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									Peanut and Tree Nut


            Peanut and Tree Nut Allergy
              Information for Parents
What is a peanut or tree nut allergy?
Some children have a peanut or a tree nut allergy. Nut allergy is a reaction
which occurs soon after eating nuts or nut products. When a child is over
sensitive (allergic) to nuts the body treats the food as foreign. It is proteins in
the nut which cause the allergic reaction.

How common is nut allergy?
  • About 1 in 200 children (0.5%) have a reaction to peanuts by the age of
     five years.
  • About 3% of children have a positive peanut allergy skin test, however,
     only one third of these will develop an allergic reaction when eating
     peanuts.
  • About a half of all children with peanut allergy will also have allergies to
     other nuts.
  • If your child has had a positive allergy skin test but has never eaten
     nuts or foods containing nuts, further assessment and testing is
     available to see if your child is allergic.

What are the symptoms of nut allergy?
Most allergic reactions to nuts are mild. One of the most common symptoms
is an urticarial rash (a raised white blotchy rash like a nettle sting)
Other common symptoms are:
    • Angioedema (swelling of lips, tongue and face)
    • Nausea (feeling or being sick. sometimes diarrhoea may later develop)
    • Abdominal pain (stomach ache)
    • Rhinitis (runny itchy nose)
    • Swelling of larynx (voice box), hoarse voice, difficulty in swallowing
    • Shortness of breath (wheeze, asthmatic attack, or cough)
    • Falling blood pressure (may feel anxious or restless)
    • Dizziness and loss of consciousness
    • Red or itchy eyes

Babies and young children may show different allergic symptoms, becoming
sleepy, pale in colour, and vomiting. However it is advised to avoid giving nuts
or nut products to children under 3 years.
It is only the more sensitive children who may develop severe reactions such
as breathing problems, collapsing and loss of consciousness. Only very few
children experience severe reactions to nuts. This is called anaphylaxis.

How is nut allergy diagnosed?
An allergy skin prick test and blood test are the first tests your doctor will ask
for. It is important to realise that not every child with a positive allergy skin test
will have an allergic reaction if they eat nuts. Therefore your doctor may ask
your permission to do a test. This is where your child is given increasing
amounts of the food suspected to cause an allergic reaction.

Children with peanut allergy may also react to other nuts, therefore allergy
testing is recommended.

How do I prevent my child eating nuts?
Do not bring foods containing nuts into the home. If your child is either in
nursery or school, tell the staff which foods to avoid and what to do if your
child does react. A packed lunch prepared at home is usually safer than
school provided meals. If your child is in the care of another adult they also
need to be told what to do.

Peanuts are found in foods we do not always expect them to be in. It is
important therefore, to read food labels carefully.

Avoid foods that contain any of these ingredients:
• Peanuts (salted, unsalted, roasted, dry roasted) ground nuts, beer nuts,
   monkey nuts, mixed nuts, earth nuts, bombay mix
• Peanut oil cold pressed, expressed, or expelled, arachis oil, groundnut oil
• All peanut products eg peanut butter, nut spreads, chocolate spreads
• Crushed ground peanut - in sauces or coating on food (cakes, buns, ice
   cream), satay sauce, peanut sauce.

Peanut is a member of the bean family; these include lentils, chickpeas,
kidney beans, peas, green beans and soya. However, they can usually be
eaten safely by people with a peanut allergy.

Do not buy confectionery unless there is an ingredients label.
.
Where possible check labels on the following foods that could contain peanut
as an ingredient:
Certain desserts                                Certain breads
Cake                                            Kebabs
Biscuits                                        Crackers
Soups                                           Chocolates
Pastry                                          Spaghetti sauces
Health / cereal bars                            Chinese meals
Indian / Asian / Thai meals                     ethnic cooking
Ice cream                                       Turkish delight
Marzipan                                        Breakfast cereals
Nougat                                          Salad dressing
Hydrolysed /textured vegetable protein (HVP, TVP) Vegetarian products
Vegetable burgers                             Nut cutlets / roast



Tree nuts:
Avoid almonds, brazil nuts, walnuts, pecans, cashews, and macadamia nuts.
Also avoid nut butters (eg peanut butter), or any product that mentions nuts in
the ingredient list, including ice cream or crackers, unless they are clearly nut
free.
It is usually safer to avoid contact with all nuts if your child has a peanut
allergy.

Is nut oil a risk?
The problem with nut allergy is the protein not the nut oil. Very refined nut oil
may be safe such as peanut oil used in cooking oils. Unfortunately it is often
difficult to guarantee that the oil is refined enough to remove all traces of
peanut protein. Therefore we advise people who have had the more severe
life threatening reactions to avoid all nut oil, and use vegetable oil.

Eating out
Many reactions take place when eating away from home. This is due to a
number of factors:
• Staff in restaurants may not know whether there are nuts in the food you
    have chosen.
• Some people with nut allergy experience tingling in the mouth, when food
    containing nuts touches their lips. This symptom may not be noticed when
    eating highly spiced / flavoured foods.
• Foods may be prepared on a surface, or with a utensil, that has previously
    been used for foods containing nuts.
 For these reasons it is very important to be extremely vigilant if you and your
 child are eating out. It is essential to make sure that you, or the person
 looking after your child, always carry the medication prescribed for allergic
 reactions.

What about foods with a label that says 'may contain traces of nuts'?

