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PostPosted: Sat Jun 24, 2017 3:16 pm 

Joined: Thu Dec 20, 2007 7:23 pm
Posts: 1096
Location: Kingston
Patients with nut allergies have previously been advised to avoid all nuts, but results from this study suggest that isn't always necessary, and might even lead to more nut allergies. The findings also challenge the belief that peanut and walnut allergies always co-occur, and that cashew and pistachio allergies co-occur.
"All 32 children with pistachio nut allergy had cashew nut allergy, but six cashew-allergic children could tolerate pistachio," said investigator Helen Brough, PhD, a consultant in pediatric allergy at Guy's and St. Thomas' NHS Foundation Hospital and senior lecturer at King's College London.
And "we saw clusters of other nut allergies, most notably between pecan, walnut, and hazelnut," she explained here at the European Academy of Allergy and Clinical Immunology Congress 2017.
The optimal way to prevent and manage nut allergies has been in flux for several years, especially after publication of the LEAP (Learning Early About Peanut) study (N Engl J Med. 2015;372:803-813) and the follow-up LEAP-On study (N Engl J Med. 2016;374:1435-1443). Both showed that the early introduction of peanuts can prevent the development of peanut allergy.
Dr Brough and her colleagues designed their study to determine the actual rate of coexisting peanut, tree nut, and sesame seed allergies. They also wanted to assess the feasibility of multiple nut challenges, precautions related to the introduction of safe nuts, the use of component resolved diagnostics to diagnose tree nut and sesame seed allergy, and quality of life after safe nuts have been introduced into a child's diet.
Although the team has not completed the data analysis, the preliminary findings on improvement in children's quality of life "look promising," Dr Brough told Medscape Medical News.

Although only 2.8% of children allergic to pistachio were not allergic to cashew, the reverse was not true; 16.7% of those allergic to cashew were not allergic to pistachio. Similarly, although 6.1% of those allergic to pecan were not allergic to walnut, 29.5% of those allergic to walnut could safely eat pecans.
Because of the risk for walnut and pecan coallergy in Valencia, challenges to all 11 nuts and seeds were only possible in London and Geneva.
"In Spain, because of the severity of reactions to walnuts in some participants, pecans were not challenged," Dr Brough told Medscape Medical News. The severity of walnut allergy surprised her, she added.
"The thing I took most from the ProNut study is that we need to think about walnut allergy and how severe walnut allergy can be," she explained. "It's not something that I was anticipating, because often you get lower allergy testing to walnut, but actually they can have very severe allergic reactions. That was one of my on-the-shop-floor experiences, and for pecan also."
Walnut is the most common nut allergy in the United States, said Hugh Sampson, MD, professor of pediatrics at Mount Sinai Hospital in New York City, who presented an abstract on peanut allergy during the same session.
"The one thing that's important is this differential between cashew and pistachio allergy, and also the walnut and pecan allergy," he told Medscape Medical News. "Up until today, if I had somebody who reacted to walnut, I probably wouldn't bother challenging pecan, but now, clearly, there is a subset that is okay doing that."
Overall, these new data are valuable to those in clinical practice trying to make sense of the changing evidence related to nut allergy, he explained.
"It puts some solid data behind what people are starting to think is the more favorable approach," Dr Sampson explained. "Hopefully, there will be more introduction of nuts, and I think one of the points Dr Brough made is that this is something we have to look at early."
As the LEAP trial did, these new data give "us more impetus to put some of these tree nuts into the diet early to try to prevent the development of nut allergy," Dr Sampson said.

The study:


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