Abstract
BackgroundTo 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.FindingsOpen 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.ConclusionsOpen mixed nut challenge can efficiently exclude multiple tree nut allergies in children with a lifelong nut free diet and low suspicion of clinical allergy.
Highlights
Introduction all nuts AlmNone8 11,4 Multiple sensitization B and reaction to 1 nut (Pis S5)
Suspected food allergy based on sensitisation without known ingestion often results in elimination diets and subsequent social isolation, fear of anaphylaxis and a decreased quality of life [1]
In children presenting with a long elimination diet for tree nuts, multiple challenges would be necessary to rule out the presence of relevant tree nut allergies
Summary
Introduction all nuts AlmNone8 11,4 Multiple sensitization B and reaction to 1 nut (Pis S5). In this study we describe our experience with open mixed nut challenges as a diagnostic tool to exclude multiple nut allergies in children with long term elimination diets for tree nuts. Nineteen children with a previous negative hazelnut challenge and a lifelong preventive elimination diet for multiple tree nuts underwent a mixed nut challenge as part of clinical care.
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