The natural history of tree nut allergy

被引:197
作者
Fleischer, DM [1 ]
Conover-Walker, MK [1 ]
Matsui, EC [1 ]
Wood, RA [1 ]
机构
[1] Johns Hopkins Univ, Sch Med, Dept Pediat, Baltimore, MD 21205 USA
关键词
tree nut allergy; peanut allergy; food challenge; CAPRAST; food hypersensitivity;
D O I
10.1016/j.jaci.2005.09.002
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
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 (W,)[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% CL 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 kU(A)/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 kU(A)/L or less should be considered for challenge.
引用
收藏
页码:1087 / 1093
页数:7
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