Factors predicting anaphylaxis to peanuts and tree nuts in patients referred to a specialist center

History, blood tests or skin prick testing? Is it possible to predict the severity of allergic reactions in children with IgE-mediated food allergy?

“…The questionnaire-based population studies [18][19][20][21] included in this study also support asthma as a risk factor for severe reactions. However, three studies looking at children undergoing food challenge 1 12 22 show no difference in reaction severity for a history of asthma or other atopy.…”

“…They found that severe asthma gave a significantly increased relative risk (RR) of 6.8 for life-threatening bronchospasm in comparison with patients with milder asthma symptoms who had an RR of 2.7 for a severe reaction. 21 This underlines the importance of achieving good asthma control in all children, particularly those with a diagnosed food allergy.…”

Health Benefits of Nut Consumption

“…Indeed, fatal anaphylactic reactions following nut ingestion have been documented. Severity of coexisting atopic diseases [asthma, rhinitis, and eczema] predicts which patients are most likely to develop life-threatening allergic reactions to tree nuts and peanuts [147]. A minority of children with peanut allergy developed tolerance with time.…”

Does this patient with urticaria/angioedema have anaphylaxis?

“…Risk factors for a fatal outcome to anaphylaxis may include age (and age-related comorbidities such as hypertension, ischaemic heart disease (IHD)) and drug therapy (particularly angiotensin-converting enzyme inhibitors (ACE-I)). Summers et al 9 have examined risk factors for anaphylaxis in peanut and tree nut allergic patients and found that severe pharyngeal oedema was more likely to be present in patients with severe rhinitis and those with low levels of ACE (Ͻ37 mmol/l). Lifethreatening bronchospasm was more likely in patients with severe asthma, while altered consciousness was more likely in those with severe eczema.…”