Managing a Peanut Allergy

Even when you do everything “right” like breastfeed, eat a good diet, and feed peanuts early, it is still possible that a peanut allergy will sneak through. 

I know from experience, dealing with an infant peanut allergy is a mix of scary and defeating. But living with a peanut allergy is easier than ever. Restaurants, schools, and friends are much more aware of food allergies and ready to handle them. 


Common Peanut-Containing Foods:

The first step in managing a peanut allergy is knowing what foods peanuts are commonly found in:

  • Baked goods. Cookies, pastries, pies and other baked goods are often made with peanuts
  • Candy ( Reese’s)  including nougat and marzipan
  • Ice cream, frozen desserts, puddings, and hot chocolate are often peanut flavored
  • Cereals and granola may have peanut 
  • Trail mix
  • Chili and soups. Peanuts or peanut butter are sometimes used as thickeners.
  • Energy bars
  • Indian foods
  • Thai food
  • Chinese food
  • African foods
  • Veggie burgers or other meat replacements
  • Sauces. These may include barbeque sauce, hot sauce, pesto, gravy, mole sauce, glazes, or marinades.
  • French fries and other friend foods cooked in peanut oil (maybe)
  • And more

Can you eat peanut oil with a peanut allergy?

Highly refined, 100% pure peanut oil should not have peanut protein in it, which means it can be safe for people with peanut allergy. But if you have a very sensitive peanut allergy, peanut oil may not be safe because it is possible for it to have trace amounts of peanut or peanut protein. 

Cold pressed or extruded peanut oil, however, still has peanut in it, and labels will list “peanut” as an ingredient. 

Every person has a different level of comfort with foods that may have “cross contamination” or  trace amounts of peanut. Each person with a peanut allergy must find their own comfort level with the risk of a peanut exposure, based on their past sensitivity and the food’s labeling


Peanut Allergy Labeling

The Food Allergen Labelling and Consumer Protection Act (FALCPA) was passed in the U.S. in 2004. This Act requires the presence of the eight major food allergens — milk, egg, fish, crustacean shellfish, tree nuts, wheat, peanuts, soybeans — in any packaged food to be declared using a name that is recognizable in the ingredients list. 

In addition to the ingredients list there may also be a 'Contains' statement which must either immediately follow the ingredients list or be next to it on the package. If there is no 'Contains' statement on the package then the common English name for the allergen must be included in the ingredients list.

list showing how allergens appear in food labels

If a 'Contains' statement is used then the food may be listed in the ingredients list using just its chemical name e.g. sodium caseinate, because in this case, the milk from which it is derived will be listed in the "Contains" statement saying “Milk.”

 

Peanut Allergy Cautionary or Advisory Labeling

The FDA rules around allergens do not require a manufacturer to list facility and potential cross-contact allergens, but more and more companies are doing so to be transparent with their customers. 

Examples of cautionary labels include:

  • "May contain peanut"
  • "Manufactured in a facility that uses peanut ingredients"
  • "Manufactured in a facility which processes peanuts"
  • "Processed in a facility that uses peanut"
  • "Manufactured on equipment that processes products containing peanuts"
  • "Manufactured on equipment that uses peanuts"
  • "Manufactured in a facility that processes peanuts, but not on the same equipment"
  • "Manufactured on shared equipment...may contain peanuts"

Each manufacturer uses their own discretion to determine what, if any, statement they make about other allergens. You should not assume that one statement means there is less likelihood of cross contamination than another statement. 

On the other hand, since no statement is required, you should not assume that one of these statements increases the chances of cross contamination either. Every parent of a child with a peanut allergy or person with a peanut allergy must determine for themselves, based on their past experiences with packaged foods, what they are comfortable with.


How You Can Prevent Accidental Peanut Exposure

If your child has a food allergy, it is important to tell everyone who takes care of your baby and everyone who might offer them food both what not to do, and what to look out for. 

Servers: 

  • Make sure every person bringing or making food for your child is aware of their peanut allergy 
  • Never feel uncomfortable asking about the ingredients, including what kinds of oils or sauces the food is prepared with
  • Depending on your child’s sensitivity, it is also okay to ask that utensils be cleaned separately, or that you be allowed to bring your own food

Leaving a Child with Friends or Family Members:

  • Give each person an emergency plan, and talk through it with them. 
  • Bring food or give caregivers specific lists of brands you are comfortable with. As mentioned, each person has different levels of labeling they are comfortable with, and other caregivers may not know where your comfort level is. If someone else is shopping for your baby, tell them which brands you trust and be specific — it’s easy to get the wrong flavor or product type with different ingredients.
  • Take your time and only trust others with your baby once you feel comfortable doing so. Take care of your baby together with a family member as a trial period, if you need to. 


Schools:

For some parents, sending their baby to a school or daycare with a peanut allergy can seem too scary. But for many parents there’s also no way around it. 

  • Remember that each school wants to keep your child safe. Ask to set up a meeting to discuss your baby’s peanut allergy and what she needs.
  • Most schools are required to create a 504 plan with parents. The goal of 504 plans is for children to be in the same classrooms with all other children, but with the services, changes, or help they need.

Have An Exposure Plan

The organization FARE, Food Allergy Research & Education, is one of the best out there. They have a number of great resources, but their action plan is a go-to for many parents of children with food allergies.

FARE exposure plan
You can download their action plan here.

Exposure plans are pretty similar overall. Here are the major rules.

  1. At the earliest signs of a reaction, use an antihistamine like Benadryl or Zyrtec (if the child can swallow pills)
  2. If two body systems are involved in the reaction (like skin AND stomach), use epinephrine and go to the ER
  3. If any critical body systems are involved in the reaction (trouble breathing, fast heart rate, drop in blood pressure) use epinephrine and go to the ER.

Reactions can show up minutes to hours after exposure, so it is important to stay with your baby. If it is late at night and you feel you won’t be able to stay awake, go to the ER.

Whenever epinephrine is used, a child must get additional care. It doesn’t necessarily mean your baby will get more medication, but because symptoms can worsen or improve over several hours after an exposure, it is important to be under the care of trained healthcare providers until your baby is in the clear.


Always Carry An “Epipen” (Epinephrine Auto Injector)

It is critical for a baby with a food allergy to always have an epipen nearby. Allergic reactions can happen at unexpected times. 

People eat and snack EVERYWHERE, and rarely wash their hands after eating. At most, they may wipe their hands with a napkin, but this does not stop peanut protein transfer. Children also often put toys in their mouths, which can transfer peanut protein onto the toy. 

You baby’s sensitivity to peanuts can change as they get older, when they’re tired, if their stress levels are high, or if they have a cold.

Carrying an epipen at all times is baby’s most important line of defense.

Epipens can be sensitive to heat and cold. Never leave an epipen in the car on a hot day, out in the sun, or out in the cold. There are many epipen carrying cases and holders available that can help control temperature, or make them easier to place in a bag or attach to your body. Epipens are easy to slip into a diaper bag.

Epipens expire so you have to buy new ones every year. While several studies have shown that the medicine inside is still effective well past the expiry date, your baby’s allergist will write a new prescription each year.



It’s Easier Than Ever to Keep Your Child Safe 

While talking about action plans and epinephrine sounds scary, it truly is easier than ever to minimize your child’s risk of accidental exposure and to get them help if they do have a reaction. 

With food allergies becoming more prevalent, it means more people are aware of how serious they are. As we’ve mentioned before, more and more people know somebody with some form of food allergy, and more and more people are willing to be accommodating to those who need it.