Medications: Watch out for an ingredient labelled "arachis" or "arachis oil" on medicines, shampoos and cosmetics, This is a label used to indicate the presence of Peanuts or Nuts in the product.  Always test new products on a small patch of skin on your upper arm. Leave two days. If your skin doesn't react, it's pretty safe to assume you are not sensitive to the product.

For peanut and nut avoidance, exclude:

 1) Peanuts and nuts including Brazil nuts, walnuts, hazelnuts, almonds, cashews, pistachio and pecans. Some of these may be called Ground nuts, monkey nuts, earth nuts or goober nuts.

 2) Foods made from peanuts including peanut butter, nut spreads, praline, noisette, marzipan, frangipan, amaretto products, macaroons, Bakewell tarts, almond essence, marron, Worcester sauce, satay sauce, hydrolysed vegetable protein, nut containing or nut-coated cheeses.

 3) Cold pressed ‘gourmet’ oils: peanut oil, arachis oil, groundnut oil, walnut oil, almond oil, hazelnut oil.

 All manufactured foods could contain traces of peanuts/nuts but those most likely are: cakes, biscuits, pastries, ice-cream, desserts, dessert toppings, cereal bars, confectionery, savoury snacks, breakfast cereals especially muesli type cereals, meat products, vegetarian products and ready meals containing hydrolysed vegetable protein, Oriental food, particularly Chinese, Thai and Indonesian, sauces and salad dressings, mixed salads and wild rice.

Almonds
Probably originated in the Near East but now grows in Southern Europe, Western Asia, California, South Australia and South Africa. Almond oil is used for flavouring and for skin care preparations and is extracted from the kernel of the Bitter Almond. The Sweet Almond is grown for nuts for eating and have the largest share of the nut trade world-wide. Almond flour is available and it is possible to make a nutritious nut milk from almonds.

• Minimise the risk by taking great care and being vigilant. If you are food allergic, read labels like Sherlock Holmes: look for the "hidden" allergen. You can easily recognise a packet of peanuts but may miss the word "groundnuts" in tiny print on the side of a tin of curry sauce, or the Latin term arachis used to signify the presence of peanut in pharmaceutical products.
   
• If you are food-allergic, be assertive about asking for detailed information from manufacturers and supermarket staff.
   
• Be particularly careful in restaurants, where proprietors are under no obligation to list ingredients. Question staff very directly. It may be necessary to speak with a senior manager. Some restaurants have ingredient lists available for you to check. You may wish to telephone the restaurant in advance to ensure your allergy is taken seriously.
   
• Be alert to all symptoms and take them seriously. Reach for the adrenaline (epinephrine) if you think you are beginning to show signs of a severe reaction. Do not wait until you are sure. Even if adrenaline is administered, you will still need to get to hospital as soon as possible. Someone must call an ambulance.
   
• Make sure others in your family know how to administer the adrenaline kit - and when. Do not be frightened of adrenaline. It is a well-understood drug. The dose you will administer has very few side effects, which will pass quickly in any case. However, if you have heart difficulties, discuss these with your doctor.
   
• Develop a crisis plan for how to handle an emergency. Get your allergist or GP to help. Have this written out for family and friends - put it on the bulletin board at home; carry one in your pocket. If a child is the person at risk, make sure his teachers and friends' parents have a copy - along with the adrenaline. Make sure everyone knows where the adrenaline is when you go out, or when you are at home.
   
• Wear a Medic Alert talisman (details: 020 7833 3034).
   
• Be open about your allergy problem with your family, friends and colleagues. It's easy to avoid a Thai, Chinese or Indian restaurant if everyone knows you are allergic to peanuts.

Because the majority of peanut allergies can lead to anaphylactic attacks, we will deal only with Epinephrine. There are other "alternate medications" out there but in a life threatening situation, I am all for sticking with what we know works.

The treatment for a serious allergic reaction is adrenaline (also known as epinephrine). During anaphylaxis, blood vessels leak, bronchial tissues swell and blood pressure drops, causing choking and collapse. Adrenaline (epinephrine) acts quickly to constrict blood vessels, relax smooth muscles in the lungs to improve breathing, stimulate the heartbeat and help to stop swelling around the face and lips (angioedema).
Pre-loaded adrenaline injection kits are available on prescription for those believed to be at risk. These are available in two strengths - adult and junior. The injection must be given, as directed, as soon as a serious reaction is suspected and an ambulance must be called. If there is no improvement in 5-10 minutes, give a second injection.

Because this must be administered without delay, patients known to be at risk often carry their own adrenaline injection kits for use in an emergency.

The injection many doctors prescribe is the EpiPen, an easy-to-use device with a concealed needle. The EpiPen is available on prescription and distributed by ALK -Abelló, 2 Tealgate, Hungerford, Berkshire RG17 0YT. Tel 01488 686016.

A relatively new adrenaline injection kit called the Anapen is also available on prescription. It is manufactured and distributed by Celltech Pharmaceuticals Ltd, 208 Bath Road, Slough, Berkshire SL1 3WE. Tel 01753 447690.

Both companies provide trainer pens for practice purposes. For information on how to administer the EpiPen (click here) and Anapen, (click here).

It is important to emphasise that even after adrenaline is administered, medical assistance should be sought urgently because the effects may wear off after 5 to 10 minutes and the injection may have to be repeated.

In fact, doctors often prescribe more than one injection kit so that if medical assistance is delayed, patients may administer a second dose.

Peanuts, unlike tree nuts, are not nuts from a taxonomical point of view, but belong to the legume family and are thus related to peas, beans and lentils. The protein fraction of peanuts makes up 25-30% of the kernel. Recently an increasing number of peanut proteins have been identified as potential allergens. It is uncertain what causes peanut proteins to be such strong allergens. Studies have shown that the allergenicity of these proteins is very resistant to thermal, chemical and proteolytic denaturation.

More than one child in 100 is believed to suffer severe allergic reactions to peanuts, tree nuts or both. A small but significant number are affected by other foods.

What about other Nuts or Legumes?
The peanut (Arachis hypogaea) is a legume but elimination of other legumes (such as peas, beans and lentils) is not appropriate unless sensitivity is suspected. Cross-allergenicity has been demonstrated in vitro between the serum of peanut allergic patients and several other legumes. However most peanut allergic patients can eat other legumes and vice versa.
It is much more common for the peanut allergic individual to react to tree nuts particularly brazil, almond, hazel. Adverse reactions to other nuts are reported less often presumably reflecting the frequency of consumption in the UK.
A recent American study reveals that of 122 nut allergic children, 68 reacted only to peanuts, 20 only to tree nuts and 34 to peanuts and tree nuts. Here the most common tree nuts implicated were walnut, almond and pecan. In common with peanuts, tree nut allergy is rarely outgrown. If a peanut sensitive individual has not yet been exposed to any tree nuts then these should eventually be introduced singly and with appropriate caution. Tree nut allergy can pose a serious problem for peanut allergic people.