Breaking the Peanut Allergy Misconception: Five Eye-Opening Insights

Peanuts are a nutritious, delicious, and a­ffordable food. Yet, for foodservice professionals, accommodating requests to eliminate peanuts can pose a dilemma. Balancing the safety of diners with the practicality of policies becomes paramount. By exploring these five evidence-based insights, we unravel the misconceptions surrounding peanut allergies, paving the way for a more informed and effective approach to allergen management.

1. Only a small percentage of the population has a peanut allergy. Though it’s increasingly in the news, the fact is less than 1% of Americans have a peanut allergy, and overall food allergies only affect about 5% of children and 4% of teens and adults [1].

2. Research shows that casual contact presents an extremely low risk for anaphylaxis. Smelling or touching peanuts or peanut butter does not cause anaphylaxis. Research does not support skin contact or airborne peanut butter exposure as a source of anaphylaxis, though hay fever-type reactions may occur [1]. Most instances of anaphylaxis are the result of accidental ingestion of peanut proteins or exposure through the eyes or mouth.

No reactions occurred in a double-blind, placebo-controlled study of 30 peanut-allergic children (median age, 7.7 years) who smelled peanut butter for 10 minutes, as might occur when a person with peanut allergy is near someone consuming a peanut butter sandwich [2]. There were also no life-threatening reactions from one minute of skin contact with a pea-sized amount of peanut butter, as might occur from contact with poorly cleaned tables. One third of the participants had a local reaction to the skin contact that did not progress.

There were several limitations to the study. Selected challenge format was chosen due to its believed ability to mimic unintentional casual exposures to a common form of peanut, peanut butter, among subjects avoiding peanut butter. Results cannot be generalized to larger exposures or to contact with peanut in other forms (flour and roasted peanuts). The statistical power of the study was limited, but a much larger data set would be needed for minimal increases in power.

More recently, allergists from Children’s Mercy Hospital documented their practice of placing allergens in close proximity to allergic patients to show them that just being near peanut foods doesn’t cause anaphylaxis. Similarly, they applied a small amount of the allergen to the skin of allergic patients for five minutes. Foods or butters tested in the proximity food challenges include peanut, almond, cashew, sunflower, soy, walnut and cow’s milk. In their article, the clinicians reported that none of their patients experienced a systemic reaction and only one had a hive at the site of application [4].

The Centers for Disease Control and Prevention has simple and easy-to-follow recommendations to prevent casual contact from surfaces and hands. Clean and sanitize with soap and water or all-purpose cleaning agents and sanitizers that meet state and local food safety regulations, all surfaces that come into contact with food, including in kitchens, classrooms and other locations where food is prepared or eaten. Hand-washing procedures that emphasize the use of soap and water can prevent cross contact from allergens [3].

3. There is no such thing as a peanut oil allergy when it comes to highly refined peanut oil. Allergic reactions are caused by proteins in peanuts, which are removed in highly refined peanut oils. It's important to distinguish between refined and unrefined peanut oils. Refined oils are safe for people with peanut allergies and are frequently used for frying, while unrefined oils contain proteins that can cause allergic reactions. The refining process involves removing peanut proteins from the oil, making refined peanut oil non-allergenic according to the FDA.

4. Experts do not recommend banning peanuts in dining establishments. According to a Canadian study of 1,941 children, more allergic reactions occurred in “peanut-free” schools (4.9%) compared to schools that allowed peanut foods (3%). Authors warned about a false sense of security when foods are banned. The study participants were predominately white males with a mean age of 6.9 years. In the study population, 567 food allergy reactions occurred in 429 children over 4,589 patient-years, yielding an annual incidence rate of 12.4% (95% CI, 11.4, 13.4). Of 377 AEs that were moderate or severe, only 109 (28.9%) sought medical attention and of these, only 40 (36.7%) received epinephrine. Researchers state the study is limited in that its inclusion parameters for the study population may not have been sufficiently rigorous [5].

According to a retrospective study of schools in Massachusetts, schools with policies that restricted peanut foods brought from home, served in the cafeteria or peanut-free classrooms had no effect on epinephrine administration rates [6]. Schools with peanut-free tables did have lower epinephrine administration rates for peanut or tree nut reactions compared to those without. There was no difference in the impact of school policies on epinephrine administration for children with previously diagnosed versus new presentation of peanut or tree nut allergies.

The study analyzed rates of epinephrine administration and Massachusetts public school nurse survey reports of school peanut-free policies from 2006-2011. Responses from 209 school nurses were included in the study, representing more than 1.1 million students from 2,223 public schools during 2006-2011. Limitations of the study include relying on school nurse reports, epinephrine administration as a proxy for anaphylaxis and the possibility of inaccurately identifying the cause of reactions. Further studies are required before decisions can be made regarding peanut-free policies in schools [6].

Best practices for managing food allergies in foodservice include using basic food safety techniques, separating allergens, clearly labeling allergens and avoiding cross contact in kitchens and serving areas. Most importantly, allergic diners should be encouraged to notify staff of their allergy and be prepared in case of accidental ingestion.

5. Peanuts are not tree nuts. Peanuts do not grow in trees and are legumes, not nuts. This means individuals allergic to tree nuts, like almonds or cashews, may not necessarily be allergic to peanuts, and vice versa. This highlights the importance of accurate diagnosis and understanding the specific allergens an individual may be sensitive to, as well as the importance of accurate food labeling.

What to do:

Focus on Training – all foodservice staff (or anyone who provides oversight, care and services for a food-allergic student or diner) should be trained in identifying symptoms of a reaction and how to respond.

• FARECheck is an enhanced training and review program in food handling and safety practices to help keep food-allergic individuals safe and included when dining out. It was developed by FARE, the largest private funder of food allergy research.
• The National Restaurant Association offers an online, on-demand training in food allergen handling called ServSafe Allergen®. This quick and affordable resource helps foodservice staff learn to keep allergic diners safer in the foodservice environment.
• Because dining out is one of the vulnerable areas of exposure for the food allergic, the National Peanut Board offers presentations and trainings for large foodservice operators to help educate them about strategies for meeting patron and student needs without unnecessarily eliminating foods from their menus.

Learn more about managing peanuts and other potential allergens at PeanutAllergyFacts.org.

Additional Resources

1. Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA) | FDA
2. Publication: USDA ARS
3. Peanut allergy – Symptoms and causes – Mayo Clinic

References

1. NIAID. Guidelines for the Diagnosis and Management of Food Allergies in the U.S. Available at http://www.jacionline.org/article/S0091-6749%2810%2901566-6/pdf
2. Simonte S., M. S. (2003). Relevance of casual contact with peanut butter in children with peanut allergy. J Allergy Clin Immunology, 180-182. https://pubmed.ncbi.nlm.nih.gov/12847496/
3. Centers for Disease Control and Prevention. Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. Washington, DC: US Department of Health and Human Services; 2013. https://www.cdc.gov/healthyschools/foodallergies/pdf/20_316712-A_FA_guide_508tag.pdf
4. Dinakar C., S. J. (2016). The transforming power of proximity food challenges. Annals of Allergy, Asthma & Immunol, 135-137.
5. AAACI. Accidental exposure (AE) to peanut in a large cohort of Canadian children with peanut allergy. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389801/
6. JACI. Impact of School Peanut-Free Policies on Epinephrine Administration. Available at http://www.jacionline.org/article/S0091-6749(17)30472-4/abstract