JAMA Clinical Reviews Update on Peanut Allergy
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Mar 19, 2026 Elissa (Alyssa) Abrams, MD, MPH, pediatric allergy professor and food allergy expert, discusses peanut allergy basics and impact. She covers who is affected and typical symptoms. She explains testing limits, early infant introduction findings, and prevention trends. She highlights treatment options from epinephrine routes to oral immunotherapy and emerging therapies.
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Skin Symptoms Dominate Peanut Reactions
- The most common organ system affected is the skin (80–90%), presenting as hives or swelling; respiratory and GI symptoms are also common.
- GI reactions to peanut tend to be profuse vomiting or diarrhea rather than isolated abdominal pain.
Anaphylaxis Is Serious But Rarely Fatal
- Anaphylaxis is a rapid systemic reaction involving skin, respiratory, GI, cardiovascular, or CNS symptoms and can be life-threatening.
- Actual mortality is very low (~1 in 10 million) and early epinephrine use is the best way to prevent fatal outcomes.
Use Epinephrine Early And Know New Routes
- Use intramuscular epinephrine pens for community anaphylaxis treatment, and note that intranasal epinephrine became available in 2024 as an alternative.
- Research is exploring sublingual and other routes to reduce injection barriers and increase timely use.