Peanut
Allergy Facts, Symptoms, and Treatment

Part of the legume family, peanuts (aka ground nuts, earthnuts, and goobers) are valued as a nutritionally dense food that's rich in protein and fat.1 While consumed mostly in roasted form throughout the world, peanuts are often eaten whole, made into peanut butter, and incorporated into many food products, such as bakery goods, candies, cereals, sauces, and marinades.2,3

Despite the nutritional value of peanuts, peanut allergy is the most common cause of fatal food allergic reactions.4 Plus, prevalence of peanut allergy has increased steadily in recent years, making it the most common food allergy in children and the second most common food allergy in adults.4,5 Furthermore, in the United Kingdom, peanut allergy affects up to 2 percent of children, and in the United States roughly 2.5 percent of children may be allergic according to at least one study.3,4

Unfortunately, only about 20 percent of affected children outgrow the allergy, so untreated peanut allergies tend to be lifelong.5 Since peanuts are used in a host of foods, avoiding them can be difficult, and accidental reactions are common. There's also a risk for cross-contamination in food-manufacturing facilities that handle peanuts. And according to at least one study, nearly one-third of nut allergic children can't identify the nut to which they're allergic, which further increases the chance of accidental ingestion.4

Where are peanuts found?

Peanuts may be found in the following:8 artificial flavoring, baked goods, candy, chili, chocolate, crumb toppings, egg rolls, enchilada sauces, fried foods, flavorings, graham cracker crusts, hydrolyzed plant protein, hydrolyzed vegetable protein, marzipan, mole sauces, natural flavorings, nougats, and various cuisines (e.g., African, Asian, Chinese, Indian, Indonesian, Thai, Vietnamese, and Mexican).

If found on a food label, the following indicates the presence of peanut protein:8 arachic oil, arachis, arachis hypogaea, artificial nuts, beer nuts, boiled peanuts, cold pressed peanut oil (and extruded or expelled peanut oil), crushed nuts, earth nuts, goober peas, ground nuts, hydrolyzed peanut protein, mandelonas, mixed nuts, monkey nuts, flavored nuts, nut pieces, nut meat, peanut butter, peanut butter chips, peanut butter morsels, peanut flour, peanut paste, peanut sauce, peanut syrup, Spanish peanuts, and Virginia peanuts.

Most peanut allergy reactions are due to eating peanuts or foods containing peanuts, but merely touching peanuts can trigger a reaction in some allergic individuals.9 In addition, the food manufacturing and preparation processes also pose a risk for cross-contamination.3 Peanut protein that has become airborne via peanut flour and peanut cooking spray or during grinding or pulverization processes can also cause reactions.3,9 Finally, since peanuts and tree nuts (e.g., pecans, cashews, and walnuts) often touch one another during manufacturing and serving processes, talk with your healthcare provider to determine if it's best to also avoid all tree nuts.5

While relatively new to the United States market, lupine is a common food ingredient in Europe that has a high rate of cross-reactivity with peanuts. That is, if you're allergic to peanut, you might also react to lupine. Also known as lupinus albus, lupine is used in seed, bean, and flour forms, and is a popular ingredient in gluten free foods.8

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Are there other allergens I could be sensitized to?*

Some people with a peanut allergy may also experience symptoms when eating other seemingly unrelated foods. This is called cross-reactivity and occurs when your body's immune system identifies the proteins, or components, in different substances as being structurally similar or biologically related, thus triggering a response. The most common cross-reactivities with peanuts are plant foods, e.g., tree nuts, fruits, soybeans, vegetables, and legumes.2

If you experience an itchy mouth or ears, scratchy throat, hives on the mouth, or swelling of the lips, mouth, tongue, or throat after eating peanuts or other related fresh fruits, raw vegetables, or tree nuts, you may suffer from Pollen Food Allergy Syndrome (PFAS) also called Oral Allergy Syndrome (OAS). This condition is caused by your immune system's reaction to similar proteins, or components, found in foods and pollens.7 It is quite common, as one study suggests that up to 25 percent of children with allergic rhinitis (aka hay fever) also suffer from PFAS.11 Common pollen allergies that could cause OAS when eating peanuts include tree (e.g., birch), grass, and weed.2

Do I need to avoid all forms of peanut?

Peanut consists of different types of proteins that all have different characteristics and different levels of risk for causing symptoms.2 Some people with peanut allergy may tolerate peanuts if they are extensively cooked, as high temperatures break down the causative proteins. However, roasting seems to have the opposite effect, making the peanut more allergenic. For another patient, peanut should be avoided completely, as the proteins are stable even when heated, and could potentially cause a severe event called anaphylaxis. Your specific risk profile depends on which proteins in the peanut you are allergic to.2

*These products may not be approved for clinical use in your country. Please work with your healthcare provider to understand availability.

How do I manage my allergy?

