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Peanut, tree nut, and seed allergy: Management

Author
Julie Wang, MD
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Elizabeth TePas, MD, MS

INTRODUCTION

Peanut, tree nut, and seed allergies are some of most common food allergies in both children and adults. These allergies tend to cause severe reactions and usually persist over time.

This topic reviews various aspects of management of peanut, tree nut, and seed allergy, including instructions about avoidance of these allergens, education in the proper management of accidental exposures, and monitoring for resolution of the allergy. The epidemiology, pathogenesis, clinical features, and diagnosis of peanut, tree nut, and seed allergy are discussed separately. General discussions of food allergy are presented separately in appropriate topic reviews. (See "Peanut, tree nut, and seed allergy: Clinical features" and "Peanut, tree nut, and seed allergy: Diagnosis".)

The management of food allergy in the specific settings of schools and camps is discussed in detail separately. (See "Food allergy in schools and camps".)

DIETARY RECOMMENDATIONS

Management of peanut, tree nut, and seed allergies begins with instructions about avoidance of products containing these foods.

Avoidance — The most straightforward approach in managing any food allergy is complete avoidance of the culprit food (table 1 and table 2 and table 3). Foods that are at higher risk of containing peanut, tree nuts, or seeds include African, Asian, and Mexican dishes; baked goods (eg, pastries, cookies, crackers, bread); and candy. (See "Management of food allergy: Avoidance" and "Food allergy in children: Prevalence, natural history, and monitoring for resolution", section on 'Role of avoidance'.)

         

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Literature review current through: Nov 2016. | This topic last updated: Thu Mar 24 00:00:00 GMT+00:00 2016.
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References
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  1. Pieretti MM, Chung D, Pacenza R, et al. Audit of manufactured products: use of allergen advisory labels and identification of labeling ambiguities. J Allergy Clin Immunol 2009; 124:337.
  2. Hefle SL, Furlong TJ, Niemann L, et al. Consumer attitudes and risks associated with packaged foods having advisory labeling regarding the presence of peanuts. J Allergy Clin Immunol 2007; 120:171.
  3. Wensing M, Penninks AH, Hefle SL, et al. The distribution of individual threshold doses eliciting allergic reactions in a population with peanut allergy. J Allergy Clin Immunol 2002; 110:915.
  4. Peeters KA, Koppelman SJ, van Hoffen E, et al. Does skin prick test reactivity to purified allergens correlate with clinical severity of peanut allergy? Clin Exp Allergy 2007; 37:108.
  5. Leung DY, Sampson HA, Yunginger JW, et al. Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med 2003; 348:986.
  6. Flinterman AE, Pasmans SG, Hoekstra MO, et al. Determination of no-observed-adverse-effect levels and eliciting doses in a representative group of peanut-sensitized children. J Allergy Clin Immunol 2006; 117:448.
  7. Kilburn SA, Nordlee JA, Hefle SL, et al. An evaluation of the sensitivity of subjects with peanut allergy to very low doses of peanut protein: a randomized, double-blind, placebo-controlled food challenge study. J Allergy Clin Immunol 1997; 100:596.
  8. Ferdman RM, Church JA. Mixed-up nuts: identification of peanuts and tree nuts by children. Ann Allergy Asthma Immunol 2006; 97:73.
  9. Fleischer DM, Conover-Walker MK, Christie L, et al. Peanut allergy: recurrence and its management. J Allergy Clin Immunol 2004; 114:1195.
  10. Ball H, Luyt D, Bravin K, Kirk K. Single nut or total nut avoidance in nut allergic children: outcome of nut challenges to guide exclusion diets. Pediatr Allergy Immunol 2011; 22:808.
  11. Savage JH, Limb SL, Brereton NH, Wood RA. The natural history of peanut allergy: Extending our knowledge beyond childhood. J Allergy Clin Immunol 2007; 120:717.
  12. Kagan R, Hayami D, Joseph L, et al. The predictive value of a positive prick skin test to peanut in atopic, peanut-naïve children. Ann Allergy Asthma Immunol 2003; 90:640.
  13. Johannsen H, Nolan R, Pascoe EM, et al. Skin prick testing and peanut-specific IgE can predict peanut challenge outcomes in preschoolchildren with peanut sensitization. Clin Exp Allergy 2011; 41:994.
  14. Sicherer SH, Furlong TJ, Muñoz-Furlong A, et al. A voluntary registry for peanut and tree nut allergy: characteristics of the first 5149 registrants. J Allergy Clin Immunol 2001; 108:128.
  15. Chiang WC, Pons L, Kidon MI, et al. Serological and clinical characteristics of children with peanut sensitization in an Asian community. Pediatr Allergy Immunol 2010; 21:e429.
  16. David TJ. Anaphylactic shock during elimination diets for severe atopic eczema. Arch Dis Child 1984; 59:983.
  17. Ito K, Morishita M, Ito A, et al. [Immediate type food hypersensitivity associated with atopic dermatitis in children]. Arerugi 2004; 53:24.
  18. Eller E, Kjaer HF, Høst A, et al. Food allergy and food sensitization in early childhood: results from the DARC cohort. Allergy 2009; 64:1023.
  19. Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 2006; 117:391.
  20. Busse PJ, Nowak-Wegrzyn AH, Noone SA, et al. Recurrent peanut allergy. N Engl J Med 2002; 347:1535.
  21. Boyle RJ, Tang ML. Recurrent peanut allergy may not be prevented by continued peanut ingestion. Int Arch Allergy Immunol 2008; 147:260.
  22. Sampson HA, 2009, unpublished observation.
  23. van Erp FC, Boot J, Knulst AC, et al. Reintroduction failure after negative peanut challenges in children. Pediatr Allergy Immunol 2014; 25:580.