There is some good news for children with peanut allergy.

The White House - Let there be peace! (Dr. Noorali Bharwani)
The White House - Let there be peace! (Dr. Noorali Bharwani)

Allergy to peanuts is the most common children’s food allergy. And the prevalence of peanut allergy is rising. It tends to present early in life, and affected individuals generally do not outgrow it. It is not clear why some people develop allergies while others don’t.

Eight foods are responsible for more than 90 per cent of food allergies: cow’s milk, eggs, soy, wheat, peanuts, tree nuts (walnuts, hazelnuts, almonds, cashews, pecans and pistachios), fish and shellfish. Peanuts and tree nuts are responsible for the majority of serious acute allergic (anaphylactic) reactions.

While EpiPens are used to control general allergic reactions, there is no specific treatment available for peanut allergies – until now. A Harvard University blog of March 1, 2018 (A cure for peanut allergies in sight?) reports that within the past year, three new peanut allergy therapies have gone through clinical trials.

Despite the treatment’s success, there were some safety concerns: 20 per cent of patients discontinued the trial, with 12 per cent withdrawing due to moderate side effects. But there is still hope. The researchers are planning to get FDA approval, which would make it the first protective treatment against peanut allergies, says the Harvard University blog. We have to learn more about the complex mechanisms of peanut allergy and tolerance before success is achieved.

Food allergies affect between four and eight per cent of children and between one and two per cent of adults. The perceived prevalence of food allergies is substantially higher than the actual prevalence. Up to 30 per cent of the general population believe they have a food allergy, and up to 30 per cent of parents believe that their children have a food allergy.

All food allergies have the potential to induce anaphylaxis, but some foods are more likely than others to cause potentially life-threatening reactions. Peanut allergy deserves particular attention. It accounts for the majority of severe food-related allergic reactions, it tends to present early in life, it does not usually resolve, and in highly sensitized people, trace quantities can induce an allergic reaction.

Parents have to understand that all degree of peanut allergy should be taken seriously – even mild allergy can cause serious problems. An allergic response to peanuts usually occurs within minutes after exposure.

Should pregnant women avoid peanuts to prevent peanut allergy in their children?

We need more studies to advise pregnant mothers about avoiding peanuts during pregnancy. We have no evidence to suggest that pregnant women should be encouraged to ingest peanut or suggest an amount of peanut to be ingested to ensure a preventive effect, as there is insufficient evidence to support it at this time, say experts.

To summarize, peanut allergy is the most common cause of food-induced anaphylaxis, a medical emergency that requires treatment with an epinephrine (adrenaline) injector (EpiPen) and a trip to the emergency room.

Call 911 if you or someone else displays severe dizziness, severe trouble breathing or loss of consciousness. There is no time to waste.

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Nuts – what about them?

You may ask, “What kind of a nut are you to ask such a question?”

The word nut has many meanings, depending on how you use it. The word can be used to express love, disgust or enthusiasm. It can be a fruit. It can be used as a slang to describe your head, testicles, your boss, your spouse, your foolish, silly or eccentric friend, an insane psychotic person and for tools like nuts and bolts. Well, I can go on and on at the risk of you saying, “You’re off your nut doc, make your point now.”

The point is, we are going to talk about a seed borne within a fruit having a hard shell, as in the peanut or almond.  We know that Mediterranean diet is good for your heart and brain. A Mediterranean diet is described as a diet rich in plant foods (vegetables, fruits, legumes, nuts), including fish, some poultry, limited red meat, and primarily unsaturated vegetable oils.

Then there is the Portfolio eating plan. This is a vegetarian/Mediterranean-type diet with less than seven per cent of calories from saturated fat. It consists of 2000 cal/day. Besides other things, Portfolio diet requires you to eat 30 gm of almonds (one handful= 23 almonds = one ounce).

In general, nuts are a rich source of unsaturated fatty acids, plant protein, fibre, vitamins and minerals, plant sterols and flavonoids, all of which have health benefits. Studies have shown that if you eat one ounce of nuts (¼ cup) or more per day then you can reduce the risk of coronary heart disease by 50 per cent. Isn’t that wonderful?

Studies of walnuts, almonds, pecans, peanuts, macadamias and pistachios show modest changes in blood lipid levels. Similar to other foods rich in unsaturated fat, nuts help maintain HDL (good cholesterol) levels. To control calorie intake, moderate quantities of nuts should be substituted for other foods, since one ounce of nuts (¼ cup) contains approximately 170 calories (Rakel: Integrative Medicine, 2nd ed.)

According to US Department of Agriculture, 68 per cent of the nuts eaten in the United States are peanuts and peanut butter, about six per cent are almonds, six per cent are coconuts, five per cent are pecans, five per cent are walnuts and 10 per cent are all other nuts combined.

Peanuts are considered to be mother-nature’s complete food. They belong to legume or dried bean family and are a great source of protein, fibre, a variety of vitamins and minerals and beneficial unsaturated fats. Since they are a plant food, they contain no cholesterol.

Harvard School of Public Health researchers report that consuming a half serving (one tablespoon) of peanut butter or a full serving of peanuts or other nuts (an ounce), five or more times a week is associated with a 21 per cent and 27 per cent reduced risk of developing type 2 diabetes, respectively (JAMA 2002).

Many studies have examined the eating patterns of both men and women and found that small, frequent servings of peanut butter, nuts and peanuts can reduce the risk of heart disease by 25-50 percent.

