Health Essentials from Cleveland Clinic

Separate school lunch tables. No sharing treats. Living with a peanut allergy can make childhood feel like a downer.

But here’s some good news: “Food allergy reactions remain pretty rare. We respect all food allergies, but we don’t want parents to be afraid,” notes allergist and immunologist Jaclyn Bjelac, MD.

Dr. Bjelac offers four science-backed tips on how to help keep your child allergy-free — or living their best life in spite of a severe peanut allergy.

The lowdown on peanut allergies

A peanut allergy is the ultimate irony: Your child’s immune system mistakenly thinks peanuts are dangerous. It then overreacts to the point where eating peanuts becomes, well, dangerous.

“Peanut proteins are very allergenic,” explains Dr. Bjelac. “We also believe that the cooking method affects their allergenicity. Most peanut products consumed in the U.S. are roasted, which increases how allergenic they are.”

And unfortunately, peanut allergies are on the rise, tripling between 1997 and 2008. Dr. Bjelac estimates that peanut allergies now affect around 3% of U.S. children, or 1.2 million children and teens.

“While most food allergy is found in childhood, peanut allergies tend to persist into adulthood. Less than 20% of kids will outgrow a peanut allergy,” relates Dr. Bjelac. “But if you empower yourself with the right information, you and your child can still have a great quality of life.”

Four ways to take control of peanut allergies

Dr. Bjelac recommends these four steps to protect your child from the unthinkable — while avoiding a police state in the process:

1. Prevent peanut allergy

Eat the peanut. Wait, what? Take a lesson from the Israelis. Unlike American children, who were often told to wait till age 3 to eat peanuts, Israeli children are exposed as babies. And they have far less peanut allergies than Americans.

“One of their first finger foods is called Bamba — a puffed peanut butter snack. I call them the Cheerios of Israel,” says Dr. Bjelac. “We now understand that the earlier you eat a food, the more likely your immune system will recognize that it’s safe.”

Still a little skittish? Dr. Bjelac says to take it slow. “Peanuts shouldn’t be your child’s first food. Talk to your pediatrician about how to introduce them.” Some tips for safely introducing your baby to peanut include:

• Try other foods first: Make sure your child is doing well with swallowing purees and other foods before trying a peanut product. That way spitting out the food or gagging will be less likely to occur, which can sometimes be alarming.
• Mix it up: Start with a small amount of a peanut product mixed in with fruit puree, or another food that your child is eating regularly.
• Start small: Feed your baby a small amount of peanut powder or peanut butter mixed with pureed food and wait 15 minutes. If your child has no symptoms, try a normal serving size.
• Don’t wait if there’s a problem: If your child tries a new food and then develops a rash, vomits, has trouble breathing or has any other concerning symptoms, seek immediate medical care.

2. Team up with an allergy doctor

If your child has had an allergic reaction to any food, an allergist can help you figure out what it was and how to manage it. “Parents should be empowered after a visit to an allergy specialist,” notes Dr. Bjelac. Armed with a food allergy action plan, you’ll know about:

• Labels: How to avoid peanuts by reading food labels.
• Symptoms: What peanut allergy symptoms look like.
• Meds: What medicines your child should take for certain symptoms.
• EpiPen®: When your child should use a self-injectable epinephrine device such as EpiPen or Auvi Q.
• Advocate: How to advocate for your child at school or restaurants.

An allergy doctor can also tell you if your child is a good candidate for immunotherapy to treat their allergy. Immunotherapy introduces tiny doses of an allergen to desensitize the immune system to it. There are three main types of peanut allergy treatment:

• Epicutaneous immunotherapy, or the “peanut patch”: Sends small amounts of peanut protein through the skin. Currently being studied.
• Oral immunotherapy “OIT”: When the child eats a small amount of a food allergen such as peanut, and continues that dose every day to help them be “bite-proof.” Some patients who pursue this treatment are able to consume normal serving sizes of the food.
• Sublingual immunotherapy “SLIT”: When very small doses of a food allergen is administered under the tongue and absorbed through the mouth. This “low and slow” process has been shown to confer protection to accidental peanut ingestion in a recent study.

3. Don’t leave home without it (your child’s epinephrine injector)

“I hope you never have to use it, but the epinephrine needs to go wherever your child goes,” cautions Dr. Bjelac. “If you ever need it, I don’t want you to wish you had it.”

4. Trust yourself

While schools are doing their part with peanut-free tables and snacks, these precautions can make children feel on the outs with their peers. “Parents know their child better than anyone else. If you know your child will make smart food choices, won’t share food and will ask for visible peanut residue to be wiped away before sitting down, then your child can sit with their peers,” relates Dr. Bjelac. 

Add to that a surprising silver lining: Most food allergy reactions require mucosal exposure. The peanut has to come in contact with the mouth, inside of the nose or eyes. It’s rare for a child to react to airborne exposure.

“Peanut proteins don’t cause reactions like that. Typically, incidental contact, such as touching surfaces without visible peanut product on them, wouldn’t be enough to cause a whole body reaction.”

But her recommendation goes both ways. “If parents are worried their child is a risk-taker and likes to share food, the peanut-free table is probably a better choice. But these decisions are not always black and white and need to be made based on the individual child. And we need to give kids some credit for taking care of themselves, too.”