Eating and nutrition

• It’s important to eat healthy foods during pregnancy.
• Most pregnant women need around 300 extra calories per day.
• Take a prenatal vitamin every day.

About 1 percent of children and adults in the United States are allergic to peanuts and peanut products, including peanut butter and any food containing peanuts ^{(1, 2)}. For reasons that are not well understood, peanut allergy has doubled in the past decade ⁽³⁾. Individuals with a peanut allergy can have a serious (such as difficulty breathing and loss of consciousness) or even fatal reaction if they eat peanuts. This reaction occurs because the immune system of an affected individual reacts abnormally to usually harmless proteins in peanuts. Children and adults who are allergic to peanuts should not eat them at any time. Unfortunately, there is no proven way to prevent peanut allergy in a child.

Which foods may contain peanuts?
Besides peanut butter and peanut oil, some foods that may contain peanuts include:

• Arachis oil (another name for peanut oil)
• Many ethnic foods, including Chinese, Mexican, Thai and Vietnamese
• Many candies, especially chocolate (which often is made on machinery that also processes candies made with nuts)
• Some cereals, including granola
• Marzipan
• Pesto sauce
• Some veggie burgers
• Some health food bars

Should a pregnant woman eat peanuts or peanut products?
Women who are allergic to peanuts should not eat peanuts or peanut products during pregnancy or at any other time. Studies suggest that women who are not allergic to peanuts can safely eat peanuts during pregnancy ⁽³⁾.

Because peanut allergy tends to run in families, health care providers have been seeking ways to help prevent this allergy in babies from affected families. Until recently, experts recommended that women who aren’t allergic to peanuts but who have a family history of peanut allergy avoid peanuts during pregnancy ^{(3, 4)}. However, recent studies have found no evidence that avoiding peanuts in pregnancy helps prevent peanut allergies in the child ^{(3, 5)}.

Peanuts can be healthy food choices for pregnant women. Peanuts are a good source of protein and folate. Folate is the form of folic acid that is found naturally in foods. Taking folic acid before and during early pregnancy helps prevent certain serious birth defects of the brain and spine. The March of Dimes recommends that all women who could become pregnant take a multivitamin containing 400 micrograms of folic acid daily, and make healthy food choices that include foods rich in folic acid.

Is it safe to eat peanuts while breastfeeding?
If a woman is not allergic to peanuts, she can eat peanuts and peanut products while breastfeeding. There is no evidence that avoiding peanuts during breastfeeding helps prevent peanut allergies in the child ^{(3, 5)}.

Is it safe for infants and young children to eat peanuts and peanut products?
Infants and young children who have been diagnosed with a peanut allergy should never eat peanuts or peanut products. Until recently, experts recommended delaying introduction of peanuts and peanut products to children with a family history of peanut allergy until age 3 ⁽⁴⁾. Recent studies suggest that this delay does not help prevent peanut allergy ⁽³⁾.

In fact, a 2008 study found a 10-fold greater risk of peanut allergy in children who did not eat peanuts in infancy and early childhood compared to those who ate high quantities of peanuts ⁽⁶⁾. Additional studies are needed to determine whether eating peanuts in early childhood can help prevent peanut allergy in high-risk children.

Can exposures other than food contribute to the development of peanut allergy?
One study suggests that using lotions (such as diaper creams) containing peanut oil, especially when the baby has broken skin, may increase the risk of the baby having peanut allergy ⁽⁵⁾. While lotions containing peanut oil are not commonly used in this country, this study suggests that exposures other than food may contribute to peanut and other food allergies.

At what age do children develop symptoms of peanut allergy?
A peanut allergy often is diagnosed in children in the first 2 years of life, though it can develop at any age ^{(2, 7)}.

What are the symptoms of peanut allergy?
Someone who is allergic to peanuts usually develops symptoms within seconds to 2 hours after eating a food that contains peanuts ⁽²⁾. Symptoms range from mild to severe and can include:

• Tingling in the mouth
• Hives (itchy bumps on the skin)
• Swelling of the tongue and throat
• Abdominal cramps
• Vomiting and/or diarrhea

The most serious reaction is called anaphylaxis. In such cases, blood pressure drops suddenly and the individual loses consciousness. This condition requires emergency medical treatment.

How is peanut allergy diagnosed?
Peanut allergy usually is diagnosed by doctors who specialize in treating allergies. The child’s health care provider can provide a referral to an allergy specialist. The specialist most likely recommends a skin test and/or a blood test to help diagnose peanut allergy.

How is peanut allergy treated?
There is no drug or “allergy shot” that can prevent an allergic reaction when a person with peanut allergy eats peanuts or any food containing peanuts.

Treatment involves avoiding peanuts and any foods that may contain them. This can be difficult because many foods contain peanuts. Affected individuals must carefully read food labels, and children must be taught not to eat someone else’s foods outside the home. Most providers also recommend that they avoid eating tree nuts (such as walnuts, cashews, pecans and pistachios) because up to half of those allergic to peanuts are allergic to at least one kind of tree nut ⁽⁷⁾.

Children and adults (including pregnant women) with a peanut allergy should carry with them a shot of epinephrine (a medicine that helps control serious reactions). This medicine comes in an easy-to-use pen-shaped device. Epinephrine helps reverse an anaphylactic reaction. A pregnant woman should use this medication as she normally would if she were not pregnant and then go to the hospital or see her health care provider. Prompt treatment usually protects mother and baby. Allergy medicines called antihistamines also help ease symptoms, but they do not work as well as epinephrine.

Parents of children with a peanut allergy should develop a written action plan with their child’s health care provider to give to all caretakers and school personnel. An action plan can help these individuals recognize a child’s allergic reaction and tell them what to do if one occurs. A sample action plan form is available from the Food Allergies and Anaphylaxis Network.

Do children outgrow a peanut allergy?
In most cases, peanut allergy lasts for life. However, about 1 in 5 affected children appears to outgrow peanut allergy ^{(1, 2, 7)}. An individual who has outgrown a diagnosed peanut allergy should not start eating peanuts unless a health care provider says it is safe. 

See also:  Food Allergies and Anaphylaxis Network

References

1. Chapman, J.A., et al. Food Allergy: A Practice Parameter. Annals of Allergy, Asthma and Immunology, volume 96, March 2006, pages S1-S68.
2. Burks, A.W. Peanut Allergy. Lancet, volume 371, number 9623, May 2008, pages 1538-1546.
3. American Academy of Pediatrics Committee on Nutrition. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics, volume 121, number 1, January 2008, pages 183-191.
4. American Academy of Pediatrics Committee on Nutrition. Hypoallergenic Infant Formulas. Pediatrics, volume 106, number 2, August 2000, pages 346-349.
5. Lack, G., at al. Factors Associated with the Development of Peanut Allergy in Childhood. New England Journal of Medicine, volume 348, number 11, March 2003, pages 977-985.
6. Du Toit, G., et al. Early Consumption of Peanuts in Infancy is Associated with a Low Prevalence of Peanut Allergy. Journal of Allergy and Clinical Immunology, volume 122, number 5, November 2008, pages 978-985.
7. Skripak, J.M., Wood, R.A. Peanut and Tree Nut Allergy in Childhood. Journal of Pediatric Allergy and Immunology, volume 19, June 2008, pages 368-373.

January 2009