Un-Shelling Peanut Allergy



During my childhood things were different—we drank water from a garden hose, played outside until our parents told us to come home and we ate lots and lots of peanuts. Peanuts were a staple in many households during my childhood, most commonly for peanut butter and jelly sandwiches. Today, peanut allergy is the third most common food allergy for children in America. Times have changed and we are seeing an increase in peanut allergies. To learn more, I partnered with Ronald Ferdman, MD, physician in the Division of Clinical Immunology and Allergy at Children’s Hospital Los Angeles. Below, I’ll explain peanut allergy and how you can help manage your child’s peanut-free lifestyle as it relates to grocery shopping, school, restaurants and travel.

Peanut allergy facts

A peanut allergy is a rapid reaction to the ingestion of peanuts. Symptoms can include:

  • Skin reactions (atopic dermatitis (also known as eczema), or hives, etc.)
  • Cramps, nausea and diarrhea
  • Aanaphylaxis—a potentially fatal constriction of the airways and swelling of the throat

Though these symptoms are similar to those of other food allergies, peanut allergy symptoms tend to be severe and account for the majority of fatal or near fatal anaphylactic reactions in the United States.

A peanut-allergic person produces massive amounts of histamine as soon as peanuts are introduced in the body through eating. Many peanut allergy sufferers also have tree nut allergies. For many, a peanut allergy is a lifelong problem. However, approximately 20 percent of infants with peanut allergy may outgrow the allergy.

Food items that may contain peanuts

  • Baked goods
  • Candy (chocolate, nougat, candy with nut butter
  • Cereal
  • Energy bars
  • Grain breads
  • Granola
  • Gound or mixed nuts
  • Ice cream and frozen desserts
  • Marzipan
  • Salad dressing

How do I know if my child has a peanut allergy?

Usually, it is very obvious that your child has a peanut allergy.  Most children will react within minutes of eating any product containing peanuts. Common reactions include: spitting out the food; an itchy mouth, tongue or throat; breaking out in hives, swelling or other itchy skin rashes; stomach aches or throwing up; and if severe, breathing problems. Children with more mild allergies or who eat very small amounts may have less obvious symptoms.  If you suspect your child is allergic to peanuts, there are very accurate allergy tests that can be arranged by your health care provider. If your child is diagnosed with a peanut allergy, your health care provider may prescribe an epinephrine auto-injector device, which contains a solution to be injected under your child’s skin if they experience a severe allergic reaction. I found a resource from the National Institutes of Health helpful for more information about epinephrine. If you have any questions, reach out to your child’s health care provider.

A peanut-free lifestyleUn-Shelling Peanut Allergy from Children's Hospital Los Angeles

Even though the presence of peanuts is found in a lot of foods, managing a peanut-free lifestyle can be less stressful with the following tips for grocery shopping, school, restaurants and travel.

Grocery shopping As mentioned above, there are peanuts in a lot of foods especially if the food manufacturer uses peanuts mixed in that cannot be seen. Helpful tips on grocery shopping:

  • Read the label of all manufactured foods.
  • If the label says, “Produced in a factory that processes peanuts,” or one of the many other food advisory warnings, don’t buy it.
  • Do not buy products with unclear labeling, like pastries from a bakery case.
  • If you’ve bought a manufactured food item in the past, continue checking the label—ingredients can change.
  • Create a peanut-fee home. Even if your other children do not have a peanut allergy, do not buy peanuts or peanut products. This helps eliminate cross-contamination.


Peanut butter and jelly is a popular snack in many schools. Peanut butter is sticky and can lead to cross-contamination with other foods, leave residue on lunch tables, hands or drinking fountains. Call your child’s school before their first day and ask about their protocol for peanut allergy children. Many schools have separate lunch tables for food allergic children or prohibit the presence of peanuts entirely. Other tips include:

  • If your child is older, make an arrangement with the school and day camps for your child to carry their epinephrine auto-injector (emergency medicine) in their backpack at all times. If your child has an allergic reaction, the school will know how to find it.
  • Make sure at least one school staff member knows how to operate an epinephrine auto-injector.
  • Remind your child and school staff

o   Never to trade food with school mates. o   Be aware of foods during class birthday and holiday parties o   Tell an adult the moment they feel or witness symptoms

  • Encouraging your child to wear a peanut allergy bracelet. There are cool-looking bracelets online. Search “Food allergy bracelets for kids” on the Internet.


Dining at a restaurant is a fun pastime for many families. Dr. Ferdman provides guidance to many families in situations like this and recommends these five tips for your child’s peanut-free lifestyle:

  1. Carry your child’s epinephrine auto-injector in a purse or bag.
  2. Avoid restaurants that serve a lot of peanut-containing dishes because the risk of cross-contamination increases. Cuisines with a lot of peanut-containing dishes include Chinese, Thai and African cuisine.
  3. Tell your waiter about your child’s peanut allergy. Do not be afraid to tell them that peanut contact can be life-threatening.
  4. Ask your waiter about ingredients. Even if the dish looks and sounds like it doesn’t have peanuts, always ask your waiter.
  5. If you need to, bring food from home for your child to eat.


One of the most common staples of air travel is the little bag of peanuts and in-flight meals. Call the airline in advance and let them know about your child’s peanut allergy. Many airlines are willing to serve non-peanut snacks and meals upon request if enough advance notice is given. Common recommends include,

  • Bringing your own food on trips
  • Bringing ample epinephrine auto-injector. All airlines allow injectable epinephrine as carry-ons as long as it is labeled properly.
  • Knowing how to say “My child is allergic to peanuts” in the languages of the countries you are visiting, or carry a pre-printed language-specific allergy card (which can be purchased on the internet)
  • Locating the neatest emergency department and hospital to your hotel

When you board an aircraft, wipe down seats, arm rests, tray table and window area with a handy-wipe or similar product. You may want to inspect the floor and seat area and remove any peanut residue from previous flights. Children have a tendency to put their fingers in their mouth, which can cause problems for children with peanut allergy if they touch an area known for having peanut products.

Knowledge is power and being aware of food labels, ingredients in recipes, talking to your child’s school and making special arrangements during travel will help protect your child from having an allergic reaction. Also, don’t forget to carry your child’s epinephrine auto-injector at all times.