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Making sick children better.

Dr John Chapman FRCPCH

Consultant Paediatrician (NHS & Private)

 General Paediatrics, Asthma and Allergy

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Peanut Allergy

A peanut is half pea and half nut. It comes in a pod (monkey nuts) so it is in the same plant family as peas, beans and other pulses. It is a LEGUME.

As far as allergies are concerned, some people are allergic to peanuts + tree nuts, others peanuts + peas/legumes and some unlucky souls to both food groups. Have you read about Lupin?

Peanut allergy often starts in early childhood in the UK, perhaps due to traditional advice not to feed children peanut until 3 years of age. Other cultures include peanut in a baby's weaning diet and have a very, very low incidence of peanut allergy.

Unlike the other common childhood allergies (milk and egg) most children (70%) DO NOT grow out of peanut allergy or develop tolerance to it.

Another contrast to milk and egg allergy is that peanut becomes more allergenic (allergy provoking) as it is cooked. Fresh red peanut will produce less reaction than roasted peanuts.

If you think about it, peanuts are very complicated. Each peanut is a seed which can protect itself from attack by moulds and bacteria and it has everything it needs to grow into a complete peanut plant. To do this it needs lots of different protein machines. Some proteins are for storage of energy, some are defence proteins etc. if you are allergic to peanut, then you will be allergic to one or more of these peanut proteins. In scientific papers they are given number-names such as Ara h8 - short for Arachis hypogea protein number 8. Some proteins are very stable and produce severe reactions and others are easily broken down in the digestive tract and these tend to produce lesser reactions such as a peanut Oral Allergy Syndrome.


Currently there is no treatment for peanut allergy other than avoidance and and Allergy Emergency Plan.

There are ongoing studies into peanut desensitisation. Desensitisation or Oral Tolerance Induction involves taking increasing amounts of peanut (or other allergen) until your immune system gives up reacting. DO NOT TRY THIS AT HOME. Currently the research team has shown that they can desensitise a peanut allergic child. However, it is not clear how long this lasts and whether it makes the child more or less safe in the future. There is concern that a child might be desensitised, but not eat enough peanuts regularly to maintain the desensitisation. They might then eat peanuts thinking that they are safe to do so, but go on to have a significant anaphylactic reaction. This method of treatment should be clarified in the next few years.

An important recent advance in our understanding of peanut allergy comes from the recently reported LEAP study - Learning Early About Peanut. An observation was made that cultures that fed their babies peanut as part of their weaning diet had a much lower incidence of peanut allergy in older children. In this study, atopic babies (after screening for established peanut allergy) were fed peanut early in the weaning process. These children proved less likely to develop peanut allergy. These findings contradict standard UK weaning advice to avoid peanut in children under the age of three years especially if they are allergic. This is probably exactly the WRONG advice. LEAP tells us that atopic babies (with eczema for example) should have screening allergy tests and, if they are not shown to be peanut allergic, they should eat peanut on a regular basis.  

Gazing into my crystal ball, I can see a future where we have less peanut allergic children due to better weaning advice and where children with peanut (and other nut) allergy are safely desensitised to the point of no longer being allergic.

I don't think that this future is more than 10 years away.

Fingers crossed ...

Getting good advice about peanut allergy can make a big difference to the current and future health of your child.

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