Your healthcare provider may recommend a plan that includes the following.12-15

  • Read ingredient labels and "may contain" advisory panels on food and nonfood products carefully, and avoid all foods and products containing any form of the allergen. Note that these lists and panels may not appear on the same side of a product's packaging and that manufacturers frequently change ingredients. If you're unable to obtain a list of ingredients, it's safest to avoid that item.
  • Avoid cross-contamination when cooking by using two sets of cooking and eating utensils, with one exclusively for the allergic individual. Wash all dishes and utensils in hot soapy water between uses.
  • Craft an action plan with a list of steps for you and others to take should you accidentally ingest the allergen. Print out a copy of the plan and carry it with you.
  • Talk with restaurant chefs about your allergy and order food that's simply prepared and void of any form of the allergen. Avoid desserts, as they often contain or have come into contact with food allergens.
  • Plan ahead for traveling to ensure your food allergy will be managed and any emergency medication is always available.
  • Wear a medical ID bracelet identifying the allergen to which you're allergic.
  • Carry any recommended or emergency medication with you at all times.
  • Teach children with food allergies which foods to avoid. Work with caregivers and school staff to eliminate or reduce exposure to the allergen and to ensure they understand when and how to use medication to treat symptoms.

Your health care provider may direct you to take one of the following medications:

  • Epinephrine auto-injector when there are signs of an acute severe event, aka anaphylaxis (see below). Ensure your family members know how to administer it in case of an emergency.
  • Antihistamines as supplement may be useful in relieving mild symptoms (e.g., itch); however, they do not halt the progression of an allergic reaction.
  • Bronchodilator (albuterol) is a supplemental therapy for respiratory symptoms, especially in those with a history of bronchospasm or asthma.

If you're with someone who's having an allergic reaction and shows signs of shock, act fast. Look for pale, cool, and clammy skin; a weak, rapid pulse; trouble breathing; confusion; and loss of consciousness. Do the following immediately:

  • Call local emergency services.
  • Ensure the affected individual is lying down with legs elevated.
  • Administer epinephrine immediately for any obvious signs of anaphylaxis.
  • Check the affected individual's pulse and breathing and administer CPR or other first-aid measures if necessary.

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Peanut Allergen Facts, Symptoms, and Treatment

Common Symptoms

Peanut allergy can range from mild to severe and may vary over time, resulting in mild symptoms during one episode and severe symptoms in another. Although food allergy symptoms can start a few minutes to several hours after ingestion, most begin within two hours. Symptoms may involve the skin, gastrointestinal tract, cardiovascular system, and respiratory tract, and may include one or more of the following:6

  • Vomiting, stomach cramps
  • Hives (aka allergic urticaria)
  • Wheezing, shortness of breath, repetitive cough
  • Shock, circulatory collapse
  • Tight, hoarse throat, trouble swallowing
  • Pale or blue skin coloring
  • Dizziness, weak pulse
  • Swelling of the tongue, affecting the ability to talk or breathe

Peanut allergy symptoms can also include anaphylaxis, a whole-body reaction that can impair breathing, cause a dramatic drop in blood pressure, and affect heart rate. The most severe allergic reaction, anaphylaxis can come on within minutes of exposure and can be fatal.6

Symptoms may also include the following, which are associated with Oral Allergy Syndrome (OAS), aka Pollen Food Allergy Syndrome (PFAS):7,8

  • Itchy mouth and hives on the mouth
  • Scratchy throat
  • Swelling of the lips, mouth, tongue, and throat
  • Itchy ears

How do I know if I'm allergic?*

Together with your symptom history, skin-prick testing or specific IgE blood testing can help determine if you are allergic to a particular allergen. If you are diagnosed with an allergy, your healthcare provider will work with you to create a management plan.

Please note that allergies can change over time, and 10 to 20 percent of children with peanut and tree nut allergies may outgrow them.10

*These products may not be approved for clinical use in your country. Please work with your healthcare provider to understand availability.

Is there a risk for a severe event?

Knowing the proteins, or components, within each allergen that are triggering your symptoms can help guide your management plan. With that in mind, and based on your symptom history, your healthcare provider may suggest something called a specific IgE component test, which can help reveal other pollens and foods you may react to.2

Already have your specific IgE component test results?

Your component test results will include the name of the components (a series of letters and numbers). Your healthcare provider will likely review the results with you, but here you'll find an at-a-glance breakdown you can use as a reference. Simply match the component names to the list below to see what they mean in terms of symptom management.2

rAra h 1, rAra h 2, rAra h 3, Ara h 6

  • Usually associated with a higher risk for severe reactions or anaphylaxis.
  • Stable to heat and digestion; cooked, roasted, and raw peanuts may cause symptoms.

rAra h 9

  • Usually associated with an intermediate risk for severe reactions but also with milder symptoms such as Oral Allergy Syndrome (OAS).
  • May cause symptoms due to cross-reactivity to pollens (e.g., parietaria, ragweed, mugwort, olive, plane tree), plant foods (e.g., peach, apple, citrus fruits, grape, tomato, asparagus, lettuce, etc.), nuts (e.g., hazelnut, walnut), and more.
  • Stable to heat and digestion; cooked, roasted, and raw peanuts may cause symptoms.

