Evaluation of clinical characteristics of patients with tree nut sensitivity

Introduction:
Nut allergies represent a significant public health issue due to their potential for severe reactions, including skin conditions, respiratory symptoms, and life-threatening anaphylaxis. Nuts account for 18–40% of all anaphylaxis cases and 70–90% of anaphylactic deaths related to food allergies, with peanuts being the most frequent cause. Global studies, especially from the United States, Europe, and Australia, highlight an increasing prevalence of nut allergies. Clinical manifestations appear shortly after exposure and include urticaria, angioedema, gastrointestinal symptoms, respiratory symptoms, and anaphylaxis. Diagnostic approaches involve measuring specific IgE levels, skin testing, and oral food challenges. Nut allergies tend to persist, with only about 10% resolving fully. Avoidance remains the cornerstone of management, although food immunotherapy can be considered in certain cases. Early peanut introduction has demonstrated effectiveness in reducing peanut allergy risk. This study retrospectively evaluates the clinical characteristics of nut allergies in children aged 0–5 years, aiming to contribute to the existing body of knowledge.

Aim:
To retrospectively evaluate the clinical characteristics of children aged 0–5 years with tree nut sensitivities and contribute to the existing literature.

Material and methods:
This retrospective descriptive study included all children diagnosed with tree nut sensitivities at our clinic from May 2022 to May 2024. Clinical data, including age, sex, allergic disease profile (urticaria, atopic dermatitis, gastrointestinal symptoms, asthma, allergic rhinitis, anaphylaxis), total IgE, eosinophils, specific IgE levels, and skin prick test results, were reviewed. Tree nut sensitivities were diagnosed based on skin prick tests with results greater than 3 mm and specific IgE levels higher than 0.35 IU/ml. Statistical analyses were performed using SPSS 29.0.

Results:
A total of 229 children with tree nut sensitivities were evaluated. The median age was 10 months, with ages ranging from 1 to 59 months. 67.7% of the participants were male. Single tree nut sensitivity was present in 52.0% of the cases, while 48.0% had multiple tree nut sensitivities. The most common allergens were hazelnut (71.2%), peanut (56.3%), walnut (20.5%), pistachio (13.1%), and almond (13.1%). Accompanying food and respiratory allergens in tree nut allergy were identified as egg (59.8%) and milk (15.7%) among food allergens, while aeroallergens were house dust mites (22.7%), pollen (10.5%), and cat dander (10.0%). Clinical manifestations included atopic dermatitis (33.2%), respiratory symptoms (16.7%), anaphylaxis (9.6%), gastrointestinal symptoms (9.6%), and urticaria (5.2%). Total IgE levels were significantly higher in children with multiple tree nut sensitivities (median: 273.5 IU/ml) compared to those with single tree nut sensitivities (median: 79 IU/ml) (p < 0.001). Anaphylaxis and gastrointestinal symptoms were more common in children with multiple tree nut sensitivities (p < 0.047).

Conclusions:
This study highlights the prevalence and clinical characteristics of tree nut sensitivities in children aged 0–5 years. The evidence suggests that children with multiple tree nut sensitivities may exhibit more severe allergic profiles and require closer monitoring. Although further extensive studies are needed, it is believed that early diagnosis and treatment of tree nut sensitivities may help prevent serious outcomes such as anaphylaxis.