TY - JOUR
T1 - The natural history of tree nut allergy
AU - Fleischer, David M.
AU - Conover-Walker, Mary Kay
AU - Matsui, Elizabeth C.
AU - Wood, Robert A.
N1 - Funding Information:
Supported by National Institutes of Health training grant T32 AI 07007 from the National Institute of Allergy and Infectious Disease, the Eudowood Foundation for the Consumptives of Maryland, The Myra Reinhard Family Foundation, and General Clinical Research Center grant M01-RR000052.
PY - 2005/11
Y1 - 2005/11
N2 - Background: Although 20% of children outgrow peanut allergy, the natural history of tree nut (TN) allergy has not been well studied. Objective: The goals of the study were to estimate the proportion of children who outgrow TN allergy and examine predictors of outgrowing it. Methods: Patients with TN allergy, defined as a history of reaction on ingestion and evidence of TN-specific IgE (TN-IgE) or positive TN-specific IgE level but no history of ingestion, were evaluated. If all current TN-IgE levels were less than 10 kilounits of antibody (kUA)/L, double-blind, placebo-controlled food challenges were offered. Patients who had undergone open TN challenges as part of routine clinical care were also included. Results: Two hundred seventy-eight patients with TN allergy were identified. One hundred one (36%) had a history of acute reactions, 12 (12%) of whom had reactions to multiple TNs and 73 (63%) of whom had a history of moderate-to-severe reactions. Nine of 20 patients who had previously reacted to a TN passed challenges, so that 9 (8.9%; 95% CI, 4% to 16%) of 101 patients with a history of prior TN reactions outgrew TN allergy. Fourteen of 19 who had never ingested TNs but had detectable TN-specific IgE levels passed challenges. One hundred sixty-one did not meet the challenge criteria, and 78 met the criteria but declined challenges. Looking at specific TN-IgE cutoffs, 58% with TN-IgE levels of 5 kUA/L or less and 63% with TN-IgE levels of 2 kUA/L or less passed challenges. Conclusions: Approximately 9% of patients outgrow TN allergy, including some who had prior severe reactions. Although ideal cutoffs for challenge cannot be firmly recommended on the basis of these data, patients aged 4 years or older with all TN-IgE levels of 5 kUA/L or less should be considered for challenge.
AB - Background: Although 20% of children outgrow peanut allergy, the natural history of tree nut (TN) allergy has not been well studied. Objective: The goals of the study were to estimate the proportion of children who outgrow TN allergy and examine predictors of outgrowing it. Methods: Patients with TN allergy, defined as a history of reaction on ingestion and evidence of TN-specific IgE (TN-IgE) or positive TN-specific IgE level but no history of ingestion, were evaluated. If all current TN-IgE levels were less than 10 kilounits of antibody (kUA)/L, double-blind, placebo-controlled food challenges were offered. Patients who had undergone open TN challenges as part of routine clinical care were also included. Results: Two hundred seventy-eight patients with TN allergy were identified. One hundred one (36%) had a history of acute reactions, 12 (12%) of whom had reactions to multiple TNs and 73 (63%) of whom had a history of moderate-to-severe reactions. Nine of 20 patients who had previously reacted to a TN passed challenges, so that 9 (8.9%; 95% CI, 4% to 16%) of 101 patients with a history of prior TN reactions outgrew TN allergy. Fourteen of 19 who had never ingested TNs but had detectable TN-specific IgE levels passed challenges. One hundred sixty-one did not meet the challenge criteria, and 78 met the criteria but declined challenges. Looking at specific TN-IgE cutoffs, 58% with TN-IgE levels of 5 kUA/L or less and 63% with TN-IgE levels of 2 kUA/L or less passed challenges. Conclusions: Approximately 9% of patients outgrow TN allergy, including some who had prior severe reactions. Although ideal cutoffs for challenge cannot be firmly recommended on the basis of these data, patients aged 4 years or older with all TN-IgE levels of 5 kUA/L or less should be considered for challenge.
KW - CAP-RAST
KW - Food challenge
KW - Food hypersensitivity
KW - Peanut allergy
KW - Tree nut allergy
UR - http://www.scopus.com/inward/record.url?scp=27644562985&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=27644562985&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2005.09.002
DO - 10.1016/j.jaci.2005.09.002
M3 - Article
C2 - 16275381
AN - SCOPUS:27644562985
VL - 116
SP - 1087
EP - 1093
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
SN - 0091-6749
IS - 5
ER -