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    What is ?
    Information and statistics courtesy of the Scottish Nutrition & Diet Resources Initiative

    Allergy to peanuts and other types of nuts and seeds is the most serious form of food allergy. Peanut allergy is commonly associated with allergy to tree nuts, especially Brazil nuts, almonds, hazelnuts and walnuts. The reason why peanuts and nut derivatives are so allergenic remains unknown, though the rise in prevalence is probably due to increased exposure, because of widespread use of peanuts in food manufacture. Sensitivity is often extreme, with minute amounts of the allergen being capable of triggering a rapid and severe type 1 allergic response.

    This causes acute oropharyngeal swelling and systematic circulatory effects which can result in asphyxiation and fatal anaphylaxis. In the UK, about six deaths, usually in young people, occur each year as a result of peanut anaphylaxis and many near-fatal episodes occur. The prevalence of peanut allergy is currently in the region of 1.3%.


    It appears to be increasing and the age of onset getting younger. It is increasingly being reported during the first year of life. Nut allergy is less likely to be outgrown than most other childhood allergies with only about 10% of sufferers developing a tolerance to peanuts. It is much more likely to resolve if it appears before the age of 3 years. It is less likely to resolve if it develops in older children or adults, or if other IgE mediated food allergies co-exist
     


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    Symptoms of
    In allergic individuals, peanuts are a well recognised cause of severe and rapidly occurring symptoms, such as vomiting, diarrhoea, urticaria, angioedema (swelling of the face, throat or skin), acute abdominal pain, exacerbation of atopic eczema, asthma and anaphylactic shock. If untreated, anaphylactic shock can result in death due to obstruction of the upper or lower airway (bronchiospasm) or hypotension and heart failure. This happens within minutes to hours of eating the peanuts. The first symptoms may include sneezing and a tingling sensation on the lips, tongue and throat followed by pallor, feeling unwell, warm and light headed.

    Severe reactions may return after an apparent resolution of 1-6 hours. Asthmatics with peanut sensitivity are more likely to develop life threatening reactions. Peanuts are the most likely food to provoke fatal anaphylaxis in children and adults but many other foods (including tree nuts, seeds (e.g. sesame, sunflower), cow milk, eggs, fish and shellfish) can also precipitate this.


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    Risk Indicator

    If you suspect you are having, or might have an anaphylactic attack, SEEK MEDICAL ASSISTANCE IMMEDIATELY. If you suffer an attack, and have no medication such as Epinephrine to hand, dial 999 immediately. Even after administering Epinephrine, you MUST STILL SEEK MEDICAL ASSISTANCE. Symptoms can and often do reappear.

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    Triggers and nut information

    Medications: Watch out for an ingredient labelled "arachis" or "arachis oil" on medicines, shampoos and cosmetics, This is a label used to indicate the presence of Peanuts or Nuts in the product.  Always test new products on a small patch of skin on your upper arm. Leave two days. If your skin doesn't react, it's pretty safe to assume you are not sensitive to the product.

    For peanut and nut avoidance, exclude:

     1) Peanuts and nuts including Brazil nuts, walnuts, hazelnuts, almonds, cashews, pistachio and pecans. Some of these may be called Ground nuts, monkey nuts, earth nuts or goober nuts.

     2) Foods made from peanuts including peanut butter, nut spreads, praline, noisette, marzipan, frangipan, amaretto products, macaroons, Bakewell tarts, almond essence, marron, Worcester sauce, satay sauce, hydrolysed vegetable protein, nut containing or nut-coated cheeses.

     3) Cold pressed ‘gourmet’ oils: peanut oil, arachis oil, groundnut oil, walnut oil, almond oil, hazelnut oil.

     All manufactured foods could contain traces of peanuts/nuts but those most likely are: cakes, biscuits, pastries, ice-cream, desserts, dessert toppings, cereal bars, confectionery, savoury snacks, breakfast cereals especially muesli type cereals, meat products, vegetarian products and ready meals containing hydrolysed vegetable protein, Oriental food, particularly Chinese, Thai and Indonesian, sauces and salad dressings, mixed salads and wild rice.

    Almonds
    Probably originated in the Near East but now grows in Southern Europe, Western Asia, California, South Australia and South Africa. Almond oil is used for flavouring and for skin care preparations and is extracted from the kernel of the Bitter Almond. The Sweet Almond is grown for nuts for eating and have the largest share of the nut trade world-wide. Almond flour is available and it is possible to make a nutritious nut milk from almonds.

