Peanut allergy - diagnosis and treatment (2023)


The discussion between you and your doctor about your symptoms and medical history initiates the diagnostic process. This interview is usually followed by a physical examination. The next steps typically involve some of the following:

  • beat upYour doctor may ask you to keep a food journal detailing your eating habits, symptoms, and medications.
  • elimination diet.If it's not clear that peanuts are causing your symptoms, or if your doctor thinks you're reacting to more than one type of food, he or she may recommend an elimination diet. You may be asked to stop eating peanuts or other suspicious foods for a week or two, and then reintroduce the foods into your diet one at a time. This process can help associate symptoms with certain foods. If you have had a severe reaction to food, this method is not safe to use.
  • skin test.A small amount of food is applied to your skin and then pricked with a needle. If you are allergic to a specific substance, you will experience an increased bump or reaction.
  • blood test.A blood test can measure your immune system's response to certain foods by checking the amount of allergy-type antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies.

Information from all of these sources can help determine if you have a peanut allergy or if your symptoms are likely due to something else, such as a food intolerance.

Reine Information

  • Allergy Skin Test


While the standard approach in treating peanut allergy is to avoid exposure, researchers continue to investigate various therapies, including oral immunotherapy.

Oral immunotherapy, also called desensitization, involves giving increased doses of foods containing peanuts over time to children who are allergic to peanuts or who are at risk of developing peanut allergies. Oral immunotherapy is not a cure for peanut allergy. Rather, this type of therapy is intended to reduce the risk of serious reactions, including anaphylaxis, that can occur from exposure to peanuts.

US. The Food and Drug Administration recently approved the first oral immunotherapy drug, Peanut (Arachis hypogaea) Allergen Powder-dnfp (Palforzia), for the treatment of children ages 4 to 17 with a confirmed peanut allergy. This drug is not recommended for people with uncontrolled asthma or certain medical conditions, including eosinophilic esophagitis.

Additionally, as with any food allergy, treatment includes taking steps to avoid the foods that are triggering your reaction, knowing how to recognize a reaction when it occurs, and being prepared to respond quickly, including maintaining it the adrenaline level.

Be prepared for an answer

The only way to avoid a reaction is to completely avoid peanuts and peanut products. But peanuts are common, and despite your best efforts, you're likely to come across peanuts at some point.

If you have a severe allergic reaction, you may need an emergency shot of epinephrine and a visit to the emergency room. Many people with allergies carry an epinephrine auto-injector (EpiPen, Auvi-Q, others). This device is a syringe and hidden needle that injects a single dose of medicine when pressed against your thigh.

Learn how to use your auto-injector

If your doctor has prescribed an epinephrine auto-injector:

  • Always carry it with you.It can be a good idea to keep an extra auto-injector in your car and on your desk at work.
  • Always replace before the expiration date.With age, adrenaline may no longer work properly.
  • Ask your doctor to prescribe you a replacement auto-injector.If you leave one, you have a spare.
  • Know how to use it.Ask your doctor to show you. Also, make sure people close to you know how to use it - if someone close to you can give you a shot, he or she could save your life.
  • Know when to use it.Talk to your doctor about knowing when you need an injection. However, if you are not sure if you need an injection, it is usually better to use epinephrine in an emergency.

Request an appointment

Clinical Trials

Discover the Mayo Clinic studiesExperimenting with new treatments, interventions, and tests as a means of preventing, detecting, treating, or treating this condition.

lifestyle and home remedies

One of the keys to preventing an allergic reaction is to avoid the foods that are triggering your symptoms. Follow these steps:

  • Never assume that a food does not contain peanuts.Peanuts may be in foods you didn't know they were in. Always read the labels on processed foods to make sure they don't contain peanuts or peanut products. Manufactured foods must clearly state whether the foods contain peanuts and whether they were manufactured in facilities that also process peanuts.

    Even if you think you know what a food contains, look at the label. Ingredients are subject to change.

  • Don't ignore a label that says a food product was made in a facility that processes peanuts.Most people with a peanut allergy should avoid any products that may contain traces of peanuts.
  • When in doubt, say "No thanks."In restaurants and social gatherings, there is always a risk of accidentally eating peanuts. Many people are unaware of the severity of an allergic food reaction and may not realize that a small amount of food can cause a serious reaction. If you are concerned that a food contains something you are allergic to, do not try it.
  • Be prepared for an answer.Talk to your doctor about bringing emergency medication with you in case of a severe reaction.

