Bruce's Crib Notes for The Peanut Allergy Answer Book
The Peanut Allergy Answer Book by Michael
C. Young, M.D. is an indispensable reference for anyone
associated with a peanut-allergic child or adult. My
crib notes are below. He also has an appendix B of main
What's the big deal about peanut allergy?
- Annually, there are 100 deaths from food allergy, the
majority from peanuts and tree nuts (presumably
- There is no good test to predict who is at risk for a
life-threatening allergic reaction.
- Most people never outgrow peanut allergy. Those few who do
outgrow this life-threatening allergy have been successful at
avoiding exposure to it.
- The protein in roughly one tenth of a peanut is enough to
cause a reaction. A tiny bit of peanut butter on another
child's hand is a threat (p. 48).
- There are reports in the medical literature of people
experiencing allergic reactions merely from smelling the odor
of foods (p. 49)
- There was no peanut allergy research at all until 1976.
- First research linking anaphylaxis deaths to peanut allergy
was in 1988.
- In 1989 it was shown that peanut allergy usually persists
- As of 2001, estimates are that about 1 in 200 children in
the US and UK have peanut allergy.
- Peanuts are legumes, unlike tree nuts. However, most
peanut-allergic individuals are not allergic to other legumes
- Many allergists (including the author) recommend that peanut
allergic children generally avoid tree nuts (details p. 32).
- Most people never outgrow peanut allergy.
- Ten to twenty percent of people outgrow or resolve their
peanut allergy. These "resolvers" have meticulous avoidance
of peanut with nearly no accidental ingestions, smaller skin
test results, and fewer food allergies in total. It is
possible that the younger your child is when diagnosed with
peanut allergy, the better his chances of outgrowing it (pp
- Some ingredients are obviously peanut, others aren't. For
example, in the UK and Europe, peanut oil can be referred to
as arachis oil (p. 54). See the book for many important
- It is important for families to provide a written
action plan to schools and school nurses (details p. 72).
- A skin rash with no other symptoms can be treated just with
antihistamines. This is mild anaphylaxis.
- A skin rash plus other symptoms (e.g. difficulty breathing,
gastrointestinal) should be treated with epinephrine,
antihistamines and emergency medical attention.
- In severe anaphylaxis, swelling of tissues in the upper
airway obstructs breathing. This is why epinephrine must be
injected immediately, and why emergency medical care is
- Annually, there are 100 anaphylaxis deaths from food
allergy, the majority from peanuts and tree nuts (presumably
- There is no available test to predict who is at risk for a
life-threatening allergic reaction, except an actual challenge
test. [Bruce note: I think this means they give you the
allergen and stand ready with medical equip. Not a good idea
since avoiding anaphylaxis increases chances of outgrowing.]
- You should keep at least two Epipens(R) on your person
because of the risk that one may misfire or be defective.
Plus the dose only lasts 20-30 min.
- All peanut-allergic individuals and their families [and
caregivers!] should be prepared to treat anaphylaxis.
- The likelihood of developing allergies is lessened by
exclusive breastfeeding at least 4-6 months (p. 86) [Bruce
note: the World Health Oranization recommends a minimum of two
years breast feeding, though obviously not exclusive that whole time.]
- Somewhere in 4-6 months, introduce rice cereal, fruits and
vegetables (p. 87)
- From 6-12 months, introduce individual foods sequentially,
one food per week. [Bruce note: among foods listed in book
are wheat, dairy, egg. I got an egg allergy at 11 months, but
outgrew it later in childhood.]
- Wait until 12 months for fish.
- Wait at least until 36 months for peanut, tree nuts,
shellfish. Five years if there's a family history.
Last modified: Tue Jul 23 11:16:51 EDT 2002