Peanut allergy is one of the most common food allergies in the United States, affecting approximately 1–2% of the population. Peanuts are legumes that grow underground. Although they are related to foods such as peas, lentils, soybeans, and chickpeas, most individuals with peanut allergy can safely eat these other legumes. Only about 5–10% have allergies to additional legumes.

Many patients with peanut allergy tolerate tree nuts, including almonds, cashews, walnuts, pistachios, and hazelnuts. However, about 30% also have a tree nut allergy, which is why individualized evaluation by an allergist is important.

Most peanut allergic reactions are caused by IgE antibodies and occur soon after exposure. Symptoms may include:

• Hives or itching

• Swelling of the lips, tongue, or throat

• Coughing, wheezing, or shortness of breath

• Nausea, vomiting, or abdominal pain

• Dizziness or fainting

Severe reactions, known as anaphylaxis, can be life-threatening and require immediate treatment with epinephrine.

Peanut allergy is diagnosed using a combination of medical history and allergy testing, which may include:

• Skin prick testing

• Blood testing for peanut-specific IgE

• Component testing to peanut proteins

Certain peanut proteins (Ara h 1, Ara h 2, and Ara h 3) are associated with higher risk of severe reactions. Ara h 8 is more commonly linked to pollen-food allergy syndrome and typically causes milder symptoms. Component testing helps determine true allergy risk and guide management decisions.

In select cases, a medically supervised oral food challenge may be recommended. This is typically considered when:

• Skin or blood test results are low

• The diagnosis is uncertain

• There is a possibility the allergy has been outgrown

All food challenges are performed in our medical office under close supervision, with emergency treatment readily available.

Strict avoidance of peanuts remains the foundation of peanut allergy management. Patients should:

• Carefully read food labels

• Communicate food allergy needs clearly

• Always carry epinephrine

FDA regulations require packaged foods to clearly identify peanuts when present. Despite precautions, accidental exposure can occur, so preparedness is essential.

An FDA-approved oral immunotherapy for peanut allergy is available and designed to reduce the risk of severe reactions from accidental exposure. Treatment involves gradually increasing doses under close medical supervision.

Patients must continue to avoid peanuts and carry epinephrine at all times.

Omalizumab is the latest treatment option for Peanut Allergy.

Marketed as Xolair, Omalizumab treated multi-food allergy more effectively than oral immunotherapy (OIT) in people with allergic reactions to very small amounts of common foods allergens.https://www.nejm.org/doi/full/10.1056/NEJMoa2312382

Peanut allergy often begins in childhood and may persist into adulthood. However, about 20% of individuals outgrow their peanut allergy over time. Repeat testing and clinical evaluation help determine whether tolerance may have developed.