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


• Child with known peanut allergy

   ○ Prevention is the mainstay of therapy because no treatment or ongoing therapy exists.

      ▪ Avoidance is very difficult because many products contain less-obvious peanut products (e.g., fruit snacks, baked goods, candies, fried foods, and graham cracker crust; (Kids with Food Allergies, 2015).

• Child without known peanut allergy

   ○ Low risk (no history of eczema)

      ▪ Introduction of age-appropriate peanut products can begin as early as 4 months based on family preference.

   ○ Moderate risk (a history of mild to moderate eczema)

      ▪ Consider introduction of peanut products at 6 months after consultation with the child's pediatric provider to inquire about the potential need for allergy testing.

   ○ High risk (a history of severe eczema)

      ▪ Referral to an allergist should be made for testing before the introduction of peanut products (Togias et al., 2017).

Treatment of Allergic Reaction (Epocrates, Inc., 2016, Sicherer, Simons, 2017)


○ Administration of an antihistamine is also appropriate.

   ▪ Diphenhydramine

      • Age 2 to 11 years: 1 to 2 mg/kg/dose oral (PO)/intramuscular (IM)/intravenous (IV), every 6 hours as needed, with a maximum 50 mg/dose, not exceeding 300 mg/day (Epocrates, Inc, 2016)

      • Age 12 years and older: 20 to 50 mg PO/IM/IV every 2 to 4 hours as needed, not exceeding 300 mg/day PO or 400 mg/day for IM/IV (Epocrates, Inc, 2016)

   ▪ Cetirizine for localized cutaneous symptoms

      • Age 2 to 5 years: 2.5 to 5.0 mg PO daily. No more than 5 mg/day (Epocrates, Inc, 2016).

      • Age older than 5 years: 5 to 10 mg PO daily. No more than 10 mg/day (Epocrates, Inc, 2016).


○ Injectable IM epinephrine

   ▪ Auto injectors for children who weigh less than 15 kg

      • Although there is concern that the 0.15-mg dose of epinephrine at 1:1,000 (1mg/1mL) may be high for a child less than 15 kg, the consensus at this time remains that the benefit still outweighs the risk. Therefore, current guidelines recommend the 0.15-mg epinephrine 1:1,000 (1mg/1mL) auto injector for children weighing less than 15 kg (Sicherer et al., 2017).

   ▪ Auto injectors for children who weigh 15 to 30 kg

      • Epinephrine 1:1,000 (1mg/1mL) 0.15-mg dose: may repeat dose once after 5 to 15 minutes if needed (Sicherer et al., 2017).

   ▪ Auto injectors for children who weigh more than 30 kg

      • Epinephrine 1:1,000 (1mg/1mL) 0.3-mg dose: may repeat once after 5 to 15 minutes if needed (Sicherer et al., 2017).

   ▪ Injectable IM

      • Epinephrine 1:1,000 (1mg/1mL) at a dose of 0.01 mg/kg, with a maximum dose of 0.3 mg for pre-pubertal patients and 0.5 mg for adolescent patients. This dose can be repeated every 5- to 15 minutes up to two times if the desired response is not achieved (Sicherer et al., 2017).

○ Transport to the nearest emergency department for follow-up and further treatment or call 911.