Tree Nuts Anaphylaxis in Preschool Age Children
J M De Matias, Angéla Gáspár, Luís Miguel Borrego, Susana Piedade, G. Pires, C Arêde, Graça Sampaio, M. Morais Almeida
Abstract
Introduction. The incidence of food-induced anaphylaxis (FIA) is increasing in young children. Although the commonest culprits are cow's milk and egg, FIA to tree nuts (TNs) have been increasing. Objective. Characterization of children referred to our allergy department due to TNs-induced anaphylaxis (TNs-FIA) during preschool age. Materials and methods. We have retrospectively included 25 children with clinical history of preschool TNs-FIA, proven by allergological work-up. TNs sensitization was assessed by skin prick tests and/or specific IgE. Results. The mean age of the first anaphylactic episode was 3.11.2 years. The majority (92%) had an allergic disease (52% asthma). The implicated TNs were cashew (11 children), walnut ( The reaction occurred after the first known ingestion in 68%. In 92%, symptoms appeared within 30 minutes after exposure. The most frequent clinical symptoms were mucocutaneous (96%), respiratory (80%) and gastrointestinal (52%). Twenty-one children were admitted to the emergency department, although only 48% were treated with epinephrine. An underneath IgE-mediated mechanism was proven in all cases. Immunologic cross-reactivity with other TNs was identified in 84%, and with peanut in 36%. Overall, in our center, TNs-FIA represents 18% of all causes of FIA. Conclusions. In preschool age children with TNs-FIA, cashew and walnut were the commonest implicated nuts. Most reactions occurred briefly after exposure to minimal amounts of TNs, demonstrating the high potency of these allergens. About one-third also had peanut sensitization. Potentially life-threatening TNs allergy can occur early in childhood and adequate management should be undertaken. adamia, brazil nut and pine nut Although botanically unrelated, TNs and peanut (that belongs to the botanical family of Leguminosae) share many allergenic similarities (17). Overall, TNs allergy affects 0.5 to 3% of the population However, its prevalence differs according to the geographical region and dietary patterns In the United States, walnut is the most commonly reported culprit of TNs allergy, followed by cashew and almond In Europe, hazelnut allergy is the most prevalent (17). The exact TNs allergy prevalence in Portugal is unknown.