Avoid foods that contain peanuts

Peanuts are common and avoiding foods that contain them can be a challenge. The following foods commonly contain peanuts:

  • Ground or mixed nuts
  • Baked goods such as cookies and cakes
  • ice cream and frozen desserts
  • energy bars
  • cereals and muesli
  • cereal bread
  • Marzipan, a candy made from nuts, egg white and sugar

Some foods that may contain peanuts or peanut proteins because they were either made from them or came into contact with them during the manufacturing process are less obvious. Some examples are:

  • Carefully
  • salad sauce
  • Chocolates, nut butters (e.g. almond butter) and sunflower seeds
  • Ethnic dishes including African, Chinese, Indonesian, Mexican, Thai and Vietnamese cuisine
  • Grocery sales in bakeries and ice cream parlors
  • Peanut oil, another name for peanut oil
  • pet food

cope and support

If your child has a peanut allergy,Take these steps to protect him or her:

  • Involve the nursing staff.Ask relatives, babysitters, teachers and other relatives for help. Teach the adults who spend time with your child how to recognize the signs and symptoms of an allergic reaction to peanuts. Emphasize that an allergic reaction can be life-threatening and requires immediate attention.

    Also, make sure your child knows how to ask for help right away if they have an allergic reaction.

  • Use a written plan.List the steps to take in the event of an allergic reaction, including the order and dosage of any medication to be given, and contact information for family members and healthcare providers. Give a copy of the plan to family members, teachers, and others who care for your child.
  • Discourage your child from sharing food.It is common for children to share snacks and treats. But while you play, your child can forget about food allergies or intolerances. If your child is allergic to peanuts, encourage them not to eat other people's foods.
  • Make sure your child's adrenaline auto-injector is always available.An injection of adrenaline (epinephrine) can immediately reduce the severity of a potentially life-threatening anaphylactic reaction, but it must be administered immediately. If your child has an emergency epinephrine injector, make sure family members and other caregivers know about your child's emergency medication—where it is, when it's needed, and how to use it.
  • Make sure your child's school has a food allergy management plan in place.Policies are available for establishing policies and procedures. Personnel must have access to and be trained in the use of an epinephrine injector.
  • Have your child wear a medical alert bracelet or necklace.This will help ensure he or she gets the right treatment if he or she is unable to communicate during a severe reaction. The alert will include your child's name, the type of food allergy they have, and possibly brief emergency instructions.

If you have a peanut allergy,Do the following:

  • Always carry your adrenaline auto-injector with you.
  • Wear a medical alert bracelet or necklace.

Prepare for your appointment

To get the most out of your business, it's a good idea to be well prepared. Here's some information to help you prepare for your appointment and what to expect from your doctor.

  • Description of your symptoms.Be ready to tell your doctor what happened after you ate peanuts and also how long it took for a reaction to occur. Try to remember how many peanuts you ate. If you don't know how many peanuts you ate, tell your doctor which peanut-containing food caused your symptoms and how much of it you ate.
  • Make a list of all the medications you are taking.Including vitamins or dietary supplements.
  • Bring a family member or friendif possible. Sometimes it can be difficult to remember all the information you received during an appointment. Someone accompanying you may remember something you missed or forgot.
  • Write down any questions you have.

Some of the basic questions to ask your doctor include:

  • Are my symptoms likely to be caused by a peanut allergy?
  • What else could be causing my symptoms?
  • What tests do I need?
  • What is the best treatment?
  • Do I need to see a specialist?
  • Is there a generic alternative to the medications you are prescribed?
  • Are there brochures or other printed materials I can take with me? Which websites do you recommend?
  • Do I need to bring an adrenaline auto-injector?

If your child is going to the doctor for a peanut allergy, you can also ask:

  • Are there alternatives to the foods that are causing my child's allergy symptoms?
  • How can I protect my child with a peanut allergy at school?
  • Is my child likely to outgrow their allergy?
  • Don't hesitate to ask further questions.

