COT report on peanut allergy (1998)

Peanut allergic individuals can undergo a severe, life-threatening reaction following exposure to peanut allergens. A Working Group of the COT was established to advise whether there is an association between early exposure to peanuts and peanut products and the incidence of peanut allergy in later life.

Executive summary

1.1 Peanut allergic individuals can undergo a severe, life-threatening reaction following exposure to peanut allergens. Due to the severity of this reaction and the possibility that the incidence of peanut allergy is increasing in the UK, a Working Group of the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment was established to advise whether there is an association between early exposure to peanuts and peanut products and the incidence of peanut allergy in later life. If so, the Working Group was asked to give advice on the consumption of peanuts and peanut products by pregnant and lactating women, infants and children. The Working Group prepared a report which was considered and endorsed by the Committee.

1.2 It was noted that, although crude peanut oil can contain peanut allergens, refined peanut oil is a neutralised bleached deodorised product which contains no proteins detectable by immunoassay and which has not caused reactions in peanut-allergic individuals. It was considered that the use of the refined oil in food and medicinal products is without risk to sensitive individuals. Refined peanut oil is therefore not included in the category of ‘peanut products’in the advice below.

1.3 There is some support for the suggestions that peanut allergy in an infant can result from exposure in utero or during lactation. However, following a review of the scientific literature, it was decided that the data on the relationship between peanut consumption by pregnant and lactating women and the incidence of peanut allergy in their offspring were inconclusive. With regard to the mechanism of sensitisation and allergy such a link is, however, possible. It was decided therefore that it would be unwise to discount sensitisation of offspring resulting from exposure of the mother.

1.4 Because of this uncertainty we have recommended a number of topics for further research, a detailed list of these can be found in section 13 of this report.

1.5 It was noted that peanut allergy occurs in individuals who have atopic eczema, asthma, hayfever or other manifestations of allergic disease (known as atopy) or who have parents, brothers or sisters with atopy. Overall, in common with other atopic diseases, the evidence indicates that the prevalence of peanut allergy is increasing. Given that exposure of sensitive individuals to peanut allergens can result in anaphylaxis, a life-threatening reaction, the advice given is precautionary.

1.6 It is advised that:

  • pregnant women who are atopic, or for whom the father or any sibling of the unborn child has an atopic disease, may wish to avoid eating peanuts and peanut products during pregnancy;
  • breast-feeding mothers who are atopic, or those for whom the father or any sibling of the baby has an atopic disease, may wish to avoid eating peanuts and peanut products during lactation;
    • in common with the advice given for all children, infants with a parent or sibling with an atopic disease should, if possible, be breast-fed exclusively for four to six months;
    • during weaning of these infants, and until they are at least three years of age, peanuts and peanut products should be avoided;
  • infants or children who are allergic to peanuts should not consume peanuts or peanut products.

1.7 It is also recommended that the parents or those charged with the care of peanut allergic infants and children should:

  • be vigilant in reading labels on all multi-ingredient foods and should avoid any for which doubt exists about the ingredients;
  • be aware that even minute amounts of peanut allergens may result in severe reactions. They should therefore be alert to the possibility of accidental exposure and should ensure that cross contamination of foodstuffs with peanut allergens does not occur;
  • be aware of the treatment for anaphylaxis should inadvertent exposure occur at, for example, school or the homes of other children.

1.8 The Committee would encourage the labelling of foodstuffs to indicate the presence of any peanuts or peanut products even where this is not specifically required under existing labelling legislation.