Peanut butter problem?
June 17, 2010 10:08 AM   Subscribe

My kid is having a reaction to peanut butter. As in, a rash around his mouth after he ate a bite of my PBJ toast. I'm trying to figure out how much I need to worry, and the Internets aren't helping.

He's one year old (13 months if you want to be specific). He's had peanut butter before, but no reaction at the time, so I hadn't worried about it. The last two times he had peanut butter he ended up with a rash, so now we're concerned and are making sure he doesn't come in contact with it again. He has no sign or history of any other allergies, and no one in either my family or my wife's have a history of food allergies either. I'm trying to look up info on this topic, but am running into a wall of fear from the anti-peanut butter crusaders: almost every single site I find lays it on thick, "no peanut butter for LIFE or it's CERTAIN DOOM for your BABY!" kind of stuff. I don't want to know how bad peanut allergies can be for some people. I want to know how often an early reaction can turn into a serious allergy, or if early reactions can simply end up going away on their own. Basically, I'm looking for rational info from people who have dealt with it themselves.

My main questions: Will he grow out of this? Will it get worse? And does this really mean my little guy has to grow up never having had the simple joy that is a PBJ? It seems unfair.

(And yes, we are planning on discussing this with his doctor at the next well-baby checkup.)
posted by caution live frogs to Health & Fitness (27 answers total) 2 users marked this as a favorite
 
Best answer: He needs to go to an allergist, probably not just a general practitioner.
posted by OuttaHere at 10:16 AM on June 17, 2010 [2 favorites]


I think this merits a call to the pediatrician now. I'm not sure if there's a possibility of his next reaction being serious (I suspect there is a chance it will get worse and a chance it will get better), but this is certainly an area where you need specific medical guidance. The tone of your question concerns me a little - I think that peanut allergies can go from a minor reaction to a life threatening one from one exposure to the next. You don't need to panic and ban peanuts for ever right this second, but yeah, this is potentially serious and you need to talk to his doctor and maybe arrange for some allergy testing.
posted by robinpME at 10:20 AM on June 17, 2010


What about the J that was on the toast? Has he had that before, and could he possibly be reacting to that?
posted by bolognius maximus at 10:20 AM on June 17, 2010


The doctor will probably want to refer you to an allergist, a move I would highly recommend. The thing is, I think reactions can be so individual that you want to find out your kids' allergen numbers. The allergist can tell you what your son is in for MUCH BETTER than the internet can. Everyone is different. You might be looking at avoiding peanuts and peanut butter and you might be looking at having to carry an Epi pen whenever you leave the house. There is so much in-between, too.

See an allergist.
posted by cooker girl at 10:21 AM on June 17, 2010


Best answer: It could be Oral Allergy Syndrome (related to hay fever and pollen allergies). Does he react only around his mouth (blotchy, slight swelling)? Peanut allergies can be severe, but if it's OAS, it could just be an annoyance (OAS rarely results in anaphylaxis)

I have OAS. I also have bad hay fever. It started when I was a child with raw carrots. Then I had a long dormant time of no allergic reactions. Then about 5 years ago I reacted orally (itching, slight burning sensation, blotchy, slightly swollen lips) to apples. Since then, every spring/summer, a few more culprits are added to the things which induce reactions. Last summer, I began to have reactions to peanut butter. Itchy tongue and throat, and itchy, blotchy lips.

Get your son tested by an allergies. If they can do a blood test (not skin prick/scratch test), I would recommend it to avoid false positives and negatives.

If it's OAS, he will likely have these (likely non-certain doom) reactions that are annoying and uncomfortable, mostly from late spring to late fall - coinciding with increased production of pollen. He could eat peanut butter (and possibly other things, likely raw fruits and vegetables) comfortably with an anti-histamine a little before hand.

OAS sucks. It's likely not doom-worthy, but it's June and I just want to eat cherries and salads and watermelon, but I never know when I'm going to break out in an itchy blotch. I just have to think about things ahead of time, and keep anti-histamines on me.
posted by raztaj at 10:23 AM on June 17, 2010


I'll add that OAS is supposed to be connected to a family history of similar food allergies, but no one in my family has food allergies, and no one has bad hay fever. My sister has dermatitis and eczema, and one cousin has an allergy to strawberries (berries are ironically the one produce-group that I haven't had a reaction to... yet). A family history (or non-history) doesn't mean squat in my opinion. OAS is friggin' weird, wide, and very varying.

