The only established therapy against a food allergy, including peanut allergy, is strict elimination of the offending food allergen from the diet and avoidance of any contact with the food by ingestion, skin contact, inhalation, or injection.
Biphasic anaphylaxis may occur in some patients with peanut allergies as well as other food allergies. Biphasic reactions have been reported to occur in 1%-20% of all anaphylaxis episodes and usually occur approximately 8 hours after the first reaction; however, recurrences have been reported as long as 72 hours later. Treating physicians should consider this possibility before discharge.
Injectable epinephrine is the drug of choice for the initial management of all food-induced anaphylactic reactions. Ensure that patients with food allergies have self-injectable epinephrine readily available at all times. The intramuscular route is preferred, with injection placement in the lateral thigh. If used, intravenous administration should be performed in an inpatient setting with appropriate monitoring.
Guidelines suggest that antihistamines and corticosteroids may be used as adjunctive treatment in patients with peanut or other food allergies who have experienced anaphylaxis. Patients with food allergies and asthma should always have access to a rapid-acting bronchodilator.
The US Food and Drug Administration approved the first immunotherapy for peanut allergy in early 2020. Peanut (Arachis hypogaea) allergen oral powder (Palforzia) mitigates allergic reactions that may occur with accidental exposure to peanuts. It is indicated for mitigation of allergic reactions, including anaphylaxis, that may occur with accidental exposure to peanut in patients with a confirmed diagnosis of peanut allergy. It is not a cure but mitigates allergic reactions, including anaphylaxis. The oral powder can be started in children aged 4-17 years who have a confirmed peanut allergy and then continued as a maintenance medication.
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Cite this: Michael A. Kaliner. Fast Five Quiz: Food Allergies - Medscape - Sep 08, 2020.