title: Usefulness of open mixed nut challenges to exclude tree nut allergy in children.
abstract: BACKGROUND
  To minimize the risk of accidental reactions, atopic children with multiple sensitizations to tree nuts are advised to avoid all nuts. Multiple food challenges would be needed to confirm the clinical relevance, but are too burdensome to be practical. The usefulness of open mixed nut challenges in terms of safety, reactions during challenge, tolerance of the challenge material, effect on the elimination diet and satisfaction of the parents was evaluated.
  
  
  RESULTS
  Open mixed nut challenges were performed in 19 children with a previous negative hazelnut challenge and long term elimination diet for tree nuts. Challenges were negative in 13 (68 %) children, in four (21 %) children (non-severe) allergic symptoms were observed. The challenges were well accepted, safe and efficient. We were able to avoid multiple nut challenges in 15 (79 %) children.
  
  
  CONCLUSIONS
  Open mixed nut challenge can efficiently exclude multiple tree nut allergies in children with a lifelong nut free diet and low suspicion of clinical allergy.
authors.affiliation: Department of Paediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, 3508 AB, P O Box 85090, Utrecht, The Netherlands.
authors.forename: Francine C
authors.initials: FC
authors.lastname: Van Erp
authors.affiliation: Department of (Paediatric) Dermatology and Immunlogy, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: André C
authors.initials: AC
authors.lastname: Knulst
authors.affiliation: Department of Dietetics, Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Irene L
authors.initials: IL
authors.lastname: Kok
authors.affiliation: Department of Paediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, 3508 AB, P O Box 85090, Utrecht, The Netherlands.
authors.forename: Maartje F
authors.initials: MF
authors.lastname: van Velzen
authors.affiliation: Department of Paediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, 3508 AB, P O Box 85090, Utrecht, The Netherlands.
authors.forename: Cornelis K
authors.initials: CK
authors.lastname: van der Ent
authors.affiliation: Department of Paediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, 3508 AB, P O Box 85090, Utrecht, The Netherlands.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Meijer
keywords: Diagnostics; Food challenge; Nut allergy; Tree nuts