Managing Nut Allergy: A Remaining Clinical Challenge
Peanut and tree nut allergies have become a public health problem over the last 2 decades. The diagnostic procedure relies on a suggestive history, as well as on evidence of sensitization (skin prick testing and/or specific IgE blood testing), followed in selected cases by a food challenge. Standard...
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Published in | The journal of allergy and clinical immunology in practice (Cambridge, MA) Vol. 5; no. 2; p. 296 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.03.2017
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Abstract | Peanut and tree nut allergies have become a public health problem over the last 2 decades. The diagnostic procedure relies on a suggestive history, as well as on evidence of sensitization (skin prick testing and/or specific IgE blood testing), followed in selected cases by a food challenge. Standard IgE tests may be positive to more than 1 nut, due to cross-reactivity (allergens common to several nuts) or cosensitivity (frequently associated positive test results without cross-reactivity). Thus, many patients with a peanut or a tree nut allergy avoid all nuts, relying on positive test results without clinical evidence of reactivity. In addition, coexisting pollen sensitivity may add to diagnostic uncertainty due to potential cross-reactivity between pollens and nuts. In this article, we discuss challenges in diagnosis and clinical management of peanut and tree nut allergy related to cross-reactivity and cosensitization, as well as the avoidance of nuts tested positive to reduce the risk of reactions by cross-contamination. Studies to provide more accurate characterization of genuine clinically relevant cross-reactivity or cosensitivity to multiple nuts are needed. |
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AbstractList | Peanut and tree nut allergies have become a public health problem over the last 2 decades. The diagnostic procedure relies on a suggestive history, as well as on evidence of sensitization (skin prick testing and/or specific IgE blood testing), followed in selected cases by a food challenge. Standard IgE tests may be positive to more than 1 nut, due to cross-reactivity (allergens common to several nuts) or cosensitivity (frequently associated positive test results without cross-reactivity). Thus, many patients with a peanut or a tree nut allergy avoid all nuts, relying on positive test results without clinical evidence of reactivity. In addition, coexisting pollen sensitivity may add to diagnostic uncertainty due to potential cross-reactivity between pollens and nuts. In this article, we discuss challenges in diagnosis and clinical management of peanut and tree nut allergy related to cross-reactivity and cosensitization, as well as the avoidance of nuts tested positive to reduce the risk of reactions by cross-contamination. Studies to provide more accurate characterization of genuine clinically relevant cross-reactivity or cosensitivity to multiple nuts are needed. |
Author | Mazon, Angel Haddad, Diab Nieto, Antonio Caubet, Jean-Christoph Lack, Gideon Brough, Helen A Eigenmann, Philippe A |
Author_xml | – sequence: 1 givenname: Philippe A surname: Eigenmann fullname: Eigenmann, Philippe A email: Philippe.Eigenmann@hcuge.ch organization: Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland. Electronic address: Philippe.Eigenmann@hcuge.ch – sequence: 2 givenname: Gideon surname: Lack fullname: Lack, Gideon organization: King's College London, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom – sequence: 3 givenname: Angel surname: Mazon fullname: Mazon, Angel organization: Children's Hospital La Fe, Pediatric Pulmonology and Allergy Unit, Instituto de Investigacion La Fe, Valencia, Spain – sequence: 4 givenname: Antonio surname: Nieto fullname: Nieto, Antonio organization: Children's Hospital La Fe, Pediatric Pulmonology and Allergy Unit, Instituto de Investigacion La Fe, Valencia, Spain – sequence: 5 givenname: Diab surname: Haddad fullname: Haddad, Diab organization: St Peter's Hospital, Chertsey, United Kingdom – sequence: 6 givenname: Helen A surname: Brough fullname: Brough, Helen A organization: King's College London, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom – sequence: 7 givenname: Jean-Christoph surname: Caubet fullname: Caubet, Jean-Christoph organization: Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland |
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Keywords | Tree nut allergy IgE testing Cross-reactivity Peanut allergy |
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Title | Managing Nut Allergy: A Remaining Clinical Challenge |
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