    Brazils
    A native of South America. The nuts grow inside a hard, woody fruit rather like a coconut shell which has to be broken open to expose the 12-24 nuts inside. Brazils are high in fat, which causes them to go rancid very quickly, and protein.

    Cashews
    Native to America but now grown extensively in India and East Africa. It will withstand rather drier conditions than most other nuts. The nut grows in a curious way on the tree, hanging below a fleshy, apple-like fruit. It is related to the mango, pistachio and poison ivy.

    Chestnuts
    The sweet chestnut is a native of South Europe but is planted elsewhere extensively for both nuts and timber. The nuts can be used in soups, fritters, porridges, stuffing's and stews, as well as being roasted or boiled whole. Available fresh, dried, canned - whole or pureed, or ground into flour.

    Coconuts
    The coconut palm is common in tropical regions all over the world. The nut is covered in a fibrous outer coating on the tree and all parts of the tree are useful, the trunks for timber, the leaves for thatch, the fibrous husk produces coir - the starting material for ropes and coconut matting - and the nuts are used for food. Unripe nuts contain coconut milk. The nutmeat can be eaten fresh or dried (desiccated or flaked coconut) and is also available in blocks of creamed coconut. A valuable oil is also extracted from the nut meat and used for cooking.

    Hazels
    Hazel, also called Cob, is a common wild tree in Europe and Asia and its nuts have been eaten by humans since earliest times. The cultivated varieties are bigger and the filbert is a similar but bigger species from SE Europe. Used in sweet and savoury dishes, they are available whole, ground and flaked, or made into oil and nut butter.

    Macadamia Nuts
    A native of NE Australia now also grown commercially in Hawaii. Notoriously difficult to extract from their shells, they are expensive but have a delicious creamy flavour and crunchy texture.

    Peanuts
    Also known as groundnuts or monkey nuts, peanuts are actually legumes. Of South American origin, it's now an important crop all over the tropics and southern USA. It gets its name groundnut because as the pods ripen, they are actually forced underground. Peanuts are high in protein and contain 40-50% oil. The oil is used in cooking, as salad oil, in margarines and the residue is fed to animals.

    Pecans
    A native of N America where it is used extensively in ice cream, cakes, nut bread and confectionery.

    Pine Nuts
    These are the seeds of the Stone Pine, a native of the Mediterranean region, but the seeds of various other pines are eaten in various parts of the world including the seeds of the Korean Pine or North American pinon tree. They are very difficult to harvest, hence their cost. They are vital for pesto sauce.

    Pistachios
    Native to the Near East and Central Asia but has long been cultivated in the Mediterranean region and more recently in the Southern US. The kernels are green and are prized as much for their ornamental colour as for their flavour.

    Walnuts
    The walnut is native to SE Europe and West & Central Asia but is now grown in the UK, California and China as well. It is grown for timber as well as its nuts. Walnut oil has been used for centuries in the preparation of artists paints. The black walnut is a native of North America, introduced into Britain in the 17th century. The butternut is also from North America. These two have much thicker shells than European walnuts.

     


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    What helps?
    Advice courtesy of Anaphylaxis.Org
    • Minimise the risk by taking great care and being vigilant. If you are food allergic, read labels like Sherlock Holmes: look for the "hidden" allergen. You can easily recognise a packet of peanuts but may miss the word "groundnuts" in tiny print on the side of a tin of curry sauce, or the Latin term arachis used to signify the presence of peanut in pharmaceutical products.
       
    • If you are food-allergic, be assertive about asking for detailed information from manufacturers and supermarket staff.
       
    • Be particularly careful in restaurants, where proprietors are under no obligation to list ingredients. Question staff very directly. It may be necessary to speak with a senior manager. Some restaurants have ingredient lists available for you to check. You may wish to telephone the restaurant in advance to ensure your allergy is taken seriously.
       
    • Be alert to all symptoms and take them seriously. Reach for the adrenaline (epinephrine) if you think you are beginning to show signs of a severe reaction. Do not wait until you are sure. Even if adrenaline is administered, you will still need to get to hospital as soon as possible. Someone must call an ambulance.
       
