How do we know when peanut and tree nut allergy have resolved, and how do we keep it resolved?
Article first published online: 20 JUL 2010
© 2010 Blackwell Publishing Ltd
Clinical & Experimental Allergy
Volume 40, Issue 9, pages 1303–1311, September 2010
How to Cite
Byrne, A. M., Malka-Rais, J., Burks, A. W. and Fleischer, D. M. (2010), How do we know when peanut and tree nut allergy have resolved, and how do we keep it resolved?. Clinical & Experimental Allergy, 40: 1303–1311. doi: 10.1111/j.1365-2222.2010.03554.x
- Issue published online: 4 AUG 2010
- Article first published online: 20 JUL 2010
- Submitted 10 December 2009; revised 7 May 2010; accepted 17 May 2010
Over the last two decades, the prevalence of peanut and tree nut allergy has increased throughout the western world. Adverse reactions to these foods account for over 50% of all deaths resulting from food-related anaphylaxis. Until recently, evidence suggested that all peanut and tree nut allergy were permanent. It is now known that about 20% and 10%, respectively, of young patients outgrow peanut and tree nut allergies. Achieving tolerance is associated with increasing circulating T regulatory cells and reduced production of allergen-specific IgE. Reliable predictors of resolution are not yet available. A direct correlation between skin test weal size and allergen-specific IgE, at the time of diagnosis and likelihood of resolution, has been reported. Resolution of peanut or tree nut allergy cannot be determined conclusively by either allergen-specific IgE analysis or by skin prick testing. Oral food challenge is the gold standard for determining resolution of food allergy. Food challenges should only be undertaken in a clinical setting fully equipped to deal with a potential severe adverse reaction. Approximately 8% of patients who outgrow peanut allergy may suffer a recurrence, but recurrent tree nut allergy has not been reported to date. Infrequent ingestion of peanut may be related to the re-emergence of allergy. Induction of tolerance through oral immunotherapy or sublingual immunotherapy is now being actively studied, but remains experimental. Studies have reported short-term desensitization to peanut, but ongoing follow-up will determine whether tolerance is achieved long term.
Cite this as: A. M. Byrne, J. Malka-Rais, A. W. Burks and D. M. Fleischer, Clinical & Experimental Allergy, 2010 (40) 1303–1311.