What to expect from your doctor

Your doctor will likely ask you a number of questions, including:

  • When did you start experiencing symptoms?
  • How long after eating peanuts did it take for symptoms to appear?
  • How many peanuts did you eat?
  • Have you taken over-the-counter medications like antihistamines and if so, has that helped?
  • Does your reaction seem to be caused only by peanuts or by other foods?
  • How severe are your symptoms?
  • What seems to improve your symptoms?
  • What seems to make your symptoms worse?

What you can do in the meantime

If you suspect you have a peanut allergy, avoid contact with peanuts until you see your doctor. If you have a severe reaction, seek emergency help.

Former employees of the Mayo Clinic


What is the treatment protocol for peanut allergy? ›

Peanut allergy immunotherapy is a type of treatment that focuses on building tolerance to peanut. The treatment desensitizes the body to the allergen. The treatment starts with a tiny amount of peanut protein, and then gradually larger amounts, until a target dose is reached.

What is the diagnostic test for peanut allergy? ›

Your healthcare provider may use a blood test to diagnose a peanut allergy. A blood test called an immunocap radioallergosorbent (RAST) checks the number of antibodies (immune response cells) in your blood. A higher number of certain types of antibodies can indicate an allergy.

How successful is peanut allergy treatment? ›

Of the 54 peanut-allergic children participating in the study, 47 completed the treatment, with 70% showing protection against accidental exposures of peanut (>800 mg peanut, ~3 peanuts) and 36% showing full desensitization (5000 mg of peanut, ~16 peanuts).

What number is considered high for peanut allergy? ›

Levels of Peanut Allergies
ClassIgE kU/LInterpretation
417.5-49.9Strongly positive
550.0-99.9Strongly positive
6> or =100Strongly positive
4 more rows

What is the first line treatment for peanut allergy? ›

Treatment / Management

To date, the recommended management of peanut allergy relies on avoidance of peanut ingestion. Unfortunately, severe reactions such as anaphylaxis may occur despite best efforts in avoidance. Epinephrine is the first-line medication for the treatment of anaphylaxis.

Does Benadryl help with peanut reaction? ›

Yes, Benadryl can help relieve peanut allergy symptoms associated with a mild reaction to peanuts. These symptoms include mild stomach discomfort, sneezing, itchiness of the mouth or nose, or a mild rash. However, Benadryl will not help with a severe allergic reaction such as anaphylaxis.

How accurate is peanut allergy testing? ›

A positive SPT is reliable about 50 percent of the time, but a negative SPT result is about 95 percent predictive. By itself, the positive result just indicates that your body has made allergic antibodies, called IgE, to a specific food.

What is the most definitive test to confirm food allergies? ›

The gold standard for diagnosing food allergy is an oral food challenge. In this procedure, a food is eaten slowly, in gradually increasing amounts, under medical supervision to accurately diagnose or rule out a true food allergy.

Are there different levels of peanut allergies? ›

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.

How much does peanut immunotherapy cost? ›

Finally, to maintain tolerance to one peanut, daily doses are administered at home. The drug cost alone is about $4200 a year, according to Institute for Clinical and Economic Review.

What is a Level 3 peanut allergy? ›

There are three levels of peanut allergies: Level 1: Mild reaction, such as hives, itching, or swelling around the mouth or face. Level 2: Moderate reaction, such as difficulty breathing, stomach pain, or vomiting. Level 3: Severe reaction, such as anaphylaxis, which can be life-threatening.

How successful is oral immunotherapy for peanut allergies? ›

Oral immunotherapy is successful for about 80% of people; meaning that they are able to reach maintenance dosing of their food allergen within about six months (or longer for multiple allergens) and are safer from accidental exposures of their allergen. However, OIT does not work for everyone.

What is a Class 1 peanut allergy? ›

Class I food allergies can be associated with mild clinical symptoms (like oral allergy syndrome (OAS)) to severe clinical symptoms (systemic reactions like urticaria, asthma, gastrointestinal disorders) that can lead to anaphylactic shock.

Does everyone with a peanut allergy need an epipen? ›

Not every allergic reaction calls for an injection of epinephrine – in fact, most of them do not. Common allergic reactions include runny nose, itchy or watery eyes, red eyes, a scratchy throat or cough, and even hives. Sometimes, these reactions resolve on their own.

