Allergic reactions to peanuts in children have become a significant medical and legal concern worldwide, with a rising incidence of this potentially fatal condition. Peanut allergy represents an immunoglobulin E (IgE)–mediated hypersensitivity reaction to peanut proteins and is responsible for the majority of cases of food-induced anaphylaxis. Even trace quantities of peanut in a sensitized individual can be fatal, with rapid onset of symptoms often including the cutaneous findings of urticaria, angioedema, or a diffuse nonspecific dermatitis. Peanut allergy is usually a lifelong condition, since only about 20% of affected individuals outgrow it. Some schools ban peanut butter and jelly sandwiches, once a common dietary option, as fear of medical and legal consequences is escalating. Children with peanut allergy and their families should be knowledgeable about management strategies, including carrying and properly administering self-injectable epinephrine. New immunotherapeutic options are being investigated and appear promising.