peanut allergy

A peanut allergy occurs when the body's immune system overreacts to proteins in peanuts, mistaking them for something harmful [3]. This can cause a range of symptoms, from mild to severe, including:

• Hives and swelling
• Vomiting
• Life-threatening airway swelling (anaphylaxis)
• Impaired breathing
• Difficulty swallowing or drooling

In severe cases, anaphylaxis can occur, which is a life-threatening whole-body response to an allergen [2]. Symptoms of anaphylaxis may include impaired breathing, rapid heartbeat, and a drop in blood pressure.

Peanut allergies happen when the body's immune system mistakenly identifies peanut protein as something harmful, triggering an overreaction that can cause these symptoms [3].

It's worth noting that peanuts grow underground and are considered legumes, but most individuals with a peanut allergy can tolerate other legumes, such as peas, soybeans, lentils, and chickpeas [4].

Peanut Allergy Signs and Symptoms

A peanut allergy can cause a range of symptoms, from mild to severe. Here are some common signs and symptoms:

• Skin: Hives (red, blotchy skin that can itch) and may include mild to severe swelling [3]
• Lungs: Difficulty breathing, wheezing, coughing, hoarseness, throat tightness, belly pain, vomiting, diarrhea [4]
• Other Symptoms:
  • Impaired breathing
  • Swelling in the throat
  • Sudden drop in blood pressure
  • Pale skin or blue lips
  • Fainting and dizziness [1]
  • Hives, airway swelling, difficulty breathing, vomiting and dangerously low blood pressure [2]
  • Itching or tingling feeling in the mouth
  • Runny nose or congestion [6]

It's essential to seek medical attention immediately if you experience any of these symptoms after consuming peanuts. If left untreated, a peanut allergy can lead to severe reactions, including anaphylaxis.

References: [1] Symptoms may include impaired breathing, swelling in the throat, a sudden drop in blood pressure, pale skin or blue lips, fainting and dizziness. [2] Peanut allergies can cause hives, airway swelling, difficulty breathing, vomiting and dangerously low blood pressure. [3] Signs and symptoms of a peanut allergy · Skin: hives (red, blotchy skin that can itch) and may include mild to severe swelling [4] What Are the Signs & Symptoms of a Peanut Allergy? · wheezing · trouble breathing · coughing · hoarseness · throat tightness · belly pain · vomiting · diarrhea [6] Signs of a peanut allergy · Hives (small red, itchy spots or large welts) · Red, itchy skin · Itching or tingling feeling in the mouth · Runny nose or congestion.

Diagnosing Peanut Allergy: A Guide to Diagnostic Tests

Peanut allergy diagnosis involves several tests that help determine if you have an immune system reaction to peanuts. Here are some common diagnostic tests used for peanut allergy:

• Skin Prick Testing (SPT): This test involves placing a small amount of peanut extract on your skin and pricking it with a tiny needle. If you're allergic, you'll experience redness, swelling, and itching within 15 minutes.
• Peanut Component Panel: This blood test measures IgE antibodies to specific peanut allergens (Ara h 1, 2, 3, 6, 8, and 9). Identifying sensitization to these components can help diagnose a peanut allergy [2].
• Allergen-Specific IgE Blood Test: A small amount of blood is drawn and tested for antibodies produced in response to peanuts. This test can rule out or confirm a food allergy [3].
• Skin Tests or Blood Tests by a Board-Certified Allergist: If done correctly, these tests are reliable and can help diagnose or rule out a peanut allergy [4].

New Diagnostic Methods

A new method for diagnosing peanut allergy was outlined in 2018, which may provide more accurate results [5]. Additionally, diagnostic tests such as skin prick testing (SPT), peanut sIgE, or component testing have a low positive predictive value for making a diagnosis of food allergy [6].

Other Nut Allergies

It's worth noting that some people with a peanut allergy may also be allergic to other nuts, such as tree nuts like hazelnut or chestnut. A diagnostic test for multiple nut allergies is available, which measures immune responses to almond, Brazil nut, cashew nut, hazelnut, macadamia nut, peanut, pecan nut, pistachio, and walnut [7].

Consulting an Allergist

If you suspect a peanut allergy, consult with an allergist who can recommend the best diagnostic test for your specific situation. They may suggest a skin test or blood test to help diagnose whether you have a peanut allergy or another substance [8]. In some cases, patients with a peanut allergy may experience positive results from tests for other tree nuts, such as hazelnut or chestnut [9].

