Dr. Bob: Please discuss history of peanut allergies. Will peanut allergies diminish in future generations?
Answer: Allergies in children are an annoying problem for the child and the parents. And they are often misdiagnosed and misunderstood. Many ailments are misattributed to allergies, and some ailments are unrecognized to be due to allergies. So, before I discuss peanut allergies, let me review some basic elements of allergies in children.
- Allergies in children are usually manifest with upper respiratory symptoms (congestion, sneezing, cough), asthma (wheezing, difficulty breathing) or skin rashes (scaly, itchy skin).
- Allergies (also called atopic disease) tend to run in families so if a parent has a history of allergies and a child exhibits similar symptoms, the family should be suspicious of allergies and seek evaluation. All children should be suspected of having allergic tendencies. Such an approach helps the family be more proactive.
- Allergies can have such a wide variety of symptoms. But the good news is that most of the symptoms can be treated and be a minimal impediment to a healthy lifestyle.
- It is important for suspected allergies to be diagnosed by a physician, and it doesn’t necessarily involve skin testing. Any concerns about GI symptoms (vomiting or diarrhea) or rashes should be brought to the attention of one’s pediatrician and an open discussion can assess whether an allergy is suspected or not.
Now let’s get to the original question. Food allergies in children under age 17 are increasing, closing in on 10%. The manifestations of food allergies can be GI symptoms, swelling or rashes such as hives (splotchy raised red areas in a general distribution). But one must remember that reactions to food can be immune-related or due to non-immune reasons. The latter might be an intolerance to lactose (a predominant milk sugar), toxins or even caffeine. A professional evaluation can help sort that out.
Allergies to nuts can be difficult to sort out. Tree nuts (pecans, walnuts, cashews and others) are different from peanuts. Peanuts are actually a legume and different from tree nuts, yet the reactions can be similar. There is limited cross reactivity between allergies to tree nuts and peanuts.
The most common symptoms for a peanut allergy (skin reactions, such as hives, redness or swelling; Itching or tingling in or around the mouth and throat; digestive problems, such as diarrhea, stomach cramps, nausea or vomiting; tightening of the throat; shortness of breath or wheezing; runny nose) can be overshadowed by an anaphylactic reaction – stopping breathing, shock, or loss of consciousness. It is these latter reactions that strike fear in all parents and lead to children carrying an epi-pen to immediately treat the onset of symptoms away from home.
There is good evidence to suggest that peanut exposure in limited amounts early in life might decrease the risk of severe problems with a peanut allergy. Since this information changes frequently, I recommend that parents work closely with their pediatrician for any recommendations.
Allergies in general have been increasing and the reason is not completely clear. Perhaps it is related to greater hygiene measures and subsequent less exposure to a variety of germs and other things. Allergies in children do tend to improve with age.
So back to the original question – peanut allergies have increased over the years. With more attention to incremental exposure to peanuts early in life, one would expect that the risk of peanut allergies will decrease over time. Stay vigilant and stay tuned.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.