The average American now ingests about 11 pounds (5 kg) of peanut products each year (United States Peanut Council, personal communication), about 55% as peanut butter and the rest in sweets, baked goods, and table nuts. As the American lifestyle has become more frenetic over the past 20 years, peanut products (such as peanut butter crackers, peanut butter and jelly sandwiches, and peanut butter sweets) have increasingly served as “snacks” or “quick meal substitutes” replacing more standard mealtime fare. Consequently, infants and young children are being exposed to peanut products earlier in life.

A study examining the efficacy of food allergen avoidance in preventing atopic disease in infants defined as being at high risk for atopy found that of 185 control infants, 80% had been exposed to peanut products by their first birthday and 100% by their second birthday. 1 Follow up at 7 years of age revealed that about 7% of high risk children had positive skin tests to peanut and 4% were felt to be reactive on the basis of history or oral food challenges. 2 The prevalence of peanut allergy seems to have increased over the past two decades. In comparable groups of children referred to us for evaluation of severe atopic dermatitis and possible food allergy, peanut sensitisation (positive skin prick test) increased by 55% while allergic reactions increased by 95% over a 10 year period. Today peanuts are believed to be one of the leading causes of food allergic reactions in the United States 3 4 and, together with tree nuts, are probably the leading cause of fatal and near fatal anaphylaxis induced by food. 5 6 7 8