References: [1] Context 1 [2] Context 2 [3] Context 3 [4] Context 4 [5] Context 5 [6] Context 6 [7] Context 7 [8] Context 8 [9] Context 9

Oral Immunotherapy (OIT) for Peanut Allergy

There are several treatment options available for peanut allergies, including oral immunotherapy (OIT). OIT involves the daily consumption of a controlled amount of peanut protein to desensitize individuals to peanuts.

• Palforzia: Palforzia is an FDA-approved form of OIT specifically designed to treat children ages 4 to 17 years with a confirmed peanut allergy. It works by gradually increasing tolerance to peanuts, reducing the severity of allergic reactions.
• Xolair (Omalizumab): Xolair is another treatment option for peanut allergies, particularly in adults. It's a biologic medication that targets an immune protein called IgE, which plays a key role in allergies.

Benefits and Considerations

While OIT can be effective in reducing the severity of allergic reactions to peanuts, it's essential to consider individual factors before starting treatment. These include:

• Age: Palforzia is approved for children ages 4 to 17 years.
• Health conditions: Certain health conditions, such as uncontrolled asthma or eosinophilic esophagitis, may contraindicate OIT.
• Monitoring and follow-up: Regular monitoring and follow-up appointments with a healthcare provider are crucial to ensure the treatment is effective and safe.

Emergency Medications

In addition to OIT, emergency medications like epinephrine (adrenaline) auto-injectors should always be available for individuals with peanut allergies. These medications can help treat severe allergic reactions, including anaphylaxis.

References:

• [1] Treatment with Palforzia may be initiated in individuals ages 4 through 17 years with a confirmed diagnosis of peanut allergy and may be continued in individuals 4 years of age and older.
• [2] A four-year phase 2 clinical trial demonstrated that a peanut allergy treatment called sublingual immunotherapy, or SLIT, is effective and safe, while offering durable desensitization to peanuts in peanut-allergic children. SLIT is a treatment using a tiny amount of peanut protein that is the equivalent of only 1/75 th of a peanut kernel.
• [4] PALFORZIA is the first and only FDA-approved oral immunotherapy to help reduce the severity of allergic reactions to peanuts, including anaphylaxis,
• [10] Palforzia (peanut allergen powder) is an oral immunotherapy product approved in patients 4-17 years of age for the mitigation of allergic reactions, including anaphylaxis, that may occur with accidental exposure to peanuts.

Differential Diagnoses for Peanut Allergy

Peanut allergy can be challenging to diagnose, and it's essential to consider other conditions that may present similarly. The following are some differential diagnoses for peanut allergy:

• Tree nut allergy: This is a common condition that can cause similar symptoms to peanut allergy.
• Acute Gastritis: Inflammation of the stomach lining can cause symptoms like abdominal pain, nausea, and vomiting, which may be mistaken for peanut allergy.
• Acute Urticaria: Hives or itchy skin can be caused by various factors, including allergies, infections, or medications, making it a differential diagnosis for peanut allergy.
• Bacterial Gastroenteritis: Infections like food poisoning can cause symptoms like diarrhea, vomiting, and abdominal pain, which may be confused with peanut allergy.
• Bulimia Nervosa: This eating disorder can lead to gastrointestinal symptoms, such as nausea, vomiting, and abdominal pain, that may be mistaken for peanut allergy.
• Celiac Disease (Sprue): An autoimmune reaction to gluten can cause symptoms like diarrhea, abdominal pain, and fatigue, which may be similar to those experienced in peanut allergy.

These conditions should be considered when evaluating patients for peanut allergy. A thorough medical history, physical examination, and diagnostic tests, such as skin prick testing or specific IgE antibody measurements, are essential for accurate diagnosis.

References:

• [1] May 13, 2024 — Differential Diagnoses · Acute Gastritis · Acute Urticaria · Bacterial Gastroenteritis · Bulimia Nervosa · Celiac Disease (Sprue) · Chronic Gastritis.
• [3] Given the burden of disease and the consequences of a diagnosis of peanut allergy, it is important that peanut allergy be accurately diagnosed so that an appropriate treatment plan can be developed. However, a test that indicates there is peanut sensitization present (eg, a “positive” test) is not always associated with clinical reactivity.
• [9] by M Greenhawt · Cited by 85 — This practice parameter addresses the diagnosis and management of food allergy, including peanut allergy.