Eigenmann Philippe A, Lack Gideon, Mazon Angel, Nieto Antonio, Haddad Diab, Brough Helen A, Caubet Jean-Christoph
Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
King's College London, Medical Research Council and Asthma UK Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
J Allergy Clin Immunol Pract. 2017 Mar-Apr;5(2):296-300. doi: 10.1016/j.jaip.2016.08.014. Epub 2016 Oct 25.
Peanut and tree nut allergies have become a public health problem over the last 2 decades. The diagnostic procedure relies on a suggestive history, as well as on evidence of sensitization (skin prick testing and/or specific IgE blood testing), followed in selected cases by a food challenge. Standard IgE tests may be positive to more than 1 nut, due to cross-reactivity (allergens common to several nuts) or cosensitivity (frequently associated positive test results without cross-reactivity). Thus, many patients with a peanut or a tree nut allergy avoid all nuts, relying on positive test results without clinical evidence of reactivity. In addition, coexisting pollen sensitivity may add to diagnostic uncertainty due to potential cross-reactivity between pollens and nuts. In this article, we discuss challenges in diagnosis and clinical management of peanut and tree nut allergy related to cross-reactivity and cosensitization, as well as the avoidance of nuts tested positive to reduce the risk of reactions by cross-contamination. Studies to provide more accurate characterization of genuine clinically relevant cross-reactivity or cosensitivity to multiple nuts are needed.
在过去20年里，花生和坚果过敏已成为一个公共卫生问题。诊断程序依赖于提示性病史以及致敏证据（皮肤点刺试验和/或特异性IgE血液检测），在某些情况下随后进行食物激发试验。由于交叉反应性（几种坚果共有的过敏原）或共敏感性（无交叉反应性但经常出现相关阳性检测结果），标准IgE检测可能对多种坚果呈阳性。因此，许多花生或坚果过敏患者避免食用所有坚果，仅依据阳性检测结果而无反应性的临床证据。此外，由于花粉与坚果之间可能存在交叉反应性，并存的花粉敏感性可能会增加诊断的不确定性。在本文中，我们讨论了与交叉反应性和共敏感性相关的花生和坚果过敏诊断及临床管理中的挑战，以及避免食用检测呈阳性的坚果以降低交叉污染导致反应的风险。需要开展研究以更准确地描述对多种坚果真正具有临床相关性的交叉反应性或共敏感性。
