Allergy & Asthma Network Mothers of Asthmatics (AANMA)

Solving the Peanut Allergy Puzzle

Published February - 10 - 2009 Print This Post

peanutBy Dawn Merritt

Amy Altizer will never forget January 3, 2007. Not because it was her baby boy’s 3-month birthday. It was the day he had a life-threatening allergic reaction.

Amy left baby James at home with a sitter while she took three-year-old Mary Grace for a checkup at the pediatrician’s office. “The doctor was running late, so I told the sitter to give James a bottle rather than wait for me to breastfeed him,” Amy remembers. “I’d given him formula once before without any problems.”

When Amy got home, James was about 2 ounces into his bottle. Amy decided to switch him over to breast milk and pulled the bottle out of James’ mouth. “The skin around his mouth was very red. My first thought was that the bottle nipple had irritated his skin. But before I could really look at it, Mary Grace announced she needed help in the potty.” By the time Amy came back, “James was covered head to toe with hives – even the bottoms of his feet!”

Amy immediately called the pediatrician’s office. The nurse told her to give James half a teaspoon of Benadryl®, but James’ lips and tongue were so swollen he couldn’t swallow. “I put some in his mouth and it just dribbled back out.” By then James’ hands, feet, head and ears were also swollen. Amy called 911.

During the ride to the hospital, James was coughing but still getting in some air. The emergency medical technicians didn’t want to give James a shot of epinephrine because they only had premeasured doses and James was far below the weight range. At the hospital, James received a weight-adjusted shot of epinephrine and an IV with prednisone. Thirty minutes later James needed another shot of epinephrine because he started wheezing. James stayed overnight at Children’s Memorial Hospital for treatment and observation.

Gooey Clues
Jennifer Kim, MD, an allergy/ immunology specialist on staff at Northwestern Memorial Hospital, came to see the Altizers the next day. Based on Amy’s description of what happened, Dr. Kim thought James had reacted to the milk in the baby formula. Amy wasn’t so sure. James had suffered terrible gas and stomach pains since he’d been born, and cutting dairy from Amy’s diet the first few months of breastfeeding had not made a difference. Dr. Kim asked Amy to keep milk out of her diet while she was breastfeeding – at least until Dr. Kim could confirm James’ diagnosis with allergy testing.

The plot got stickier at a Valentine’s Day party for Mary Grace and her friends. Amy was searching for something dairy-free to eat. The chicken salad was out. So was grilled cheese. Then Amy spied a peanut butter and jelly sandwich. “I was holding James in one hand and eating the PB&J with the other hand, and James started to break out around the mouth – just from being that close to peanut butter!” Could James have had a peanut allergy all along?

Big Allergies for Little People
If peanut allergy was the source of James’ symptoms, he’d have lots of company – recent studies put the rate of peanut allergy among children at 1 in 100. Unlike some other food allergies, peanut allergy is usually permanent. Only 20 percent of children outgrow peanut allergy by school age, and 8 percent these children will have a recurrence. A child’s first allergic reaction to peanuts usually happens between the ages of 10 and 20 months. Peanut allergy is less common in very young infants, particularly a severe reaction like James had, but not unheard of.

Risk factors for peanut allergy include a family history of any allergy – especially other types of food allergies – atopic dermatitis (eczema) or asthma. Common symptoms in children include skin problems like hives or eczema (itchy, dry patches) and intestinal distress such as nausea, vomiting, diarrhea and stomach pain. Respiratory symptoms, including wheezing, nasal congestion and mucus, are less common but can be severe.

James had several of these symptoms and risk factors. In addition to his unresolved tummy trouble, James developed eczema when he was just six weeks old. “At first we thought it was just baby acne,” says Amy. “But it never cleared up and went beyond his face to his knees, wrists and thumbs. We thought, ‘Lots of people have allergies. It will be fine.'” Food allergy causes eczema symptoms in about 40 percent of children with moderate to severe eczema. James also had a family history of allergic diseases: Big sister Mary Grace has asthma and James’ aunt developed egg allergy as a child and never outgrew it.

Top Test Scores
When James was six months old, Dr. Kim performed skin tests for milk and peanut. James tested negative for milk but had a huge reaction to peanut! Amy thought about the baby formula incident months earlier to see if she could link it to peanut exposure. Amy’s husband Jay used to snack on peanut butter every night. Did he have peanut butter on his hands while unloading bottles from the dishwasher? At this point they couldn’t be sure, but Dr. Kim recommended that Amy continued a nut- and dairy-free diet while nursing.

At 11 months old, James underwent blood tests for milk, egg and peanut allergy. (They added egg based on Amy’s family history.) James’ milk test came back negative again, but he tested positive for peanut – much higher than usually seen in babies his age – and egg.

Hide and Seek
In light of the test results and the family’s experiences, James’ physician agreed that he had a serious peanut allergy and recommended the whole family steer clear of peanuts and keep auto-injectable epinephrine on hand at all times. Peanut butter was out and reading food labels was in!

Although new food labeling laws make finding peanuts in food much easier, some not-so-obvious places peanuts may be hiding include

  • Arachis oil – another name for peanut oil
  • Artificial tree nuts – sometimes peanuts are flavored to taste like other nuts
  • Chocolate candies – some chocolates are produced on equipment used for processing peanuts or foods that contain peanuts
  • Nut butters – some alternatives to peanut butter are processed on the same equipment used to make peanut butter
  • Sunflower seeds – many brands are processed on equipment used to process peanuts

Grain breads, salad dressings, energy bars and marzipan also can contain peanuts. Peanut butter may be used to thicken sauces – even spaghetti sauce. With so many uses for peanuts, it’s easy for children with peanut allergy to accidentally eat peanuts: A 2006 study of schoolchildren in Quebec, Canada, found an annual incidence rate of more than 14 percent!

Everyday Life
“We’re learning as we go and try to stay vigilant,” says Amy, “but we want James to be a rough and tough boy with as normal a life as possible.” Amy makes sure their house is a safe haven where James can just be a kid. Even Mary Grace pitches in to keep her baby brother safe, keeping foods that could contain peanut or were made in a plant that processes peanuts out of the house and car. But Mary Grace does get one special treat. “We go out for PB&J dates!” Every Thursday, Amy takes Mary Grace out to a restaurant for a peanut butter and jelly sandwich. “We wash her hands carefully after lunch, and after that Mary Grace goes to preschool for several hours. We wash her hands again when she comes home and we haven’t had any problems.” 

Amy’s strategy for family harmony – and safety – is a good one. A study published in the Journal of Allergy and Clinical Immunology (JACI) (2004; 113:973-4) found that washing with soap and water or using commercial wipes was sufficient to remove peanut proteins from your hands. Researchers in another study took saliva samples to figure out how long peanut proteins stay in your mouth after eating peanuts (JACI 2006; 118:719-24). They found that several hours and another meal later, 90 percent of people who ate peanut butter would not have peanut protein left in their saliva. But Amy and her husband Jay don’t eat or touch peanuts or peanut butter at all, just to be safe.

If there can be a silver lining to the Altizer family’s story, it’s that “James’ eczema is actually the best that it’s ever been!” Now that they’ve eliminated foods that James is allergic to, his eczema has cleared up.


First published:  Allergy & Asthma Today, Volume 6, Issue 2
Updated:  February 2009