title: Managing Nut Allergy: A Remaining Clinical Challenge.
abstract: Peanut and tree nut allergies have become a public health problem over the last 2 decades. The diagnostic procedure relies on a suggestive history, as well as on evidence of sensitization (skin prick testing and/or specific IgE blood testing), followed in selected cases by a food challenge. Standard IgE tests may be positive to more than 1 nut, due to cross-reactivity (allergens common to several nuts) or cosensitivity (frequently associated positive test results without cross-reactivity). Thus, many patients with a peanut or a tree nut allergy avoid all nuts, relying on positive test results without clinical evidence of reactivity. In addition, coexisting pollen sensitivity may add to diagnostic uncertainty due to potential cross-reactivity between pollens and nuts. In this article, we discuss challenges in diagnosis and clinical management of peanut and tree nut allergy related to cross-reactivity and cosensitization, as well as the avoidance of nuts tested positive to reduce the risk of reactions by cross-contamination. Studies to provide more accurate characterization of genuine clinically relevant cross-reactivity or cosensitivity to multiple nuts are needed.
authors: Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland. Electronic address: Philippe.Eigenmann@hcuge.ch.
authors: Philippe A
authors: PA
authors: Eigenmann
authors: King's College London, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors: Gideon
authors: G
authors: Lack
authors: Children's Hospital La Fe, Pediatric Pulmonology and Allergy Unit, Instituto de Investigacion La Fe, Valencia, Spain.
authors: Angel
authors: A
authors: Mazon
authors: Children's Hospital La Fe, Pediatric Pulmonology and Allergy Unit, Instituto de Investigacion La Fe, Valencia, Spain.
authors: Antonio
authors: A
authors: Nieto
authors: St Peter's Hospital, Chertsey, United Kingdom.
authors: Diab
authors: D
authors: Haddad
authors: King's College London, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors: Helen A
authors: HA
authors: Brough
authors: Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
authors: Jean-Christoph
authors: JC
authors: Caubet
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000485:Allergens / Q000276:immunology*; D010367:Arachis / Q000276:immunology*; D002648:Child; D003429:Cross Reactions; D019468:Disease Management; D006801:Humans; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood; D008487:Medical History Taking; D021184:Nut Hypersensitivity / Q000175:diagnosis* / Q000178:diet therapy*; D009754:Nuts / Q000276:immunology*; D021183:Peanut Hypersensitivity / Q000175:diagnosis* / Q000178:diet therapy*; D012882:Skin Tests
chemical_list: D000485:Allergens; D007073:Immunoglobulin E
keywords: Cross-reactivity; IgE testing; Peanut allergy; Tree nut allergy