January 23, 2019
According to the National Peanut Board, the first peanut butter was a peanut paste invented by a St. Louis physician who gave it to geriatric patients because they had trouble swallowing. Today, a lot of people have trouble swallowing peanut butter. The popular, ubiquitous peanut butter and jelly sandwich may be a favorite, but it has some people fearful of a reaction that may send them straight to the Emergency Department (ED).
NCH Medical Group Allergist and Immunologist Newton Li, M.D. discusses peanut and tree nut allergies and reasons why we may becoming a more allergic population. Dr. Li has seen a growing number of patients who aren't just allergic to peanuts, but also tree nuts.
There's a blood test and skin test to look for allergic antibodies for tree nut allergies (almonds, pecans, walnuts, pistachios, cashews) and peanut allergy. To clearly determine if someone is allergic, we can do an oral challenge. Patients eat tree nuts or peanuts in small amounts in the office to monitor any clinical signs of a reaction like a rash, swelling, cough or wheezing.
The numbers in a blood test indicate the range of levels of allergic antibodies. Similarly, skin tests give a different size of reaction from a skin prick. Based on the size or the level in the blood, if it's a higher degree, it puts you at a higher probability of being allergic. If there's minimal skin reaction it puts you at a low probability of being allergic. When the testing comes back with a small reaction on the skin test or medium level of antibodies, we may do an oral challenge in the office to determine if the patient is allergic. These are the tools that we use to assess if a patient is potentially high risk or low risk for being allergic.
Some minor reactions would be hives, mild facial swelling of the lip or eye and itchiness. For example, a child may have eaten a granola bar with almonds in it and he/she might get an itchy mouth or swelling of the skin.
Signs of a severe reaction might be throat or tongue swelling, wheezing, shortness of breath, lightheadedness, or severe abdominal pain with vomiting. You should go straight to the ED if you are experiencing these severe symptoms.
Peanuts are a great food item, available in many different forms and in different foods. If a patient is currently eating peanuts and not having any kind of reaction, I would encourage them to keep eating peanuts.
Patients who are peanut allergic should continually be reading labels on foods, and when they're in restaurants they should be asking if any peanuts or peanut oil were used in preparing the meal. It's important to be very cautious about peanut exposure in and outside of the home. As a community, we should be mindful and respectful of patients who have peanut allergies.
Recent studies are being conducted on peanut desensitization, where patients with a peanut allergy are given small amounts of peanuts in a very systematic fashion and dose over a time period to try to push the immune system into tolerating peanuts. There has been good success with this in studies, although reactions can still occur during this process, and patients still need to continue eating peanuts to maintain the tolerance.
Historically, over the past 10 to 20 years, there has been a rise in the prevalence of peanut allergy. Some of that may be related to better recognition and more attention to diagnosing it. There is the thought that allergies are on the rise in general – environmental and food – and there's also the thought that the way peanuts are processed could change the peanut's allergic potential. One final thought is that our hygiene has improved so much that it's potentially making us more prone to allergies. We haven't pinpointed it to one particular reason.
Think you may be allergic? Call 847-725-8401 to schedule an appointment. You may need a referral from a primary care physician.
Newton Li, M.D., an NCH Medical Group Allergist and Immunologist, practices at 1051 W. Rand Rd., Suite L02 in Arlington Heights.