Can you have a false positive for a peanut allergy? ›

It's important to know that your child may test positive for a peanut allergy but not have a reaction. Food allergy tests (both skin tests and blood tests) may have "false positive" results. This mean that the test is positive for food allergy, but your child can eat the food without any issues.

What is the timeline of a peanut allergy? ›

When they're exposed to even the tiniest trace of peanuts, they develop a life-threatening total-body reaction called anaphylaxis. An anaphylactic reaction often starts within seconds after someone with a severe allergy eats peanuts. Rarely, symptoms can appear minutes or hours after exposure.

When should I retest my peanut allergy? ›

Two years between allergy tests is reasonable – there are no limitations to the frequency of testing. But you can talk with your allergist about whether retesting is necessary. Allergists will typically recommend retesting for symptomatic or therapeutic reasons.

How much Benadryl should I take for peanut allergy? ›

Peanut-containing Food Products

First, an injection of epinephrine (EpiPen or EpiPen Jr) should be given to reduce the severity of the reaction. Second, taking liquid diphenhydramine (Benadryl) at a dose of 5 mg for every 10 lb of body weight, up to a maximum dose of 75 mg, also is recommended.

How long does it take to get peanuts out of your system? ›

Peanut allergen appears to linger in saliva right after a meal, according to research reported by the American Academy of Allergy, Asthma and Immunology. In fact, it could take anywhere from one to almost four hours or more to become undetectable.

Is there a pill for peanut allergy? ›

The U.S. Food and Drug Administration recently approved the first oral immunotherapy drug, Peanut (Arachis hypogaea) Allergen Powder-dnfp (Palforzia), to treat children ages 4 to 17 years old with a confirmed peanut allergy.

What happens if you use an EpiPen without needing it? ›

Unintentional injection of epinephrine into fingers or hands can cause limited blood flow and injury. It sometimes requires a trip to the emergency room.

Are peanut allergies overdiagnosed? ›

A new study by a team of allergists suggests that those tests aren't as accurate as we think—meaning tree nut allergies may be massively overdiagnosed. In many cases, peanut-allergic individuals who studiously avoid other nuts could be doing so without cause, the authors conclude.

What does a mild peanut allergy look like? ›

Peanut allergy signs and symptoms can include: Skin reactions, such as hives, redness or swelling. Itching or tingling in or around the mouth and throat. Digestive problems, such as diarrhea, stomach cramps, nausea or vomiting.

Can someone have a mild peanut allergy? ›

Symptoms of peanut allergy can range from mild to severe. If you have a mild reaction, you may get: A stomach ache. A runny nose.

How can I test for peanut allergy at home? ›

Most at-home lab food allergy tests follow a similar procedure: An at-home lab company sends a test kit to your home. If your kit allows you to receive digital updates and analysis, you'll also need to register your kit with the testing company. Send a blood sample to a laboratory for testing.

How do you flush food allergens out of your system? ›

Keep yourself hydrated. "While your body is purging the allergen food from it is system, the best thing you can do is drink plenty of fluids," Zeitlin says. Water is always a good idea, but you can also sip on low calorie sports drinks to replenish the electrolytes you're likely losing, Zeitlin says.

What is the gold standard for allergy testing? ›

Allergy skin testing is the gold standard and is used along with the medical history to find out exactly what things a person is allergic to. Some medicines can interfere with skin testing, so you should let your allergist know about any medications you're taking. Skin tests are done in an allergist's office.

Do peanut allergies get worse with age? ›

You could experience mild reactions for many years, and then suffer a severe reaction without any apparent reason. Conversely, a severe allergic reaction could be followed by a more moderate response.

Can a peanut allergy not be anaphylactic? ›

Most allergic reactions to peanuts are mediated by immunoglobulin-E (IgE) antibodies, causing immediate symptoms that can range from mild reactions to severe anaphylaxis. Anaphylaxis, a very serious allergic reaction, can be life-threatening.

Can you eat almonds if you are allergic to peanuts? ›

And nearly all of the people with allergies to peanuts—which are technically legumes—were able to safely eat tree nuts like almonds, walnuts and Brazil nuts, even though tests had suggested they might be problematic.

Who pays for immunotherapy? ›

Immunotherapy is an emerging treatment for cancer and other conditions that can be very expensive. These treatments may be covered by private insurance, Medicare, or Medicaid.

