Peanuts

Peanuts are legumes (related to beans and lentils), not nuts — though they're used as a nut culinarily. They're a leading cause of severe food-allergic reactions, including anaphylaxis, and are responsible for a disproportionate share of fatal food-allergy reactions. Peanut allergy affects roughly 1–2% of children in many Western countries and persists into adulthood in about 80% of cases.

For people without peanut allergy, peanuts are a nutrient-dense protein and a useful staple — high in protein, healthy fats, fiber, and several vitamins. They're also one of the more affordable plant proteins available. Public-health messaging on peanut avoidance for children has changed dramatically in the past decade, in light of the LEAP (Learning Early About Peanut allergy) study.

Allergy severity and management

Peanut allergy reactions can range from mild (hives, itching) to severe anaphylaxis (airway swelling, drop in blood pressure, cardiovascular collapse). Anyone with confirmed peanut allergy should carry epinephrine auto-injectors and have an action plan. Cross-contamination is a real risk in shared facilities, restaurants, and processed foods — labels with "may contain peanuts" warnings should be taken seriously by people with severe allergy. Recent FDA-approved oral immunotherapy (Palforzia) offers a treatment option for children, raising tolerance thresholds though not curing the allergy.

Early introduction

The 2015 LEAP study showed that introducing peanut-containing foods to high-risk infants between 4–11 months reduced their risk of developing peanut allergy by ~80% compared to avoidance. Current US guidance for infants without other peanut-allergy risk factors is to introduce peanut around 6 months alongside other foods. For infants with severe eczema or egg allergy, an allergist consult before introduction is recommended. Whole peanuts are a choking hazard until age 4 — use thinned peanut butter or peanut puffs instead.