Practice Guidelines for Peanut Allergies

Celeste Sitton, RN, BSN, CMSRN; Heide S. Temples, Phd, APRN, PPCNP-BC


J Pediatr Health Care. 2018;32(1):98-102. 

In This Article

History and Symptoms

Assess for Risk Factors (Mayo Clinic Staff, 2015)

• Age of the child

   ○ Peanut allergies are most common in infants and toddlers because of their immature digestive systems.

• Other allergies

   ○ Children with other food or environmental allergies are at an increased risk for peanut allergies.

• Eczema history

   ○ A link between atopic dermatitis and food allergies is often noted.

• Family history

   ○ Children with close family members who have a history of food (particularly peanut or egg) allergies are at increased risk for a peanut allergy.

To assist in the diagnosis of a peanut allergy, the primary care provider should assess the following (American College of Asthma and Immunology, 2014):

  • When was the first time the parent/caregiver noticed any reaction?

  • What and how much did the patient eat?

  • How soon after he/she ate did the symptoms begin?

  • Have they noticed the symptoms worsening since the first reaction, or have the symptoms remained about the same?

  • What did they do to help with the symptoms?

  • Does anything make the symptoms worse?

  • How long did it take the symptoms to resolve?

Although most allergic reactions to peanuts are mild in nature, anaphylaxis is possible. It is essential to teach parents to recognize symptoms of a reaction. Reactions usually occur very quickly after a substance is ingested. Mild to moderate reactions may present as follows (Boyce et al., 2010):

  • Hives

  • A runny nose

  • Itchy, watery eyes

  • Blotchy skin around the mouth

  • Nausea, vomiting, diarrhea, and/or cramping

  • Wheezing, coughing, and/or sneezing

  • Gagging and/or choking

Anaphylaxis often presents differently and with much greater severity. If a child is having an anaphylactic reaction, expect to see the following (Sicherer et al., 2017):

  • Difficulty breathing/wheezing/stridor

  • Tingling around the mouth

  • Throat, tongue, or uvula swelling/tightening

  • Difficulty swallowing

  • Loss of consciousness

  • Pallor or flushing

  • Crampy abdominal pain or vomiting

  • Sudden onset of generalized itching