Leicester Royal Infirmary, Leicester, UK.
Guy's and St Thomas' NHS Foundation Trust, London, UK.
Clin Exp Allergy. 2017 Jun;47(6):719-739. doi: 10.1111/cea.12957.
Peanut nut and tree nut allergy are characterised by IgE mediated reactions to nut proteins. Nut allergy is a global disease. Limited epidemiological data suggest varying prevalence in different geographical areas. Primary nut allergy affects over 2% of children and 0.5% of adults in the UK. Infants with severe eczema and/or egg allergy have a higher risk of peanut allergy. Primary nut allergy presents most commonly in the first five years of life, often after the first known ingestion with typical rapid onset IgE-mediated symptoms. The clinical diagnosis of primary nut allergy can be made by the combination of a typical clinical presentation and evidence of nut specifc IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test. Pollen food syndrome is a distinct disorder, usually mild, with oral/pharyngeal symptoms, in the context of hay fever or pollen sensitisation, which can be triggered by nuts. It can usually be distinguish clinically from primary nut allergy. The magnitude of a SPT or sIgE relates to the probability of clinical allergy, but does not relate to clinical severity. SPT of ≥ 8 mm or sIgE ≥ 15 KU/L to peanut is highly predictive of clinical allergy. Cut off values are not available for tree nuts. Test results must be interpreted in the context of the clinical history. Diagnostic food challenges are usually not necessary but may be used to confirm or refute a conflicting history and test result. As nut allergy is likely to be a long-lived disease, nut avoidance advice is the cornerstone of management. Patients should be provided with a comprehensive management plan including avoidance advice, patient specific emergency medication and an emergency treatment plan and training in administration of emergency medication. Regular re-training is required.
花生、坚果过敏的特征是 IgE 介导的坚果蛋白过敏反应。坚果过敏是一种全球性疾病。有限的流行病学数据表明，不同地理区域的患病率不同。英国超过 2%的儿童和 0.5%的成年人患有原发性坚果过敏。严重特应性皮炎和/或鸡蛋过敏的婴儿患花生过敏的风险更高。原发性坚果过敏最常见于生命的前五年，通常在首次已知摄入后迅速出现典型的 IgE 介导症状。原发性坚果过敏的临床诊断可通过典型的临床表现和通过阳性皮肤点刺试验 (SPT) 或特异性 IgE (sIgE) 试验显示的坚果特异性 IgE 证据来做出。花粉-食物过敏综合征是一种明显的疾病，通常为轻度，伴有口腔/咽部症状，在花粉热或花粉致敏的情况下，可由坚果引发。它通常可以从原发性坚果过敏中临床区分开来。SPT 或 sIgE 的大小与临床过敏的可能性相关，但与临床严重程度无关。花生 SPT 为≥8mm 或 sIgE≥15KU/L 高度提示临床过敏。树坚果的 cut off 值不可用。测试结果必须结合临床病史进行解释。诊断性食物挑战通常不是必需的，但可用于确认或反驳有冲突的病史和测试结果。由于坚果过敏可能是一种长期存在的疾病，因此避免食用坚果是管理的基石。应向患者提供综合管理计划，包括避免食用建议、患者特定的紧急药物以及紧急治疗计划和紧急药物管理培训。需要定期重新培训。