Seconding the suggestions to skip the pediatrician, and go straight to an allergist. Or ask the ped. for an allergist recommendation.
posted by raztaj at 10:38 AM on June 17, 2010


Allergist this week. Don't wait for well baby visit.
posted by roomthreeseventeen at 10:38 AM on June 17, 2010


The main concern you're going to have (if it isn't OAS that raztaj mentioned) is that it is a mild peanut allergy that will get progressively worse with each reaction. The concern is that you'll hit the point of anaphylaxis which is where the necessity for the Epi pen comes in.

So, like everyone said, go see an allergist to determine the severity of the allergy primarily to know whether or not you've got to cart an Epi pen with you everywhere. You might find out he's allergic to something else entirely in the peanut butter (you'd better hope it isn't corn syrup because if you think avoiding peanuts is going to suck...). We eat peanut butter at our house that has egg whites and flax seed in it, for example, and our kid is allergic to eggs (see below).

Allergists aren't always entirely accurate in their assessment as we found out when our allergist suggested we just give peanut butter a try and have some Benadryl on hand and wound up in the ER for six hours instead and going home with an Epi pen prescription. (We gave her some straight up PB, not the kind with egg whites that we eat since we already knew about the egg allergy). She has a mid-level egg allergy and apparently it's unusual for kids to have combined egg and peanut allergies. So, based on the egg thing the doctor didn't do the skin test and suggested just trying it. I still think it was a fair assessment based on the known facts, but I can't say I was entirely pleased with the outcome.
posted by smallerdemon at 10:44 AM on June 17, 2010


No nut allergies here but we have several friends with kids the same age with peanut/tree nut allergies. Your doctor is the best bet for immediate answers along with a visit to an allergist but here's what we've learned from our friends.

Some food allergies, peanut especially, can get worse with repeat exposures so the trick is to catch them before they ramp up into a really scary reaction. Many kids with peanut allergies also have tree-nut allergies as well (again an allergist can find out these things) so you may feel better avoiding all nuts in the meantime. Here's the thing - some kids grow out of their peanut allergies by high school, some don't. Some kids are super-sensitive to the point that "smoke flavored deli meats" (which use peanut in their "natural smoke flavoring") give them a reaction. Other kids aren't. The good news is that your allergist can test your child now, and retest your child again at 3 (some kids reactions diminish at three it seems) and older to see any changes.

Good luck.
posted by rosebengal at 10:54 AM on June 17, 2010


I work for an institution with researchers who have had really good results treating food allergies in children (a lot of the research focuses on peanut allergies specifically) by exposing them to very small quantities of the allergen so they build up an immunity to it. I'm saying this so you know that the whole "worse with repeated exposure" thing is not necessarily true, not so you try it yourself. The therapy I've described was under very close supervision by doctors.

Also, you should go see an allergist that does food challenges because blood tests for food allergies are often inaccurate.
posted by Kimberly at 11:01 AM on June 17, 2010 [1 favorite]


Yeah, I'd see how soon you can see an allergist. This is kind of a big deal and should be treated as such -- not because it's CERTAIN DOOM, but because the parameters can vary widely and you really want to talk to someone who knows asap.
posted by KathrynT at 11:04 AM on June 17, 2010


Nthing the go soon, not eventually. The problem is that you will have environments in which you are not in complete control. You will continue to be surprised about it; it happens to me (and my kids are older and do not have allergies), and my SIL (whose kids have "only" dairy allergies, and watches like a hawk). It's so easy for kids to eat something they shouldn't.
posted by ES Mom at 11:14 AM on June 17, 2010


IANYP, but you should put in a call. Ask if this allergic reaction can be treated over the counter with a kid's version of Benadryl.

If your child is not having trouble breathing and the symptoms are just located around his mouth, then you are nowhere near freakout territory.

I have Oral Allergy Syndrome, and my symptoms are usually limited to inside my mouth when I eat the foods in question, but it may indeed be that. Look for reactions with other foods too. For me, it's a matter of whether I like the food enough to endure the discomfort. I don't care for kiwis but I will eat avocados and brave the scratchy throat afterwards.
posted by cross_impact at 11:35 AM on June 17, 2010


