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In allergic individuals, peanuts are a well recognised cause of severe and rapidly occurring symptoms, such as vomiting, diarrhoea, urticaria, angioedema (swelling of the face, throat or skin), acute abdominal pain, exacerbation of atopic eczema, asthma and anaphylactic shock. If untreated, anaphylactic shock can result in death due to obstruction of the upper or lower airway (bronchiospasm) or hypotension and heart failure. This happens within minutes to hours of eating the peanuts. The first symptoms may include sneezing and a tingling sensation on the lips, tongue and throat followed by pallor, feeling unwell, warm and light headed.

Severe reactions may return after an apparent resolution of 1-6 hours. Asthmatics with peanut sensitivity are more likely to develop life threatening reactions. Peanuts are the most likely food to provoke fatal anaphylaxis in children and adults but many other foods (including tree nuts, seeds (e.g. sesame, sunflower), cow milk, eggs, fish and shellfish) can also precipitate this.