhea, abdominal cramps
• Angioedema, swelling of eyelids, lips, and tongue
• Any combination of the above symptoms

Important Clinical Caveats

• Peanut oil is generally not allergenic and does not typically cause reactions in peanut-allergic individuals, though highly refined oils are safer than cold-pressed varieties 4
• Approximately 7-14% of patients with peanut allergy experience accidental exposure annually, with one-third to one-half potentially experiencing anaphylaxis 7
• Unlike many other food allergies, peanut allergy usually persists through adulthood and rarely resolves spontaneously 3, 2
• Conventional subcutaneous immunotherapy using crude peanut extract is NOT recommended due to high risk of severe side effects 3
• Fatalities from peanut allergy are rare despite the severity of reactions 7

Emerging Therapies

• Novel approaches under investigation include T-cell-epitope peptide vaccines, hypoallergenic mutant vaccines, and sublingual immunotherapy routes 3
• Processing techniques such as enzymatic hydrolysis, high-pressure processing, and combined hurdle technologies show promise in reducing peanut allergenicity for future therapeutic products 8
• These experimental approaches are not yet standard of care and should only be pursued in research settings 3, 8

Quality of Life Considerations

• Peanut allergy imposes significantly reduced health-related quality of life due to constant vigilance required for avoidance, fear of accidental exposure, and social restrictions 7
• Children with peanut allergy are often bullied, resulting in anxiety and social isolation 7
• Healthcare utilization and economic costs are considerably higher compared to other food allergies 7