Best answer: IANAD. However, I am a person with lifelong food allergies, including a peanut allergy. Basically, there is no way to know in advance how serious your son's peanut allergy (if that's what this is) is going to be, or how long it will last. If you go to an allergist and he tests extremely high for peanut allergies, then obviously you'll need to keep him away from them pretty strictly. But allergies do get both better and worse over time (worse can happen from one exposure to the next, though usually not straight from rash to anaphylactic shock, while better tends to take years). There is no way to predict which course any given allergy will take. Instead, just take common sense measures for avoiding things that make your child feel sick when evidence presents itself, and if the allergy is relatively mild, let your child try the food again after a couple of years if he wants to. And just a note, if the reactions continue, please be scrupulous about informing babysitters and other care-givers -- I have a bad memory of having another, older child at a friend's house forcing me to eat a peanut when I was three or four. My parents had no idea what was going on until I threw up violently on the car ride home. However, I would like to assure you that it's entirely possible to have a satisfactory childhood without eating a peanut butter and jelly sandwich. Also many alternatives are currently available, like soy butter, and (the one I eat) sunflower seed butter, which is great if you kid eventually turns out to be allergic to legumes and nuts in general.

On preview: Kimberly is correct that some treatments involve building up exposure to minute amounts of allergens. However, I would advise you to not even put that idea in the same realm as "repeated exposure" in ordinary life -- there is a world of difference between eating a bite of the wrong sandwich and a doctor administering one ten-thousandth of one peanut under controlled circumstances. I've gotten sick from eating a doughnut that had previously been sitting next to a peanut doughnut, for example, and I'm not even a person for whom peanut exposure is life-threatening (just very unpleasant).
posted by unsub at 11:44 AM on June 17, 2010


Just piping in to say find an allergist immediately. I would recommend allergy testing every year anyhow, as allergies can change over time.
posted by trishthedish at 11:48 AM on June 17, 2010


Best answer: Anecdata: I used to be moderately allergic to peanuts. Only in middle adulthood has it gotten bad enough for an epipen.

Ultimately, it's time to establish a working relationship with an allergist. Among other things, they may be able to arrange tests and see what else your child may be allergic to--better than finding out sporadically. (It was skin pricks on the forearm 25 years ago for me...no idea what current protocol would be.)
posted by stevis23 at 11:52 AM on June 17, 2010


The rash was around his mouth, which is uncomfortably close to airway aggravation. If it were my kid* I would call to the ped and/or allergist *today* NOT because you need to freak out, but because you need to know what to do instead of freak out if he has a worse reaction. It will be very helpful for you (and your kid) to talk to one of them and get medical input on what to do if he has another/stronger reaction before you can see one of them. As unsub says, there's no rhyme or reason to allergic reactions.

*I'm not anti-peanut at all, I have lifelong experience with severe allergies in my family, and I am a mom.
posted by cocoagirl at 12:03 PM on June 17, 2010 [1 favorite]


My daughter's response to peanut butter was a big yuck, it hurts. We didn't think much of it until I forgot to wipe the peanut butter off a knife completely, used it for jam, and she said her tongue hurt from the trace amounts in it.

Well, for a couple of years, we didn't give her peanut butter, and made sure her teachers knew -- and we knew her reaction would be a big yuck, it hurts, rather than shock. Eventually we took her to an allergist, who confirmed a peanut allergy big enough to keep an epi-pen around for, but we've never had to use it.

So, don't panic. Just keep your kid away from peanut butter until you can get them to an allergist, confirm the allergy (or not), then keep the epi-pen handy and see how it goes.
posted by davejay at 12:34 PM on June 17, 2010


Oh, almost forgot: buy almond butter instead. My daughter can eat that with no problems, many kids with peanut allergies can, and it's super-yummy -- my son (with no allergy) prefers it to peanut butter and gets annoyed when we don't give it to him.
posted by davejay at 12:35 PM on June 17, 2010


I'm not anti-peanut either, but I am very pro-information gathering.

A childhood friend of mine died in high school after eating a piece of candy that had been made in a facility that had previously manufactured something with peanuts.

That facility had been cleaned, but what little residue remained was enough to kill andrew before the paramedics got to the house. The notes on packages about allergen contact? His family fought for that after the fact, because what you don't know can, in fact, kill you.

So, you're up against three domains of knowledge here: the thing you know (child has a rash, at pb), the thing you know you don't know (what will happen), and lots of things you don't know you don't know.

As a parent, your job is more about narrowing that third domain.

(also, yes, an answer about a lip rash is eponysterical coming from me.)
posted by bilabial at 12:42 PM on June 17, 2010


I have a peanut allergy. Nthing the visit to the allergist, and learning what to do in case of a severe reaction.

