Nut Allergy: Clinical and Allergological Features in Italian Children

Abstract

Background: Nut allergies are an increasingly frequent health issue in the pediatric population. Tree nuts (TN) and peanuts are the second cause of food anaphylaxis in Italy. Unfortunately, knowledge of the clinical characteristics of a TN allergy in Italian children is limited. Our study aimed to identify the clinical and allergological characteristics of Italian children with a nut allergy (TN and peanut). Methods: A retrospective observational analysis was performed on the clinical charts of children with a history of nut reaction referred to the allergy unit of the hospital from 2015 to 2019. The studied population was represented by children with a confirmed nut allergy based on positive prick by prick and/or serum-specific IgE to nut plus a positive nut oral food challenge. Demographic, clinical, and allergological features were studied and compared among different nuts. Results: In total, 318 clinical charts were reviewed. Nut allergy was confirmed in 113 patients. Most patients (85/113, 75%) had a familial history of allergy and/or a concomitant allergic disorder (77/113, 68%). Hazelnut and walnut were the more common culprit nuts observed in allergic children. Anaphylaxis was the first clinical manifestation of nut allergy in a high percentage of children (54/113, 48%). The mean age of the first nut reaction was statistically higher with pine nuts. Over 75% of children reported a single nut reaction. During the OFCs, the signs and symptoms involved mainly the gastrointestinal system (82/113, 73%) and resolved spontaneously in most cases. Severe reactions were not frequent (22/113, 19%). Conclusion: To our knowledge, this is the first Italian study that provided a comprehensive characterization of children with a nut allergy. These results are important for clinicians treating children with a nut allergy.

Replacing animal proteins with plant proteins: Is this a way to improve quality and functional properties of hybrid cheeses and cheese analogs?

“…The above results suggest that blending different types of plant proteins may contribute to the production of high‐quality cheese analogs, which will be a future direction for the optimization of formulations for hybrid cheeses or cheese analog products. In addition to the high price, another reason that hinders the widespread application of nut protein in hybrid cheeses and cheese analogs is the health threat associated with nut allergy (Tagliati et al., 2021).…”

A comprehensive review on mango allergy: Clinical relevance, causative allergens, cross‐reactivity, influence of processing techniques, and management strategies

“…Moreover, commercially available extracts often lack representation of labile allergens, such as pathogenesis‐related (PR)‐10 proteins found in fruits of the Rosaceae family, including apple, peach, and cherry. Consequently, the limited presence of these allergens in commercial extracts contributes to a reduced sensitivity of the SPT (Tagliati et al., 2021). The use of fresh foods in SPT, specifically the prick‐to‐prick method, has shown to have a higher sensitivity compared to other methods.…”

Natural History of Hazelnut Allergy and Current Approach to Its Diagnosis and Treatment

“…Challenge-confirmed IgE-mediated tree nut allergy has a prevalence of less than 2%, while estimates for probable tree nut allergy are 0.05–4.9% [ 1 ]. Among nuts, hazelnut is the most frequent trigger of hypersensitivity-systemic reactions in Europe [ 1 , 3 , 17 , 18 , 19 ].…”

“…The first reaction can occur after the first known ingestion in early childhood, and in young children, severe reactions are more common [ 23 , 28 ]. Half of all children with nut allergies have an anaphylactic reaction as their first clinical manifestation, without a significant difference between types of nuts [ 18 ]. Characteristics of primary sensitization to hazelnuts and tree nuts are summarized in Table 1 [ 28 , 29 , 30 , 31 , 32 , 33 ].…”

“…The association of hazelnut allergy with allergic diseases including food allergies, asthma, atopic dermatitis, and allergic rhinitis is common [ 18 ]. Tree nut allergy is associated with early onset, persistent, and severe atopic disease [ 42 ].…”