    • Make sure others in your family know how to administer the adrenaline kit - and when. Do not be frightened of adrenaline. It is a well-understood drug. The dose you will administer has very few side effects, which will pass quickly in any case. However, if you have heart difficulties, discuss these with your doctor.
       
    • Develop a crisis plan for how to handle an emergency. Get your allergist or GP to help. Have this written out for family and friends - put it on the bulletin board at home; carry one in your pocket. If a child is the person at risk, make sure his teachers and friends' parents have a copy - along with the adrenaline. Make sure everyone knows where the adrenaline is when you go out, or when you are at home.
       
    • Wear a Medic Alert talisman (details: 020 7833 3034).
       
    • Be open about your allergy problem with your family, friends and colleagues. It's easy to avoid a Thai, Chinese or Indian restaurant if everyone knows you are allergic to peanuts.
     

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    Medication

    Because the majority of peanut allergies can lead to anaphylactic attacks, we will deal only with Epinephrine. There are other "alternate medications" out there but in a life threatening situation, I am all for sticking with what we know works.

    The treatment for a serious allergic reaction is adrenaline (also known as epinephrine). During anaphylaxis, blood vessels leak, bronchial tissues swell and blood pressure drops, causing choking and collapse. Adrenaline (epinephrine) acts quickly to constrict blood vessels, relax smooth muscles in the lungs to improve breathing, stimulate the heartbeat and help to stop swelling around the face and lips (angioedema).
    Pre-loaded adrenaline injection kits are available on prescription for those believed to be at risk. These are available in two strengths - adult and junior. The injection must be given, as directed, as soon as a serious reaction is suspected and an ambulance must be called. If there is no improvement in 5-10 minutes, give a second injection.

    Because this must be administered without delay, patients known to be at risk often carry their own adrenaline injection kits for use in an emergency.

    The injection many doctors prescribe is the EpiPen, an easy-to-use device with a concealed needle. The EpiPen is available on prescription and distributed by ALK -Abelló, 2 Tealgate, Hungerford, Berkshire RG17 0YT. Tel 01488 686016.

    A relatively new adrenaline injection kit called the Anapen is also available on prescription. It is manufactured and distributed by Celltech Pharmaceuticals Ltd, 208 Bath Road, Slough, Berkshire SL1 3WE. Tel 01753 447690.

    Both companies provide trainer pens for practice purposes. For information on how to administer the EpiPen (click here) and Anapen, (click here).

    It is important to emphasise that even after adrenaline is administered, medical assistance should be sought urgently because the effects may wear off after 5 to 10 minutes and the injection may have to be repeated.

    In fact, doctors often prescribe more than one injection kit so that if medical assistance is delayed, patients may administer a second dose.


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    Nutty facts
    Peanuts are legumes

    Peanuts, unlike tree nuts, are not nuts from a taxonomical point of view, but belong to the legume family and are thus related to peas, beans and lentils. The protein fraction of peanuts makes up 25-30% of the kernel. Recently an increasing number of peanut proteins have been identified as potential allergens. It is uncertain what causes peanut proteins to be such strong allergens. Studies have shown that the allergenicity of these proteins is very resistant to thermal, chemical and proteolytic denaturation.

    More than one child in 100 is believed to suffer severe allergic reactions to peanuts, tree nuts or both. A small but significant number are affected by other foods.

    What about other Nuts or Legumes?
    The peanut (Arachis hypogaea) is a legume but elimination of other legumes (such as peas, beans and lentils) is not appropriate unless sensitivity is suspected. Cross-allergenicity has been demonstrated in vitro between the serum of peanut allergic patients and several other legumes. However most peanut allergic patients can eat other legumes and vice versa.
    It is much more common for the peanut allergic individual to react to tree nuts particularly brazil, almond, hazel. Adverse reactions to other nuts are reported less often presumably reflecting the frequency of consumption in the UK.
    A recent American study reveals that of 122 nut allergic children, 68 reacted only to peanuts, 20 only to tree nuts and 34 to peanuts and tree nuts. Here the most common tree nuts implicated were walnut, almond and pecan. In common with peanuts, tree nut allergy is rarely outgrown. If a peanut sensitive individual has not yet been exposed to any tree nuts then these should eventually be introduced singly and with appropriate caution. Tree nut allergy can pose a serious problem for peanut allergic people.


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