rAra h 8

  • Usually associated with mild, localized symptoms, such as OAS, but may also include severe allergic reactions.
  • May cause symptoms due to cross-reactivity to pollens (e.g., birch, alder, hazel, oak, hornbeam, beech), raw plant foods (e.g., strawberry, apple, peach, pear, raspberry, kiwi, celery, carrot, soy, hazelnut, chestnut, tomato), and more.
  • Sensitive to heat and digestion; cooked or roasted peanuts may be tolerated.

rBet v 2 (profilin)

  • Usually associated with mild, localized symptoms, most often OAS.
  • May cause symptoms due to cross-reactivity to pollens (e.g., birch, alder, hazel, oak, hornbeam, beech), grass pollen, raw plant foods (e.g., tomato, melon, citrus fruits, banana, pineapple, persimmon, zucchini, tomato), and more.
  • Sensitive to heat and digestion; cooked or roasted peanuts may be tolerated.

MUXF3 (CCD)

  • Positive specific IgE for peanut in combination with MUXF3 CCD (Cross-Reactive Carbohydrate Determinant) being the only positive component test indicates that the cause of symptoms may be something other than peanut.

Test results should be interpreted by your healthcare provider in the context of your clinical history. Final diagnosis and decision on further management is made by your healthcare provider.

*These products may not be approved for clinical use in your country. Please work with your healthcare provider to understand availability.

  1. Encyclopedia Britannica [Internet]. Chicago: Encyclopedia Britannica Inc.; 2019 Dec 26. Available from: https://www.britannica.com/plant/peanut.
  2. EAACI, et al. Molecular allergology user's guide. Pediatr Allergy Immunol. 2016 May;27 Suppl 23:1-250. doi: 10.1111/pai.12563. PMID: 27288833. (235-244 p.) Available from: http://www.eaaci.org/documents/Molecular_Allergology-web.pdf.
  3. American College of Allergy, Asthma & Immunology [Internet]. Arlington Heights, IL: American College of Allergy, Asthma & Immunology; 2014. Available from: https://acaai.org/allergies/types/food-allergies/types-food-allergy/peanut-allergy.
  4. Anagnostou K, Clark A. The management of peanut allergy. Arch Dis Child. 2015 Jan;100(1):68-72. doi: 10.1136/archdischild-2014-306152. Epub 2014 Aug 25. PMID: 25157179.
  5. Food Allergy Research & Education [Internet]. McLean, VA: Food Allergy Research & Education; 2020. Available from: https://www.foodallergy.org/living-food-allergies/food-allergy-essentials/common-allergens/peanut.
  6. American College of Allergy, Asthma & Immunology [Internet]. Arlington Heights, IL: American College of Allergy, Asthma & Immunology; 2014. Available from: https://acaai.org/allergies/types/food-allergy.
  7. American College of Allergy, Asthma & Immunology [Internet]. Arlington Heights, IL: American College of Allergy, Asthma & Immunology; 2014. Available from: https://acaai.org/allergies/types/food-allergies/types-food-allergy/oral-allergy-syndrome.
  8. Kids with Food Allergies [Internet]. Arlington, VA: Asthma and Allergy Foundation of America; 2015 Feb. Available from: https://www.kidswithfoodallergies.org/peanut-allergy.aspx.
  9. Mayo Clinic [Internet]. Rochester, MN: Mayo Foundation for Medical Education and Research; 2020 Jun 25. Available from: https://www.mayoclinic.org/diseases-conditions/peanut-allergy/symptoms-causes/syc-20376175
  10. Fleischer DM, Conover-Walker MK, Matsui EC, Wood RA. The natural history of tree nut allergy. J Allergy Clin Immunol. 2005 Nov;116(5):1087-93. doi: 10.1016/j.jaci.2005.09.002. Epub 2005 Oct 10. PMID: 16275381.
  11. Roberts, G., Xatzipsalti, M., Borrego, L., Custovic, A., Halken, S., Hellings, P., Papadopoulos, N., Rotiroti, G., Scadding, G., Timmermans, F., Valovirta, E. Paediatric rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology. Allergy. 2013 Sep;68(9):1102-16.
  12. Wright BL, Walkner M, Vickery BP, Gupta RS. Clinical Management of Food Allergy. Pediatr Clin North Am. 2015 Dec;62(6):1409-24. doi: 10.1016/j.pcl.2015.07.012. Epub 2015 Sep 7. PMID: 26456440; PMCID: PMC4960977.
  13. American College of Allergy, Asthma & Immunology [Internet]. Arlington Heights, IL: American College of Allergy, Asthma & Immunology; 2014. Available from: https://acaai.org/allergies/types-allergies/food-allergy/food-allergy-avoidance.
  14. Harvard Health Publishing [Internet]. Boston, MA: Harvard Medical School; 2020. Available from: https://www.health.harvard.edu/healthbeat/6-tips-for-managing-food-allergies.
  15. Mayo Clinic [Internet]. Rochester, MN: Mayo Foundation for Medical Education and Research; 2019 Sep 14. Available from: https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468.
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