Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May;33(5):e13778.
doi: 10.1111/pai.13778.

Organ-specific symptom patterns during oral food challenge in children with peanut and tree nut allergy

Josefine Dobbertin-Welsch  1 , Olga Staudacher  1   2 , Songül Yürek  1 , Valérie Trendelenburg  1 , Sebastian Tschirner  1 , Mandy Ziegert  3 , Frank Ahrens  4 , Martina Millner-Uhlemann  5 , Susanne Büsing  6 , Anne Striegel  7 , Hagen Ott  8 , Alisa Arens  8 , Monica Gappa  9 , Lars Lange  10 , Sunhild Gernert  10 , Bodo Niggemann  1   3 , Kirsten Beyer  1
Affiliations

Organ-specific symptom patterns during oral food challenge in children with peanut and tree nut allergy

Josefine Dobbertin-Welsch et al. Pediatr Allergy Immunol. 2022 May.

Abstract

Background: Peanut and tree nut allergies are common in childhood and often severe in nature. The clinical picture shows a wide variety of symptoms.

Objective: To analyze the distribution of clinical symptoms and severity during oral food challenges (OFC) in children.

Methods: Analysis of 1.013 prospectively recorded, positive OFCs with peanut (n = 607), hazelnut (n = 266), walnut (n = 97), and cashew (n = 43). Symptoms were categorized as immediate-type skin, gastrointestinal, upper and lower respiratory, cardiovascular symptoms, and eczema exacerbation. Symptom severity and treatment were recorded.

Results: Skin symptoms presented in 78%, followed by gastrointestinal (47%), upper (42%), and lower respiratory symptoms (32%). Cardiovascular symptoms presented in 6%. In three-quarter of the reactions, more than one organ was involved. Importantly, severe reactions occurred at every dose level. Peanut- and cashew-allergic patients had a higher relative risk of gastrointestinal symptoms compared with hazelnut- and walnut-allergic patients. Patients without vomiting had a 1.7 times higher risk developing immediate-type skin and/or lower respiratory symptoms. Three-quarter of the patients ever had eczema but worsening presented in only 10.5% of the OFCs. In patients with multiple food allergies, organs involved, eliciting dose and severity differed between allergens.

Conclusion: Although comparisons between allergen groups with different clinical history, severity, comorbidities and laboratory data are difficult and might contain bias, our data confirm the high allergenic potential of peanut and tree nuts. The rare occurrence of eczema worsening emphasizes that avoidance diets of peanuts and tree nuts to cure eczema seem to be unnecessary and may hamper tolerance maintenance.

Keywords: food allergy; organ-specific symptom; peanut; severity; tree nut.

PubMed Disclaimer

References

REFERENCES

    1. Sampson HA. Update on food allergy. J Allergy Clin Immunol. 2004;113(5):805-819. doi:10.1016/j.jaci.2004.03.014
    1. Xepapadaki P, Fiocchi A, Grabenhenrich L, et al. Incidence and natural history of hen's egg allergy in the first 2 years of life-the EuroPrevall birth cohort study. Allergy. 2016;71(3):350-357. doi:10.1111/all.12801. Epub 2015 Dec 22 PMID: 26514330.
    1. Schoemaker AA, Sprikkelman AB, Grimshaw KE, et al. Incidence and natural history of challenge-proven cow's milk allergy in European children-EuroPrevall birth cohort. Allergy. 2015;70(8):963-972. doi:10.1111/all.12630. Epub 2015 May 18 PMID: 25864712.
    1. Wood RA. The natural history of food allergy. Pediatrics. 2003;111(6 Pt 3):1631-1637. PMID: 12777603.
    1. Peters RL, Allen KJ, Dharmage SC, et al. HealthNuts Study. Natural history of peanut allergy and predictors of resolution in the first 4 years of life: a population-based assessment. J Allergy Clin Immunol. 2015;135(5):1257-1266. doi:10.1016/j.jaci.2015.01.002. Epub 2015 Feb 26. PMID: 25725989.

Publication types

LinkOut - more resources