Food allergy, dermatologic diseases, and anaphylaxisThe natural history of tree nut allergy
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Study population
Clinic records of patients from The Johns Hopkins Pediatric Allergy Clinic who had been given a diagnosis of TN allergy were reviewed to collect demographic and clinical data. A diagnosis of TN allergy was defined as either a clear-cut clinical history of an allergic reaction on ingestion and a confirmatory positive test response for TN-IgE or a history of a positive TN skin prick test (SPT) response or positive TN-IgE level (>0.35 kilounits of antibody [kUA]/L) without history of ingestion.
Study population
A total of 278 patients, with an age range of 3 to 21.6 years (median, 6.9 years) at the time of evaluation, were enrolled in the study and are described in Table I. There were 180 male (65%) and 98 female (35%) patients, and their TN allergies had been diagnosed between the ages of 3 months and 15.8 years (median, 1.3 years). The initial diagnosis was made on the basis of a history of an acute reaction to a TN or multiple TNs in 101 patients, 13 of whom had positive SPT responses and 88 of
Discussion
These findings confirm that a subset of children with TN allergy outgrow their allergy over time, although the resolution rate appears to be less than in peanut allergy. The data suggest that children with TN allergy should be re-evaluated periodically to assess whether they have acquired oral tolerance. In addition, TN-IgE levels can be used to estimate the likelihood that a patient has outgrown his or her TN allergy and guide selection of appropriate candidates for TN challenges.
Our estimate
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Supported by National Institutes of Health training grant T32 AI 07007 from the National Institute of Allergy and Infectious Disease, the Eudowood Foundation for the Consumptives of Maryland, The Myra Reinhard Family Foundation, and General Clinical Research Center grant M01-RR000052.