Americans consume 2.4 billion pounds of peanuts each year. About 50 per cent is consumed as peanut butter. Research published in Paediatrics shows that high risk overweight adolescents, ages 10-15, can lose weight while substituting an ounce of peanuts or peanut butter for other less healthy snack choices.

A serving of peanuts is simply a handful and is only 160 calories. And a serving of peanut butter (two tablespoons) contains 190 calories – just enough to make a peanut butter and jelly sandwich. In addition, studies show that peanuts and peanut butter satisfy hunger longer than other foods (

So, have you gone nuts yet?

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Peanut Allergies in a Nutshell

In the last column, we discussed some important aspects of peanut allergy. Today, we will concentrate on prevention, immediate management and where to find more information on this important subject.

As in the last column, we will use information provided by Dr. Hugh Sampson, paediatrician, Mount Sinai School of Medicine, New York, in his article published in the New England Journal of Medicine.

Sharon Pudwell, a local parent of a child with peanut allergy, has also given me information to share with you.

Dr. Sampson says that children with peanut allergy, their parents and caregivers, must be educated to:

-to avoid accidentally ingesting peanuts
-learn to recognize early signs of an allergic reaction
-learn to give medication as soon as symptoms develop.

Parents and children should check all food labels. They should avoid high-risk situations such as foods served in buffets and ice-cream parlours and unlabeled candies and deserts.

Symptoms of allergic reaction can appear within few minutes to few hours. Pudwell says that some of the early symptoms are: itchy eyes, nose, and face; flushing of face and body; swelling of eyes, face, lips, tongue and throat; hives, vomiting, diarrhoea, wheezing, a feeling of fear and apprehension; weakness and dizziness; inability to breathe and eventually loss of consciousness. The condition may end in shock and death.

Treatment of acute reaction (anaphylaxis) by patient and family members include injection of epinephrine (depending on patient’s history and symptoms) with EpiPen Autoinjector and oral liquid diphenhydramine (an anti-allergic medication). Patient should be transported to hospital emergency immediately. Let emergency physician take over the care. Patients should be observed in the emergency department for at least four hours after they have recovered.

Dr. Sampson says that considerable amount of education material is available from the Food Allergy and Anaphylaxis Network (telephone number, 1-800-929-4040; web site This web site contains written emergency plan (every allergic child should carry one) and appropriate doses of liquid diphenhydramine and self-injectable epinephrine

Locally, Pudwell had started a support group. She says, “My support group no longer meets. I do not know personally how many people in this area suffer from peanut allergies. I still take an active part in education (in schools) and am available to anyone who would require support”.

She adds, “You can give my name and phone number (527-0997). Here are a few sites I use for up-to-date information:;; These are all excellent web sites for resources, alerts, food recalls, and discussion boards”.

Pudwell suggests the following rules:
-carry Epi-pen
-wear a medical alert bracelet
-carry a cell phone
-do not ever share foods – eat only foods you have prepared yourself or in a child’s case only food your parents have prepared for you.
-read and re-read labels
-be aware of your surrounding

Pudwell says, “To believe that the world can be free of peanuts is unrealistic, or to single out a child as somehow not quite equal to another because of allergies is unfair. We believe children must learn to live with the knowledge of their allergies, and be taught from a very young age the coping skills they will need for a safe and healthy survival”.

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Peanut Allergies

Did you know that the majority of fatal and near-fatal allergic reactions in North America are caused by peanut allergy?

The subject of peanut allergy is very important to parents, school administrators and anybody who looks after children. It is time to revisit the subject.

Food allergy affects about six to eight percent of children younger than four years of age. It can affect older children as well.

Peanuts have been with us since they were first cultivated in South America about 2000 to 3000 B.C. But allergy to peanut appears to be a phenomenon of the past two decades.

April 25th issue of the New England Journal of Medicine deals with this subject quite nicely. The author of the article is Dr. Hugh Sampson, Paediatrician from Mount Sinai School of Medicine, New York. Here are some important points from the article:

-In spite of increasing public awareness of food allergy, most patients are not well prepared to deal with severe allergic reactions. Over 80 percent of patients who died from allergic reactions to food were not given appropriate information to avoid accidental food-induced reactions or use self-injectable epinephrine.

-Food-induced severe allergic reaction is often mistaken for severe attack of asthma or an acute cardiac event. Therefore, taking careful history of exposure to an allergen is important. There is no laboratory test to diagnose allergic reaction to food.

-Initial symptoms of peanut or food allergy are: tingling in the mouth and lips, sensation of tightening of the wind pipe, colicky abdominal pain, and nausea and vomiting, flushing of the skin, etc.

-Delay in the initiation of therapy such as injectable epinephrine is associated with a poorer prognosis, although about 10 percent of patients who receive epinephrine early still die.

-Up to one third of patients have a biphasic reaction – that is, these patients seem to have fully recovered when severe spasm of the airway suddenly recurs, requiring patient to go on a breathing machine. This usually occurs within the first four hours of initial treatment and recovery. So all patients should be observed in the hospital at least for four hours after they have successfully responded to initial treatment.

-In 25 to 35 percent of patients with peanut allergy, an allergic reaction to tree nuts (such as walnuts, cashews, and pistachios) will develop even though tree nuts are from a different botanical family.

-In vast majority of the patients the first reaction to peanuts occurs at a median age of 14 months. Many food allergies in children disappear as they grow. But peanut allergy often is a lifelong disorder.

In the next column, we will discuss what parents should do to teach their children about peanut and other food allergies. We will also tell you where to find more information on this subject.

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