Dr. Brown is an assistant professor of pharmacy practice at Palm Beach Atlantic University, Lloyd L. Gregory School of Pharmacy, West Palm Beach, Florida. Mr. Thornby is a PharmD candidate at Palm Beach Atlantic University.
A peanut allergy involves the immune system reacting to the proteins found in peanuts. People who have peanut allergies may have additional allergies, especially to other foods. This is because the allergens (the parts of the peanut that a person is allergic to) found in peanuts also are found in beans (eg, soy, green beans, and peas), seeds (eg, sesame, sunflower), and tree nuts (eg, almond, cashew, hazelnut, pecan, and walnut). For people with a peanut allergy, only 5% or less will have an allergy to beans as well. On the other hand, 25% to 50% are also allergic to at least 1 tree nut.
It is important to see a doctor who specializes in food allergies to determine your individual risks. To make sure you are diagnosed properly, you may have to undergo a series of questions, blood tests, and a skin-prick test.
Exposure to even small amounts of peanuts may cause anaphylaxis (an-uh-fuh-lak-sis), or a severe allergic reaction. Symptoms such as itching, redness, swelling, shortness of breath, wheezing, nausea, abdominal pain, lightheadedness, or loss of consciousness may occur and usually begins within minutes after exposure to a peanut or peanut-containing product.
It is possible, however, to experience a delayed reaction, if symptoms do not appear immediately. Touching peanuts may result in hives, or areas of itchy and red skin, which may spread across your body. An allergic reaction also can occur if you inhale dust from peanut flour or mist from peanut oil cooking spray. Examples of peanut-containing products are listed in the Table.
Avoidance is the best way to reduce your chances of experiencing a severe allergic reaction. It is important to read all food labels to look for peanut-containing products. Also, when dining out, ask the server about the types of oils in which the entrees are cooked. If your child has a peanut allergy, you?should inform and educate school personnel, parents of your child?s friends, and other caregivers about foods the child needs to avoid.
Both children and adults are advised to wear a medical alert bracelet or necklace. This alert should list the specific allergy and possible reaction symptoms, and provide first aid instructions for others during an emergency.
Peanut-containing Food Products
A visit to the emergency room is necessary because additional treatment may be needed. While at the hospital, the patient may be given medication such as albuterol in the form of a nebulizer, or special breathing machine, to open up your airways, as well as additional epinephrine injections and intravenous fluids.
After a severe reaction, you should be observed by medical personnel for at least 4 hours, as some patients may have another reaction that can be delayed for several hours. These secondary reactions are very dangerous and require immediate treatment. Upon leaving the emergency room, you may be given prescriptions for antihistamines (eg, diphenhydramine) and corticosteroids (eg, prednisone), which should be taken as the doctor prescribes. It is important to follow up with your primary care physician within 3 days.
These injections, also known as auto-injectors, are designed to provide a quick dose of epinephrine for patients during severe allergic reactions. The EpiPen 0.3 mg is for patients weighing 66 lb or more. The EpiPen Jr 0.15 mg is for patients between 33 and 66 lb. The injection should begin to work quickly after it has been given. Some patients may feel a rapid heartbeat, slight nervousness, sweating, dizziness, and headache from the injection.
The EpiPen or EpiPen Jr should be kept nearby and ready for use at all times. The manufacturer recommends that you store these injections at room temperature, and they should never be exposed to extreme temperatures, such as in your vehicle?s glove compartment. The injection should be stored in the container provided to protect the medication from light. An expiration date will be printed on each product (eg, ?DEC 08? = December 31, 2008). The EpiPen should be replaced before the expiration date, even if you did not use it. A window on the outside of the pen allows you to see the solution on the inside. If the solution is discolored or contains solid particles, you should replace the injection.
Make sure your child knows what symptoms to look for and how to ask for help if he or she has an allergic reaction. All individuals with peanut allergies should develop an action plan with their medical provider detailing what should occur once they have been exposed to any peanut-containing product. Once the action plan is complete, copies should be made available for easy access.
How to Use the EpiPen
A short film on how to use the EpiPen is available at www.epipen.com/howtouse.aspx.
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