title: How do we know when peanut and tree nut allergy have resolved, and how do we keep it resolved?
abstract: Over the last two decades, the prevalence of peanut and tree nut allergy has increased throughout the western world. Adverse reactions to these foods account for over 50% of all deaths resulting from food-related anaphylaxis. Until recently, evidence suggested that all peanut and tree nut allergy were permanent. It is now known that about 20% and 10%, respectively, of young patients outgrow peanut and tree nut allergies. Achieving tolerance is associated with increasing circulating T regulatory cells and reduced production of allergen-specific IgE. Reliable predictors of resolution are not yet available. A direct correlation between skin test weal size and allergen-specific IgE, at the time of diagnosis and likelihood of resolution, has been reported. Resolution of peanut or tree nut allergy cannot be determined conclusively by either allergen-specific IgE analysis or by skin prick testing. Oral food challenge is the gold standard for determining resolution of food allergy. Food challenges should only be undertaken in a clinical setting fully equipped to deal with a potential severe adverse reaction. Approximately 8% of patients who outgrow peanut allergy may suffer a recurrence, but recurrent tree nut allergy has not been reported to date. Infrequent ingestion of peanut may be related to the re-emergence of allergy. Induction of tolerance through oral immunotherapy or sublingual immunotherapy is now being actively studied, but remains experimental. Studies have reported short-term desensitization to peanut, but ongoing follow-up will determine whether tolerance is achieved long term.
authors.affiliation: Department of Pediatrics, Division of Pediatric Allergy and Immunology, National Jewish Health, Denver, CO, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Byrne
authors.forename: J
authors.initials: J
authors.lastname: Malka-Rais
authors.forename: A W
authors.initials: AW
authors.lastname: Burks
authors.forename: D M
authors.initials: DM
authors.lastname: Fleischer
mesh_terms: D000284:Administration, Oral; D000485:Allergens / Q000008:administration & dosage; D003888:Desensitization, Immunologic; D006801:Humans; D007108:Immune Tolerance; D021184:Nut Hypersensitivity / Q000175:diagnosis* / Q000276:immunology*; D021183:Peanut Hypersensitivity / Q000175:diagnosis* / Q000276:immunology* / Q000628:therapy
chemical_list: D000485:Allergens