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Peanut Allergy Avoidance

The Asthma Center, Allergic Disease Associates, P.C.
Professional Arts Building
205 North Broad Street, Ste 300
Philadelphia, PA 19107

215-569-1111
http://www.asthmacenter.com

The diet avoidance therapy for peanut-allergic individuals usually includes avoiding all forms of peanuts as well as tree-nuts. As many as 50% of  patients allergic to peanuts will also have allergic reactions to tree nuts.  In addition, peanuts and tree nuts are often processed in the same manufacturing plant and cross-contamination can occur. Peanuts are often substituted for more expensive nuts that may be found in tree nut mixes. Peanuts are legumes, not true nuts. Cross reactions among legumes, however, are rare. Therefore, it is not necessarily recommended that a peanut-allergic individual follow a generalized legume-avoidance diet. Because peanuts are not a primary source of nutrition in the United States, diet restrictions do not produce any significant nutritional risk to the peanut sensitive individual. Peanuts do provide chromium, niacin, magnesium, manganese, vitamin E, and protein. Eating meats, whole-grains, legumes, and vegetable oils can be alternative sources of the same nutrients. Nutritional analysis also may be reviewed with a registered dietician or through computer software nutritional analysis provided by the federal government available online through the Food and Nutrition Information Center at http://www.nal.usda.gov/fnic.

Hidden Sources of Peanuts
Peanuts are commonly used to flavor and increase the protein content of foods. They are typically found in Asian and African restaurants in sauces as well as in baked goods, candies, and ice cream. Such products may result in cross-contamination from candy manufacturers, ice cream manufacturers, and bakeries. Hydrolyzed plant protein and hydrolyzed vegetable protein as labeled on imported foods may also contain peanut protein. Peanut allergic individuals should be cautious because artificial nuts may actually be reflavored peanuts, and manufacturers may use less expensive peanuts to replace tree nuts in the ingredients for their products. Peanut oils that are cold pressed may also cause reactions in peanut-allergic individuals as well. The possibility of allergic reaction to peanuts through kissing has also been reported and is usually not thought of by people with peanut allergies. Teenagers and young adults may be particularly at risk during dating to this hidden contact source.  Individuals of any age, though, should be aware of this vulnerability. Pet food may also contain protein from peanuts. For children and adults extremely sensitive to peanuts, even trace amounts of peanut exposure from animal saliva may cause a reaction.

Ingredient Terms that Indicate or May Indicate the Presence of Peanuts
The following is a partial list of terms commonly used on food labels to indicate the presence of peanuts and tree nuts. This list should be distributed to any caregiver, relatives, or food service workers who will be providing food to the peanut allergic individual. Individuals on peanut-restrictive diets should avoid all foods containing these ingredients.

Ingredients that INDICATE the Presence of Peanuts

  • Artificial Nuts
  • Beer Nuts
  • Ground Nuts
  • Imitation Nuts
  • Mixed Nuts
  • Nu-Nuts
  • Peanuts
  • Peanut Butter
  • Peanut Flour
  • Peanut Oil (cold-pressed, expelled, or expressed)

Ingredients that MAY INDICATE the Presence of Peanuts

  • African Dishes
  • Asian Dishes
  • Baked Goods (Pastries, cookies)
  • Candy
  • Chili
  • Chinese dishes
  • Chocolate candy
  • Egg Rolls
  • Hydrolyzed plant protein
  • Hydrolyzed vegetable protein
  • Marzipan
  • Nougat
  • Thai Dishes

Ingredient Terms that INDICATE the Presence of Tree Nuts

  • Almonds
  • Artificial nuts
  • Brazil Nuts
  • Cashews
  • Chestnuts
  • Filbert/Hazelnuts
  • Gianduja (a creamy mixture of chocolate and chopped toasted nuts found n premium or imported chocolate)
  • Hickory Nuts
  • Imitation Nuts
  • Macadamia nuts
  • Marzipan/almond paste
  • Nougat
  • Nut Butters (such as cashew butter)
  • Nut meal
  • Nut Oil
  • Nut Paste (such as almond paste)
  • Pecans (Mashuga nuts)
  • Pine Nuts (pinon, Indian nuts, pignoli)
  • Pistachios
  • Walnuts

The Food Allergy and Anaphylaxis Network
The Food Allergy and Anaphylaxis Network (FAAN) is a very helpful lay organization based in Fairfax, Virginia that also publishes a number of resources for individuals with food allergies including a bi-monthly newsletter called Food Allergy News. Cookbooks and videos are also available. FAAN also provides to members a convenient, laminated wallet-sized chart that delineates how to read a food label for a peanut-free diet. Their phone number is 1-800-929-4040, and their website is http://www.foodallergy.org

What Consumers Can do to Help Identify Allergens
If a consumer finds that a product causes a reaction, besides discussing it with your physician at the Asthma Center, please notify the manufacturer and notify the local FDA consumer complaint coordinator (The following provides a list of phone numbers in the US http://www.fda.gov/opacom/backgrounders/complain.html

In addition, consumers should continue to provide input about concerns and suggestions for allergen labeling issues by emailing comments to fdadockets@oc.fda.gov and noting Docket OOP-1322.

Printed with permission from The Asthma Center, copyright 2008