Introduction

Peanut is one of the most common food allergies in childhood.

It persists in 80% of cases.

Specific IgE or Skin Prick Test in early life can be used to predict persistence or resolution

In the presence of a typical, supportive history of peanut allergy, IgE-based test results do not have to be over the known 95% positive predictive value “decision points” for the diagnosis to be secure.

Most people with peanut allergy have asthma or eczema or hayfever.

85% of peanut allergic children react on their first exposure to peanut.

60-70% of first reactions are mild to moderate. Reactions are usually very stereotyped involving combinations of facial swelling, rash, hives.

30-40% of first reactions involve wheeze; wheezing and feeling faint are signs of anaphylaxis.

Second and subsequent reactions are not automatically more severe.

Severity of future reactions is hard to predict, so most peanut allergic individuals need to be equipped with Adrenalin autoinjectors.

50 % of children with peanut allergy will develop tree nut allergy. All peanut allergic children should avoid tree nuts from first diagnosis until tested for tree nuts using Skin Prick Test or specific IgE.

Negatively tested tree nuts can be introduced to the home diet, but must be avoided in prepared foods and out of home meals to avoid contamination/substitution by peanut.

Peanut allergy is easily managed by prudent avoidance and carriage of rescue medications, some families find this very difficult.

Most young children with peanut allergy can easily avoid it, while their parents control their diet. Early dialogue about care outside the home is important when counseling families.

All but the least sensitive peanut allergic children will need Adrenalin autoinjectors but other factors are important, such as severity of previous reactions, asthma, and ease of access to emergency support.

Peanut allergic teenagers are at a higher risk of severe and even fatal reactions probably related to their risk taking behavior, non compliance with peanut avoidance and carriage of Adrenalin autoinjectors.

Inhalant contact with peanut is usually well tolerated and rarely causes more than minor irritation.

Minor skin contact usually causes minor reactions.

The introduction of peanut to the infant diet should not be delayed hoping to prevent peanut allergy as this has not been proven to be effective.  Whole nut carries a risk of choking.

Oral immunotherapy for peanut allergy is not ready for routine use and remains a research exercise at present.

Peanut allergy causes most food allergy deaths.