Recent advances in the diagnosis and management of tree nut and seed allergy

Abstract

Purpose of reviewTree nut (TN) and seed allergies are frequent, and their prevalence appears to be on the rise. Allergic reactions associated with these foods are more frequently severe, and these allergies tend to persist into adulthood, consequently affecting quality of life. In this review, we summarize recent advances in diagnostic modalities and management strategies for TN/seed-allergic patients.Recent findingsClinical manifestations of TN and seed allergy range from asymptomatic sensitization to severe anaphylactic reactions. The use of emerging diagnostic tools such as component resolved diagnostics (CRD) and the basophil activation test (BAT) can help better predict clinical reactivity, the latter being currently reserved for research settings. Strict avoidance of all TN is generally not required, as most patients can tolerate select TN despite co-sensitization. Oral immunotherapy (OIT) is a promising alternative treatment instead of complete avoidance of culprit allergens, as it can safely increase the allergy threshold.SummaryOur recent understanding of co-reactivity between various TN and seeds has shaped management opportunities, including select TN introduction and optimization of OIT, two strategies which may improve quality of life. There is a need for better minimally invasive diagnostic methods for TN and seed allergy, with CRD and BAT being promising tools.

Prediction of pediatric peanut oral food challenge outcomes using machine learning

“…The relatively poor performance of SPT and IgE level results alone in predicting OFC outcome, particularly in the context of equivocal histories of allergy, has prompted attempts to develop novel test modalities. 20 , 21 Novel FA diagnostic approaches include component-resolved diagnostics, 22 , 23 ex vivo allergen activation of allergic cell types, 24 , 25 , 26 , 27 , 28 and epitope mapping. 29 Although these are of great interest and potential, various logistic or biologic aspects of these tests make their widespread adoption difficult.…”

Understanding the heterogeneity of childhood allergic sensitization and its relationship with asthma

“…However, we can now describe sensitization in much greater detail using component-resolved diagnostics (CRD, also known as molecular allergy tests) that measure sIgE response to a large number of allergenic molecules or allergen components (component-specific IgE, c-sIgE). For example, in allergy to peanut [46][47][48] and other foods [49,50], sensitization to some, but not all, allergenic proteins in allergen extracts is important for distinguishing true allergy from asymptomatic sensitization [51]. Consequently, CRD is firmly established in clinical practice in food allergy [52,53], but the data to support a similar approach in the field of asthma are lacking.…”

Current options in the management of tree nut allergy: A systematic review and narrative synthesis

“…Although there are recent reviews on the management and diagnosis of tree nut allergy, 8,9,[41][42][43] this is the first systematic review thoroughly investigating the available information on therapeutic options for the desensitization of patients with IgE-mediated tree nut allergy, other than peanut. Studies addressing the management of tree nut allergy, which did not fulfill the prespecified inclusion criteria of this review, can be found in the Supplementary information.…”