Understanding Peanut Allergy: Risks, Prevention, and Modern Management

Peanut allergy is an immune reaction that can be mild or life-threatening. Most cases begin in infancy. Modern research supports early, age-appropriate introduction for many infants to reduce risk. Management centers on avoidance of exposure, carrying epinephrine and working with an allergist. Food labeling laws require peanut disclosure, but advisory labels and school policies vary. Oral immunotherapy is an option for some patients under specialist care.

What is a peanut allergy?

A peanut allergy is an immune response to proteins in peanuts. Reactions range from mild hives or itching to life-threatening anaphylaxis. Sensitive people can react to very small amounts through eating, cross-contact (shared equipment or surfaces), or, less commonly, inhalation of airborne peanut particles.

Symptoms and emergency response

Early signs include itching, hives, swelling, stomach pain, vomiting, or nasal congestion. A severe reaction can cause throat tightness, wheezing, difficulty breathing, a drop in blood pressure, loss of consciousness, and can be fatal without prompt treatment.

If you suspect anaphylaxis, give intramuscular epinephrine immediately and call emergency services. Antihistamines can relieve itching but do not replace epinephrine. People with known peanut allergy should carry an epinephrine autoinjector and have an emergency action plan developed with their clinician.

Who is at risk and how allergies start

Peanut allergy most often appears in infancy or early childhood, frequently at first introduction of peanut-containing foods. A family history of allergies and personal history of eczema or other food allergies increases risk. While some children outgrow peanut allergy, many continue to be allergic into adolescence and adulthood.

Since 2015, randomized trials and national guidelines (for example, the LEAP study and subsequent guidance) have changed prevention advice. Introducing age-appropriate peanut-containing foods early - often around 4-6 months for high-risk infants under a clinician's guidance - can lower the chance of developing a peanut allergy. Talk with your pediatrician or allergist about the right timing and method for your infant.

Diagnosis and newer treatment options

Diagnosis starts with history and allergy testing (skin or blood tests) and may include supervised oral food challenges. Referral to an allergist is appropriate for most suspected cases.

Oral immunotherapy (OIT) for peanut allergy has become an option for some patients. An FDA-approved OIT product is available for certain children and requires strict medical oversight; it can increase the threshold that triggers a reaction but is not a cure. Discuss risks, benefits, and alternatives with an allergist.

Labels, schools, and daily management

In the United States, major food allergens including peanuts must be declared on packaged-food labels under FALCPA. Voluntary advisory statements ("may contain") indicate possible cross-contact but are not standardized. Parents and caregivers should read labels, ask about ingredients when dining out, and prevent cross-contact at home.

Inform your child's school, daycare, or camp of the allergy. Policies vary: some institutions use peanut-free tables or classrooms while others rely on individual action plans and staff training. Ensure the school has epinephrine available and staff trained to recognize anaphylaxis.

Practical tips

Carry epinephrine, wear medical ID if appropriate, read labels every time, and maintain regular follow-up with an allergist. For infants, discuss early introduction strategies with your clinician rather than avoiding peanuts by default.