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Severe Peanut Allergies Are on the Rise—Here's What to Know

Peanuts

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Key Takeaways

  • The prevalence of peanut allergies is increasing significantly, and affects both children and adults.
  • A new study shows significant and lifelong quality-of-life issues among those with peanut allergies.
  • Severe allergies can cause stress, anxiety, and more.
  • The reason for a rise in allergy prevalence isn't known yet, but may include genetic predisposition and environmental factors.

Peanuts are one of the most abundant and important food and oil crops on the planet—grown on approximately 42 million acres worldwide, according to data published by Purdue University in 2013. But peanuts are also one of the top food allergens, and according to a recent study published in the journal Allergy, quality of life for individuals suffering from peanut allergies may be getting worse.

Researchers looked at survey results from 1,300 individuals with peanut allergies in eight European countries as part of the APPEAL-1 (Allergy to Peanuts imPacting Emotions And Life) study. They found that both children and adults with peanut allergies experience considerable levels of stress, anxiety, and uncertainty, as do caregivers of those who live with peanut allergies.

In the 30-minute survey, 76% of individuals with peanut allergies were also allergic to other foods, with another 42% suffering from asthma and 50% having allergic rhinitis.

They rated their stress levels as follows:

  • 40% reported living with high uncertainty and stress
  • 90% reported stress due to peanut allergy (with 40% saying they were "very" frustrated and "very" stressed)
  • 36% reported feelings of anxiety
  • 30% reported experiencing tension

This follows a 2017 study that estimated 2.5% of children in the U.S. may have a peanut allergy, about a 20% increase from 2010.

Susan Schuval, MD

Peanut allergies are absolutely on the rise and have been for the last 30 years, to the point where it almost feels like an epidemic now. We are also seeing a rise in severe reactions, along with other food allergies on top of peanut allergies. That means parents, and even adults, need to be aware that this is a major issue.

— Susan Schuval, MD

Those who live with peanut allergies experience the following symptoms, which range from moderate to severe to deadly:

  • Breathing difficulties
  • Throat tightness
  • Swelling in the tongue, lips, and eyes

Peanuts are one of the most common foods associated with anaphylaxis, a severe allergic reaction that can be fatal if left untreated with an epinephrine shot and emergency care.

Beyond the Physical Reactions

Making the effort to plan ahead for potential allergy exposure, especially around food-based events like ordering from a restaurant or going to a family cookout, can be very helpful in reducing frustration for both kids and parents as well as adults with peanut allergy.

In the European APPEAL-1 study, quality of life difficulties cited by respondents included the following:

  • 65% report feelings of isolation (avoidance of uncertain social settings is a common tactic)
  • 43% report being bullied by their peers at least once because of their allergy
  • 71% of parents and caregivers of children with peanut allergies experience high levels of anxiety in situations where food is involved
  • General uncertainty around the use of an autoinjector

The prevalence of foods containing peanuts along with the severity of allergic reactions is having a significant impact on the quality lives of those who live with a peanut allergy.

Trying to Determine a Cause

One of the biggest challenges with peanut allergies in both children and adults is that it's difficult to predict who will develop an allergy, especially because some children outgrow the allergy, while others will have it for life. Also, adults who may have been able to eat peanut butter every day for decades can suddenly have an allergic reaction.

Prediction is nearly impossible, in large part because no one knows exactly why peanuts are so problematic, which makes it difficult to understand why prevalence is rising so quickly, says Schuval. There are several theories, though, and many experts believe multiple factors are involved.

For example, Schuval says changes in agricultural practices may play a role, or higher rates of inflammation from eating a Western-style diet that's high in sugar and saturated fat. Another key idea is the "hygiene hypothesis," says Jeffrey Neal, MD, an otolaryngologist at Abingdon Ear, Nose & Throat Associates in Virginia.

"There's an idea that we now have less exposure to viruses and bacterial infection throughout our lives," he says. "Essentially, because we live in more sterile environments with air conditioning and that we're not outside as much, this leaves our immune system unbalanced and predisposes us to allergic reaction. This is true for both adults and children."

Peanuts also contain a unique protein not found in other foods, he adds, and this may set off an aggressive immune response—but like other theories, this also hasn't been proven as a reason for such a big spike in cases.

Despite the uncertainty around potential causes, there are two factors that make kids at higher risk, Schuval says:

  1. If one or both parents have a severe peanut allergy
  2. The presence of an egg allergy

In those cases, the likelihood of a child having or developing a peanut allergy is serious enough that she suggests being more cautious with introducing peanuts, and getting allergy tests at least yearly.

What Parents Need to Know

Previously, the advice from allergists and pediatricians was to avoid any allergenic foods, including peanuts, until children were at least 3 years old, according to David Stukus, MD, specialist in allergy and immunology in Columbus, Ohio, and advisor to the Asthma & Allergy Foundation of America (AAFA). Then, doctors realized that advice was backfiring.

David Stukus, MD

Unfortunately, we now have strong evidence demonstrating that avoidance is linked with food allergy development, whereas early introduction along with ongoing inclusion in the diet is an effective prevention strategy for many infants.

— David Stukus, MD

Another misconception that's been recently corrected: In the past, women were advised not to eat peanuts during pregnancy or while breastfeeding, due to concerns about food allergies being passed on to their infants. Stukus believes too many mothers were told they had caused the allergies based on what they ate, when there's no evidence of that, he says.

At this point, parents are encouraged to introduce allergenic foods, including peanuts to an infant's diet beginning around four to six months of age, Stukus says, ideally after they can chew and swallow other solids.

"It is also very important to keep these foods in their diet consistently as well," he adds. "This can prevent food allergy from ever developing in many children, and more importantly, it's safe to do as well. We need babies eating a diverse array of foods with different tastes and textures, and help them expand their diet as early as possible."

There's a common misconception that infants are at risk of having a life-threatening allergic reaction the first time eating a peanut, says Stukus. But when babies have food allergy reactions, it most often presents with a sudden onset of rash, hives, or vomiting that occurs within minutes of eating the food. This is the reaction to notice, he advises.

Keep in mind that about 25% of children grow out of the condition, he adds, but the rest tend to be stuck with the allergies for life.

"Adjusting for peanut allergies, like all food allergies, can feel overwhelming sometimes, especially since the best treatment is avoidance," says Schuval. "But making a plan for when you go out, shopping carefully, and letting others know about the allergy does go a long way."

What This Means For You

If you or your children are living with peanut or other food allergies, education and planning are of the utmost importance. Know that many people are dealing with this issue, and that there are numerous resources available to help you lead a safe and nutritious life.

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