title: Reported food allergy to peanut, tree nuts and fruit: comparison of clinical manifestations, prescription of medication and impact on daily life.
abstract: BACKGROUND
  Peanut (PN), tree nuts (TN) and fruits are frequent causes of food allergy (FA). Peanut and TN are believed to cause more severe reactions than fruits. However, there are no studies comparing the severity of PN, TN and fruit allergy within one patient group.
  
  
  METHODS
  Four-hundred and eleven adult patients referred to our tertiary allergy center with suspicion of FA completed a standardized questionnaire. Patients with a typical history of immunoglobulin E (IgE)-mediated allergy, e.g. oropharyngeal symptoms to PN, TN (hazelnut, walnut, cashew nut) or fruit (apple, kiwi, peach, pear and cherry) were recruited (218/411). The objective was to evaluate differences in clinical severity between PN, TN and fruit allergy and how this was reflected by prescription of emergency medication and impact on daily life.
  
  
  RESULTS
  Eighty-two percent of the included 218 patients were sensitized to the respective foods. The percentages of severe symptoms (i.e. respiratory or cardiovascular symptoms) in PN, TN and fruit allergic patients were respectively 47%, 39% and 31% (respiratory) and 11%, 5.0% and 3.4% (cardiovascular). Prescription and use of emergency medication (epinephrine, antihistamines and steroids) did not differ among the three groups. The majority of patients with a PN or TN allergy (72%) and fruit allergy (62%) reported that FA influences their daily life considerably.
  
  
  CONCLUSIONS
  Fruit allergy causes less severe symptoms than TN and especially PN allergy. However, this is not reflected in the prescription or use of emergency medication. This may indicate that physicians are not fully acquainted with the guidelines for prescription of emergency medication. A high impact on daily life was found both in PN, TN and in fruit allergy.
authors.affiliation: Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: T M
authors.initials: TM
authors.lastname: Le
authors.forename: T M
authors.initials: TM
authors.lastname: Lindner
authors.forename: S G
authors.initials: SG
authors.lastname: Pasmans
authors.forename: C L H
authors.initials: CL
authors.lastname: Guikers
authors.forename: E
authors.initials: E
authors.lastname: van Hoffen
authors.forename: C A F M
authors.initials: CA
authors.lastname: Bruijnzeel-Koomen
authors.forename: A C
authors.initials: AC
authors.lastname: Knulst
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000188:drug therapy / Q000453:epidemiology; D015331:Cohort Studies; D004638:Emergency Treatment; D004837:Epinephrine / Q000627:therapeutic use; D005060:Europe; D005260:Female; D005638:Fruit / Q000009:adverse effects*; D006801:Humans; D008297:Male; D021184:Nut Hypersensitivity / Q000188:drug therapy / Q000453:epidemiology*; D017063:Outcome Assessment, Health Care; D021183:Peanut Hypersensitivity / Q000188:drug therapy / Q000453:epidemiology*; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D004837:Epinephrine