Tree nut introduction in peanut allergic children is not without risk

Stiefel, Gary; Keeton, D.; Morenas, Reynella A; Roberts, Graham; Lucas, Jane S.; Erlewyn-Lajeunesse, Michel

doi:10.1111/j.1399-3038.2011.01264.x

Cited by 4 publications

(4 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…If the weal diameter is large (equal to and >8 mm) or sIgE is high, then allergy is likely. Similarly if the SPT is negative or sIgE < 0.35 KU/L, then clinical allergy to those nuts is unlikely . Skin prick test weals 3–7 mm are indeterminant as patients could be tolerant or allergic .…”

Section: Diagnosismentioning

confidence: 99%

See 1 more Smart Citation

BSACI guideline for the diagnosis and management of peanut and tree nut allergy

Stiefel

Anagnostou

Boyle

et al. 2017

Clin Experimental Allergy

Self Cite

115

134

View full text Add to dashboard Cite

SummaryPeanut nut and tree nut allergy are characterised by IgE mediated reactions to nut proteins. Nut allergy is a global disease. Limited epidemiological data suggest varying prevalence in different geographical areas. Primary nut allergy affects over 2% of children and 0.5% of adults in the UK. Infants with severe eczema and/or egg allergy have a higher risk of peanut allergy. Primary nut allergy presents most commonly in the first five years of life, often after the first known ingestion with typical rapid onset IgE-mediated symptoms. The clinical diagnosis of primary nut allergy can be made by the combination of a typical clinical presentation and evidence of nut specifc IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test. Pollen food syndrome is a distinct disorder, usually mild, with oral/pharyngeal symptoms, in the context of hay fever or pollen sensitisation, which can be triggered by nuts. It can usually be distinguish clinically from primary nut allergy. The magnitude of a SPT or sIgE relates to the probability of clinical allergy, but does not relate to clinical severity. SPT of ≥ 8 mm or sIgE ≥ 15 KU/L to peanut is highly predictive of clinical allergy. Cut off values are not available for tree nuts. Test results must be interpreted in the context of the clinical history. Diagnostic food challenges are usually not necessary but may be used to confirm or refute a conflicting history and test result. As nut allergy is likely to be a long-lived disease, nut avoidance advice is the cornerstone of management. Patients should be provided with a comprehensive management plan including avoidance advice, patient specific emergency medication and an emergency treatment plan and training in administration of emergency medication. Regular re-training is required.

show abstract

Section: Diagnosismentioning

confidence: 99%

“…However, even with the above information these test results cannot be taken in isolation of the clinical context. [107,108]. Skin prick test weals 3-7 mm are indeterminant as patients could be tolerant or allergic [109].…”

Section: Allergy Testsmentioning

confidence: 99%

BSACI guideline for the diagnosis and management of peanut and tree nut allergy

Stiefel

Anagnostou

Boyle

et al. 2017

Clin Experimental Allergy

Self Cite

115

134

View full text Add to dashboard Cite

show abstract

“…However, among tree nut allergic, 7.9% of patients with negative SPT and 38% of the sensitized patients had a positive OFC. In a letter to the Editor, Stiefel et al (61) reported 4.3% of positive OFC to tree nuts in peanut-allergic children with negative SPT to tree nuts, underscoring the risk inherent to home introduction of tree nuts after negative SPT. It remains to be seen whether sIgE to nut extracts and their components could reduce the number of positive OFC and justify home introduction.…”

Section: Managementmentioning

confidence: 99%

“…In single‐nut‐allergic children, the question as to whether avoidance should be generalized to all nuts or limited to the culprit nut is under discussion . The general recommendation for peanut or single‐tree nut‐allergic children used to be to avoid all nuts given the common clinical cross‐reactivity between peanut and tree nuts and among tree nuts to reduce the risk of contamination leading to inadvertent exposure.…”

Section: Food Allergymentioning

confidence: 99%

Food allergy and anaphylaxis in pediatrics: update 2010‐2012

Santos

Lack

2012

Pediatric Allergy Immunology

View full text Add to dashboard Cite

This review highlights the progress made in food allergy (FA) and anaphylaxis research in pediatrics published in the journal Pediatric Allergy and Immunology since 2010. Putative risk factors for FA are as follows: a family history of allergic disease, particularly in the mother, low birth order, season of birth, and severe atopic eczema. Obstetric practices, antibiotic use, and home environment are factors deserving further research. Diagnostic decision levels and component-specific IgE are useful in the diagnosis of FA; however, oral food challenges remain the gold standard and may also be a means to reduce parental anxiety and to improve education. Oral immunotherapy studies show promise in increasing the threshold of reactivity of allergic patients and therefore improving their quality of life. In single-nut-allergic patients, introduction of other nuts allows broadening the diet and thus reducing the psychological impact of allergen avoidance. Nutritional deficiencies are not uncommon in food-allergic children and should be specifically assessed. The prescription of injectable adrenaline is still insufficient and not consistent among practitioners, requiring improved training and implementation of guidelines. Current research into the epidemiology and immunological mechanisms of FA and tolerance will enable us to devise strategies to both prevent and treat food allergies.

show abstract

Quoi de neuf en allergologie pédiatrique en 2011 ? Anaphylaxie, allergie alimentaire, médicamenteuse et aux venins d’insectes (une revue de la littérature internationale 2011)

Ponvert

2012

Revue Française d'Allergologie

View full text Add to dashboard Cite

Tree nut introduction in peanut allergic children is not without risk

Cited by 4 publications

References 8 publications

BSACI guideline for the diagnosis and management of peanut and tree nut allergy

BSACI guideline for the diagnosis and management of peanut and tree nut allergy

Food allergy and anaphylaxis in pediatrics: update 2010‐2012

Quoi de neuf en allergologie pédiatrique en 2011 ? Anaphylaxie, allergie alimentaire, médicamenteuse et aux venins d’insectes (une revue de la littérature internationale 2011)

Contact Info

Product

Resources

About