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


Physical Examination (Boyce et al, 2010, Sicherer, Simons, 2017)

• Respiratory

   ○ Wheezing

   ○ Stridor

   ○ Cough

   ○ Dyspnea

   ○ Rhinorrhea

• Gastrointestinal

   ○ Abdominal pain

• Cardiovascular

   ○ Hypotension (Sicherer et al., 2017)

      ▪ For infants and children

         • Based on age-specific guidelines, a low systolic blood pressure (BP)

         • More than 30% drop in systolic BP

      ▪ For adolescents and young adults

         • Less than 90 mm Hg systolic BP

         • More than 30% drop from the patient's normal BP

   ○ Cardiac arrest

   ○ Arrhythmia

• Integument

   ○ Urticaria

   ○ Erythema/hives

   ○ Angioedema

Laboratory/Diagnostic Studies (Sicherer & Wood, 2013)

Once a thorough history and assessment are completed by the clinician and a food allergy is suspected, a referral to an allergist should be ordered, especially if the introduction of peanut products is being considered. Because many children present with different symptoms of varying severities, all patients suspected of having a food allergy of any kind should be referred to an allergist (ACAAI, 2014). One might expect one or more of the following diagnostic studies or recommendations to result from consultation:

  • Skin prick test: A small amount of the allergen's antigen is introduced into the child's skin by means of a skin prick. Approximately 15 minutes later, the site is evaluated for severity of hives/redness compared with a control site.

  • Serum peanut-specific IgE concentration levels: The level of peanut-specific IgE is measured in the child's blood.

  • Food elimination diet: The most obvious offending agents are removed from the child's diet to see if there is a decrease or elimination of symptoms.

  • Oral food challenge (criterion standard): A highly accurate test that remains the criterion standard in the diagnosis of food allergy. The provider feeds the patient small, measured amounts of the offending food, in increasingly larger amounts, until an adverse reaction or no reaction is observed.