Introduction ( contexte de la recherche ) The performance of nuts skin prick-test (SPT) and specific IgE is known to potentially be altered by the cross-reactivity with pollens. This can result in misguidance for safe introduction of nuts in patients allergic to one or multiple nuts. We sought to evaluate the impact of pollen sensitization related to the patients age and his geographical area under the nuts diagnostic tests performance in patients with a primary nut allergy. We analyzed paraclinical data from a prospective multicenter pan-European study (the Pronuts study) including SPT and specific IgE (whole extract and major allergens) for nuts, sesame seed and pollens (Bet v 1 and Pru p 3) from allergic patients with a primary nut allergy. To analyze the performance of the tests, we made ROC curves using these variables. One hundred and twenty children were enrolled. Sensitization to Bet v 1 and PR-10 nuts components (Ara h 8 and Cor a 1) were more prevalent and significantly higher in Geneva and London than in Spain, whereas sensitization to Pru p 3 and LTP nuts components (Ara h 9, Cor a 8, Jug r 3) were more prevalent and had higher specific IgE levels in Spain. Specific IgE to PR-10s and LTP nuts components were significantly higher in older patients (≥ 6 years) than in younger children. Levels of specific IgE to nuts seed storage proteins tended to be higher in patients ≥ 6 years compared to younger children. Concerning the performance of the diagnostic tests, in children older than 6 years, specific IgE to Ara h 2 performed significantly better than peanut SPT. Similarly, the AUC for SPT to hazelnut was larger in younger children. However, specific IgE to Cor a 9 and Cor a 14 performed better than hazelnut SPT in children older than 6 years of age in Geneva and London, respectively. For cashew and walnut, no clear differences were found between the AUC for SPT, IgE or components based on age categories. For safe introduction of various nuts in patients diagnosed with a primary nut allergy, the diagnostic strategy needs to be adapted to the local pollen exposure, especially in older children, as sensitization to Bet v1 or Pru p3 may lead to false positive IgE or SPT results to various nuts.
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