Is it worth getting immunotherapy? ›

While there are no guarantees that any cancer treatment will work for everyone, immunotherapy has many potential benefits. Immunotherapy: Improves the long-term survival rate of many types of cancer. Destroys multiple tumor types and can prevent tumors from returning in many cases.

Is immunotherapy cheaper than chemo? ›

The researchers found the average cost of immunotherapy in 2015 was $228,504 versus $140,970 for chemotherapy. In 2016, the average cost was $202,202 for immunotherapy and $147,801 for chemotherapy.

What is a Level 4 allergy? ›

Class 4: Very high level of allergy (17.50 KUA/L – 49.99 KUA/L) indicative of very high level sensitization. Class 5: Very high level of allergy (50.00 KUA/L – 99.9 KUA/L) indicative of very high level sensitization. Class 6: Very high level of allergy (≥ 100.0 KUA/L) indicative of very high level sensitization.

Is a severe peanut allergy considered a disability? ›

Yes. In both the ADA and Section 504, a person with a disability is someone who has a physical or mental impairment that seriously limits one or more major life activities, or who is regarded as having such impairments. Asthma and allergies are usually considered disabilities under the ADA.

Can you outgrow a Class 2 peanut allergy? ›

About 20 to 25 percent of children with peanut allergies outgrow them, and about 80 percent who outgrow them will do so by age 8. Allergies to tree nuts, fish and shellfish may be tougher to outgrow and are often lifelong.

Is oral immunotherapy covered by insurance? ›

The cost of peanut OIT is often covered or partially covered by health insurance. Work with your allergist to determine the cost based on your insurance coverage. Note that there are also non-FDA-approved peanut OIT products that your allergist might use for treatment.

What are the disadvantages of oral immunotherapy? ›

What are the risks of OIT? The most common side effects of OIT are mild and include mouth itching, throat itching, mild abdominal pain or cramping, and mild rash. There is a risk of more severe side effects, such as severe abdominal pain, vomiting, difficulty breathing, or wheezing.

What are the cons of oral immunotherapy? ›

  • Studies on OIT are heterogeneous, hence it is difficult to assess evidence on its effectiveness.
  • In most cases, standardized products and OIT protocols are lacking.
  • There is no clear evidence of OIT efficacy in adults.
  • There is insufficient evidence of OIT efficacy for food other than cow's milk, egg and peanut.

What is immunotherapy for peanut allergy? ›

This involves giving people increasing doses of peanut flour over time in order to desensitize them to peanut. Providing such oral immunotherapy early in life, when the immune system is still maturing, might more effectively modify a child's immune response to peanut than waiting until later.

What is the new treatment to reduce effects of peanut allergy to benefit thousands of children? ›

The new treatment, known as Palforzia could help children between the age of 4 and 17 by helping to build up their tolerance to peanuts.

How long does peanut allergy immunotherapy take? ›

This phase consists of 11 visits to your allergist's office, roughly every two weeks for six months, with the first visit occurring within four days of the initial dosing appointment. During each visit, your child will receive a progressively larger dose of the peanut OIT.

How much does peanut oral immunotherapy cost? ›

The total OIT process with a new patient visit is typically $3,500 - $4,000. We will submit all but your equipment fee to your insurance carrier. You will be billed whatever they decline.

How do you reverse peanut allergy? ›

There is no cure for peanut allergies. Palforzia is a type of oral immunotherapy that is approved for use in treating peanut allergies. It contains precise amounts of peanut protein and is given to children age 4-17 years of age every day to help decrease their sensitivity to small amount of peanuts over time.

Can you desensitize a peanut allergy? ›

An alternative solution to treating a peanut allergy is peanut oral immunotherapy (OIT), otherwise known as peanut desensitization. Allergy/Immunology Associates now offers peanut OIT treatment as an effective approach to reducing the severity of a peanut allergy.

Who qualifies for immunotherapy? ›

You may be a candidate for immunotherapy if: Genomic testing reveals biomarkers that are positive for PD-L1 expression, high microsatellite instability or high tumor mutational burden. You have advanced cancer.

Is allergy immunotherapy worth it? ›

Allergy shots are usually a very effective way of treating chronic allergies. It may take some time, but most people find that regular shots can help them when other common treatments haven't worked. Studies show that 85% of people who suffer from hay fever see a reduction in their symptoms when they receive shots.


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