Nut Allergy Management in Children: A Practical Guide for Parents
Dr Mugilan Anandarajan
Consultant Paediatrician with special interest in allergy, eczema & respiratory conditions, FRCPCH
A diagnosis of nut allergy — particularly peanut allergy — can feel overwhelming for families. But with the right knowledge, a clear management plan, and appropriate prescribing of emergency medication, most children with nut allergy live full, active lives. This guide covers everything parents need to know.
Peanut allergy vs tree nut allergy — understanding the difference
Peanuts are legumes (related to peas and beans), not true tree nuts. Tree nuts include cashew, walnut, almond, hazelnut, pistachio, Brazil nut, pecan, and macadamia. Many children are allergic to both peanut and tree nuts, but not all. Component-resolved diagnostics (CRD) can identify which specific nuts are clinically relevant — meaning your child may not need to avoid all nuts, only those they are genuinely allergic to.
The cornerstone of management: avoidance and an emergency action plan
For children with confirmed nut allergy, strict avoidance of the implicated nut(s) is the foundation of management. This means careful label reading, asking about ingredients when eating out, and educating carers, teachers, and family members. Every child with a risk of anaphylaxis should have a personalised written emergency action plan that clearly sets out what to do if a reaction occurs.
Adrenaline auto-injectors — who needs one and how to use it
An adrenaline auto-injector (AAI) — such as an EpiPen or Jext — should be prescribed for all children with nut allergy who are at risk of anaphylaxis. This includes children who have had a previous anaphylactic reaction, those with co-existing asthma, and those with high-risk sensitisation profiles on component testing. Dr Anandarajan provides comprehensive training for parents, carers, and schools at the time of prescribing.
When to use the adrenaline auto-injector
- Throat tightening, difficulty swallowing, or a change in voice
- Difficulty breathing, wheeze, or stridor
- Collapse, loss of consciousness, or becoming pale and floppy
- Severe widespread hives with any of the above symptoms
- Any doubt — use the AAI and call 999 immediately
- Always call 999 after using the AAI, even if symptoms improve
Managing nut allergy at school and nursery
Every child with nut allergy should have an individual healthcare plan (IHP) in place at school or nursery. This sets out the child's allergy, the signs of a reaction, and the emergency treatment to be given. Schools in Northern Ireland are required to have policies for managing allergic conditions. Dr Anandarajan can provide a written allergy management plan and emergency action plan for school use.
Label reading and eating out
- Peanut and tree nuts are major allergens and must be declared on pre-packaged food labels in the UK
- Look for 'may contain' or 'made in a factory that handles nuts' warnings — these indicate a risk of cross-contamination
- When eating out, always inform the restaurant of the allergy and ask about ingredients
- Be aware that 'nut-free' claims are not regulated — always check with the establishment
- Carry the adrenaline auto-injector at all times, including when eating out
Annual specialist review
Children with nut allergy should have an annual specialist review to reassess their allergy status, update the emergency action plan, check that the adrenaline auto-injector prescription is current, and discuss whether any changes to management are appropriate. Some children do outgrow peanut allergy — approximately 20% — and periodic retesting can identify this.
Nut allergy management is not just about avoidance — it is about living confidently and safely. With the right specialist support, a clear plan, and appropriate emergency medication, children with nut allergy can participate fully in all aspects of life. No GP referral is required to book at Belfast Allergy Clinic.