Diet Plan for Nut / Peanut Allergy

Nut and peanut allergy is not uncommon, and can provoke milk or severe symptoms including 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 airways or heart failure. This happens within minutes to hours of eating the peanuts. 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. A dose as small as 100mg of peanut protein (216mg peanut flour) may produce symptoms. The age of onset often occurs within the first two years. Nut/peanut allergy is a life-long condition, although there may be changes in the severity and nature of the symptoms.

Peanuts are a legume, as opposed to a tree nut, but it's very rare for a peanut sensitive individual to also be allergic to other legumes, and common for peanut allergy to be associated with nut allergy.

It is usually very clear from the medical history when an individual has peanut sensitivity. Skin prick test and blood tests (RAST) can be used to identify allergic adults and children, but are unreliable in identifying the specific food(s) causing the allergic symptoms and should not be used to determine dietary restrictions. Nut allergy is often associated with other forms of allergy indicating there may be a degree of allergy sensitivity.

Sensitisation may occur via breast-feeding or in utero, therefore pregnant and lactating mothers should avoid nuts in their own diets during this time. Also in infants, the introduction of nuts and peanuts and food products containing them should be delayed until at least 3 years of age.

Exposure to nuts and peanuts can occur through ingestion, touch or inhalation of the allergen and trace amounts can trigger a reaction. Treatment involves adherence to a peanut free diet and (for some) preventing any skin contact with peanuts. There are anecdotal reports of allergic reactions to the smell of peanut and it is not easy to follow a peanut free diet entirely.

For manufactured foods, ingredient labels need to be checked for items such as:

• Roasted peanuts
• Dry roasted peanuts
• Chocolate nuts/peanuts
• Yoghurt coated nuts/peanuts
• Ground nuts
• Earth nuts
• Monkey nuts
• Goober nuts
• Mixed nuts
• Peanut butter
• Other nut butters (e.g. hazelnut butter, almond butter)
• Peanut oil
• Arachis oil
• Vegetable oil
• Groundnut oil

Heavily refined oils may be ok as all the protein will have been removed, but unrefined ones certainly are not. But if there is any doubt, avoid. Vegetable oil may contain refined peanut oil so this degree of avoidance makes the diet extremely restricted. A supervised peanut oil challenge may be warranted. Some soaps, lotions, toothpastes and ear preparations are known to contain arachis oil so may need to be avoided. There are some minor food ingredients which may be of peanut origin. Hydrolysed vegetable protein is used as a flavouring and is most likely to be derived from soya or wheat but may be made from peanut. The food additives E471 and 472 (emulsifiers/stabilisers) are derived from oil which could be peanut but, if so, it would be refined peanut oil. Lecithin is usually derived from soya but there is a possibility of preparation from egg or peanut.

Current labelling regulations make it difficult for consumers to confidently choose peanut free manufactured foods unless the product is marked 'peanut free' or 'nut free'. If nuts are part of a compound ingredient which itself makes up 25% or less of the final product, they do not have to be declared on the label. However, some of the main supermarket chains produce lists of their peanut/nut free lines and are declaring the presence of peanuts on the ingredient label even in trace amounts.

Foods Most Likely To Contain Nuts / Peanuts

• Any obvious nut or peanut product
• Cakes
• Biscuits
• Pastries
• Ice cream
• Desserts
• Dessert or cake toppings
• Breakfast cereals
• Cereal bars
• Vegetarian products (e.g. nut burgers, nut rissoles)
• Nut butters and spreads
• Salad dressings
• Satay sauce
• Indian dishes e.g. curries
• Chinese/Thai dishes
• Indonesian dishes
• Confectionery

Other points to consider

• Most severe reactions reported have been caused by foods eaten away from home. Staff in restaurants may not know the content of some foods
• Consumption of alcohol with a meal may exacerbate an adverse reaction and impair judgement about the onset of symptoms
• Play groups or schools will need to be informed about a nut allergic pupil and the provision of meals and emergency access to adrenaline discussed
• Aeroplane journeys can pose a risk from the airline meal ingredients but also from peanut dust recirculating in the cabin air from packets of peanuts opened during the flight. Most airlines no longer serve peanuts
• When travelling abroad, learn the word for peanut in the relevant language and have something in writing about the problem
• Contamination is always a potential problem. This can happen in industry where peanut containing products are not produced on dedicated lines and also in kitchens where contamination can occur from utensils or working surfaces which have previously been used for peanuts and not washed properly

The following example meal plan has been designed to eliminate all nuts, peanuts and nut/peanut products and associated ingredients from the diet. It's based on an average weight individual with a sedentary job for weight maintenance. Use this to give you an idea of what are healthy nutritious foods to include, but don't forget to vary your food choices and to drink plenty of water through the day. If you are only allergic to peanuts and not tree nuts, then adjust appropriately, and vice versa.

Remember: if in doubt, check labels, and if still in doubt, avoid.