As a substitute, I eat Sunbutter, a sunflower seed butter. It tastes like peanut butter, and is made in a plant that is completely peanut free. So there's no worry about cross contamination.
posted by spinifex23 at 1:51 PM on June 17, 2010


I just took baby anachronism for allergy testing yesterday. It was skin prick testing so not super accurate (she came up with a reaction for wheat, which she eats on a daily basis without issue) but her egg allergy came up BIG and there was a smaller peanut reaction. Her egg reaction is mildly severe; puffy red eyes and ears, rash on her abdomen and a real pissy mood - we figure her peanut reaction would be even more mild BUT we're not exposing her unless it goes down on next years test and we do a food challenge in the allergist's rooms. He said there's a good chance she'll grow out of the egg allergy but peanut is mostly to stay. Just in case it isn't, we'll do the test yearly for a while.
posted by geek anachronism at 3:00 PM on June 17, 2010


davejay - The only issue with almond butter, of course, is the same issue as peanut butter. :) i.e. allergies. Although, it is apparently highly unusual for most people to have both peanut and tree nut allergies combined (but it was supposed to be unusual for eggs and peanuts too and our kid got both). My sister-in-law has the tree nut allergies and not the peanut allergies, so pecans, walnuts and hazelnuts are basically triggers for total anaphylaxis with her (three overnight hospital stays for trace amount exposures in her past even with Epi pens on hand) and although not as terrible, almonds and cashews also cause severe reactions for her. *shrugs*

bilabial - Ugh, sad story. One of the aforementioned sister-in-law visits to the ER for an allergic reaction was similar to davejay's mention of a knife not getting fully cleaned. She ate a salad that had some things in it that were cut with a knife that had been used to cut walnuts.

We opted for sunflower seed butter like spiniflex23 mentioned. :) That stuff is full of yum as well. (It's also usually cheaper than almond butter, so that's the one we tend toward because we have tight finances right now.)

caution live frogs - Good on you for being non-overreaction oriented about it. The problem with anything that causes people's kids harm is that there is a natural built in tendency to overreact simply as a protective response. Everyone who has posted here so far has been giving great advice from what I can tell in saying (1) don't over react but (2) definitely see an allergist sooner than later just to get a hold on the level of the allergy.

I am hoping that our kid grows out of the egg allergy at the very least (most kids do) and maybe out of the peanut one as well (because otherwise how can we share our Thai takeout with her?!).
posted by smallerdemon at 3:26 PM on June 17, 2010


What Kimberly said: Get good testing from a good allergist.

"blood tests for food allergies are often inaccurate" as in the same blood from the same day showing different result to the same suspected allergen. And skin prick tests are often administered or read incorrectly – or both.

And also, that work her institution is doing, it's huge and if you do find food allergies, you should look into what may be going on at teaching/research hospitals in your area.
posted by Lesser Shrew at 4:15 PM on June 17, 2010


FYI, I have a similar reaction when I consume cashews--uncomfortable rash around my mouth & on my lips to the roof of my mouth & down my throat. No swelling or airway constriction, but really, really uncomfortable face.

You may want to keep an eye on his back end, because--AHEM TMI--I usually get a rash upon the allergen exiting my body as well. That could get really uncomfortable if he's wearing diapers.

Tips for relief (because you can't put anti-itch cream on your lips, and IDK if he's too young for Benadryl): ice packs on the affected area are very very soothing. Once the rash starts to get crusty/peely, chapstick helps on the lips.

I have never experienced anything life-threatening with my nut-related mouth rashes, just to add a data point for don't-freak-out-completely. Of course, tell your doc about it and make an appointment sooner rather than later.

I grew into this problem at 30. But there are plenty of childhood allergies that fade as kids age, so it could go either way.

My husband grew up without PB because his mom is severely allergic. He is no worse off for it, and although he has had them in adulthood, he never experienced a wistful longing for a PB & J. Even if he had, there's always almond butter, which is deliciously yummy.
posted by Fui Non Sum at 5:38 PM on June 17, 2010


Just one point of anecdata, I had my first reaction to peanuts at age 2, and have remained severely allergic ever since - I'm 26 now.
posted by Earl the Polliwog at 8:48 PM on June 17, 2010


Response by poster: Thanks everyone. Mrs. Frogs and I both like soynut butter (fortunately) and that's what we're keeping in the house right now. I agree that a call to an allergist is probably a good idea. Unfortunately the tadpole is not likely to see an allergist for a month or so because I am waiting for my insurance to kick in on my new job position. On the up side, our day care is stringently peanut- and tree nut-free.

(I like the sunbutter. Mrs. Frogs is not as happy with it, but maybe she can be persuaded to pick it up once in a while.)
posted by caution live frogs at 12:12 PM on June 18, 2010


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