Many manufactured foods have a warning on the label 'may contain traces
of nuts', this usually means that both the food that you are buying, and foods
containing nuts are processed in the same factory. However, the food may not
be contaminated with nuts. Most children do not have an allergic reaction to
foods with just traces in, or to very refined oils from nuts. If your child has tried
certain foods and has shown no sign of an allergic reaction, then your child is
usually safe to continue to eat this food. However, if you are introducing a new
food, with 'traces' or 'oil from' on the label, then do so with caution, in very
small amounts. Your doctor or dietician may be able to provide more advice.

The rule states that if a food contains a compound ingredient, which
comprises less than 25% of the total, its ingredients do not have to be
declared. Some Supermarkets produce a list of nut-free products, and are
choosing to declare the presence of nuts regardless of the 25% exemption
rule.

Is my child likely to have a severe reaction from contact with nut,
through touch or smell?
Apparently severe reactions from contact are extremely rare but localised
reactions are common. Reports of reactions triggered by the smell of nuts are
likely to be anxiety or panic attacks.

Are skin creams safe?
If the label highlights that peanut or arachis is in the product, then skin
preparations and cosmetics should be avoided. Other nut oils are not normally
used in skin creams.

Are other medications safe?
Some medicines contain peanut or peanut oil, so you should check with your
pharmacist, or with the manufacturer, before giving a medicine to your child.

How is an allergic reaction treated?
When your child is diagnosed as allergic to nuts the doctor will give you a
treatment plan suitable for your child. This will help you recognise an allergic
reaction, and how to treat your child. Allergic reactions are categorised into
mild, moderate, or severe. The treatment your child needs will depend on the
type of reaction.

Generally, a mild reaction is treated with an antihistamine medicine. If your
child does not respond to this you should phone 999 immediately telling them
that the condition is anaphylaxis.
Signs of a severe reaction or anaphylaxis are:
• Loss of consciousness.
• Severe difficulty breathing.
Try to stay calm, Give your child's epipen if they have one. If your child has a
reliever (i.e. ventolin or bricanyl) inhaler try to give this also, if they are
struggling to breathe.
Anaphylaxis is very rare in children.

What is an epipen?
Epipen is an emergency device, which injects a dose of adrenaline under the
skin. It is used to treat severe reactions to nut products. The drug adrenaline
is a treatment for shock, severe swelling, and breathing difficulty, and can be
lifesaving. If your child needs an Epipen you will be trained how to use it.

Should my child carry an epipen?
All allergy doctors agree that children who have had a serious reaction to nuts
with breathing problems should have an epipen. Your doctor will assess
whether your child needs one. The need for children to have an epipen
depends on the risk of developing anaphylaxis / severe allergic reaction, this
should be discussed with your doctor. If you have an epipen it is very
important that you understood how to use it, and that you have a written
anaphylaxis action plan provided by your doctor.
Can my child grow out of nut allergy?
80% of children with peanut allergy under 5 years of age, will have the allergy
into later childhood, 20% of young children do grow out of their allergy. Those
children who have had more severe allergic reactions with breathing problems
are much less likely to outgrow their allergy than children with milder
reactions. Your doctor can sometimes monitor the allergy by re-testing when
appropriate.
Allergies to other nuts also last for a long time and can cause severe
reactions in adult life. It is not safe to re-try nuts without advice from your
doctor.

Can I prevent nut allergy in my future children?
There are no methods, which can guarantee a child will not develop a nut
allergy. However doctors advise you to avoid nuts and nut products during
pregnancy and breast-feeding. Some skin creams contain peanut, which may
increase the chance of developing the allergy, these should be avoided.

Shopping
To help parents when shopping some supermarkets do 'Free from Lists'.
These are a full list of foods and products sold in the store, which will not
contain nuts. To request a list contact the stores below.
Asda, Co-op, Somerfield, Marks and Spencers , Safeway, Sainsbury's,
Tesco, Boots .

Where can I get more advice on food?
If your child has multiple allergies, is already on a restricted diet, or is not
gaining enough weight, you can be referred to the dieticians at University
Hospital South Manchester who will be able to provide:
    • information on alternative foods, to those your child needs to avoid
    • advice on ensuring your child continues to thrive.

This leaflet should be read along with your child's treatment plan.

Where can I find more information?
  The Anaphylaxis Campaign               Information on nut allergy
  PO Box 275
  Farnborough
  Hampshire
  GU 14 6SX
  Tel: 01252 542029
   www.anaphylaxis.org.uk/




   The British Allergy Foundation
   23 Middle Street
   London
   EC1A 7JA
   Tel: 0171 600 6166
   www.allergyfoundation.com/

   Action Against Allergy
   P.O.Box 278
   Twickenham
   Middlesex
   TW1 4QQ
   Tel: 01811 943 4244
   www.actionagainstallergy.co.uk
   Medic Alert Foundation              Emergency alert bracelets
   1 Bridge Wharf
   156 Caledonian Road
   London
   N1 9UU
   Tel: 020 7833 3034
   www.medicalert.org/

   Food Standards Agency
   Aviation House
   125 Kingsway
   London
   WC2B 6NH
   Tel: 020 7276 8000
   www.foodstandards.gov.uk/
   Eyecatchers Patches                 Patches for children with food allergy
   Clive Mark Schoolware
   Uniform House
   1 Consort Road
   Kings Norton Business Centre
   Birmingham B30 3HD
   Tel: 01214594599
   www.clivemark.co.uk/acatalog/Allergy.html

  www.allergyfoundation.com

Written by: Mrs.R.E. Aiken (Paediatric Allergy Research Sister)
Approved by: Dr.S.A. Roberts (Consultant Paediatrician) Reviewed April 08


Editorial number 0807/08

								
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