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High rates of tree nut sensitization and allergy in the HealthNuts study

Published online: August 29, 2018

Studies in children of tree nut allergy prevalence based on oral food challenge outcomes have been limited and the development of tree nut allergy in childhood is also understudied. With the first presentation for children with food allergy often via reactions to milk, peanut and/or egg in infancy, the role of early tree nut sensitization and the subsequent development of tree nut allergy among those with food allergy is uncertain.
 
In this issue of The Journal of Allergy and Clinical Immunology (JACI), McWilliam et al report the first population-based, challenge confirmed tree nut allergy prevalence rates in childhood and characterize the development of tree nut allergy between 1 and 6 years of age among those with food allergies in the population-based HealthNuts study.

Key findings include the following: tree nut allergy at age 1 year was uncommon but rates of tree nut sensitization were high with around 40% of those with food allergy sensitized to one or more tree nuts at age 1 year; in the context of tree nut avoidance (which was standard practice 10 years ago), 40% of those sensitized to tree nut at age 1 year were allergic by age 6 years; tree nut allergy prevalence was as high as peanut allergy at age 6 years (3.3%), with cashew the most common tree nut allergy (2.7%).

This study has reported the highest rate of challenge confirmed tree nut allergy in the literature to date and up to half of those with food allergy can be sensitized to tree nuts as early as 1 year of age. Skin prick testing for tree nuts among those with food allergies has the potential to impose a significant burden on allergy clinics to confirm allergy status for sensitized tree nuts.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

Patterns of tree nut sensitization and allergy in the first 6 years of life in a population-based cohort