Reviews and feature articleGood prognosis, clinical features, and circumstances of peanut and tree nut reactions in children treated by a specialist allergy center
Section snippets
Methods
Subjects were unselected children with peanut/nut allergy who attended the Allergy Centre in Addenbrooke's Hospital, Cambridge. Eighty percent of subjects had been referred by their primary care physicians. Diagnosis was made after a recent history of a typical type 1 hypersensitivity reaction (urticaria/angioedema ± wheeze ± vomiting ± abdominal pain with change in behavior) occurring within 1 hour of definite nut ingestion together with evidence of sensitization to nuts (usually by skin prick
Subject characteristics
Clinical details of 785 children with peanut and/or nut allergy with median age 68 months (interquartile range, 40-107) were collected over 3640 patient years (mean, 5.3 years; median, 4.0 years); 163 further children who were originally enrolled and characterized had no follow-up. There was no significant difference between median age, sex, nut type causing worst reaction before diagnosis (index reaction), and severity grade of index reaction for groups with or without follow-up. The
Discussion
We have shown a favorable prognosis for children attending a specialist allergy clinic with an annual incidence rate for accidental ingestion of peanut and/or tree nuts after diagnosis of 3%.
This rate is substantially lower than rates in other studies of accidental exposure to peanut alone. For example, in 1989, Bock and Atkins8 found 50% of children with peanut allergy had an accidental ingestion within the past year. Vander Leek et al14 found an annual incidence rate of 33%, and most
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Disclosure of potential conflict of interest: A. T. Clark and P. W. Ewan both have received research support from the Food Standards Agency, United Kingdom government.