Randhawa Inderpal, Morphew Tricia, Marsteller Nathan L
From the Department of Medicine, UC Irvine School of Medicine, UCLA School of Medicine, Gallegos Food Allergy Center, Pediatric Pulmonary Services, The Translational Pulmonary and Immunology Research Center, Pulmonary, Clinical Immunology and Allergy, Miller Children's Hospital-Long Beach Memorial, Long Beach, California.
Morphew Consulting, Seattle, Washington.
Allergy Asthma Proc. 2018 Nov 1;39(6):456-460. doi: 10.2500/aap.2018.39.4174.
Children with peanut allergy are regularly instructed to avoid all tree nuts. However, children with peanut allergy are likely not allergic to all tree nuts. In our cohort of patients with peanut anaphylaxis and who underwent oral immunotherapy, we sought to determine the correlation of skin-prick testing (SPT) results for tree nuts and the likelihood of successfully passing a tree nut challenge. SPT was performed for peanut and tree nuts (macadamia, pine nut, coconut, hazelnut, brazil nut, cashew, pecan, walnut, pistachio, almond) in 27 patients with known peanut allergy. The probability of a negative SPT result (wheal < 3 mm) for each nut was determined. All the patients demonstrated positive results in peanut allergy diagnostics in SPT, component testing, or food challenge. Only 15.4% of the patients had a positive SPT result to peanut alone. Macadamia, pine nut, and coconut SPT had a probability of negative SPT results of 0.97, 0.97, and 0.91, respectively. The odds ratio for this group having a negative SPT was 46.22. For hazelnut, brazil nut, and cashew, the probability of a negative SPT result was 0.81, 0.77, and 0.73, respectively. Pecan, walnut, and pistachio had odds ratios of 0.68, 0.68, and 0.64, respectively. All the patients with macadamia, pine nut, and coconut negative SPT results subsequently passed 9-g food challenges without oral immunotherapy. Despite current recommendations to avoid all tree nuts for patients with peanut allergy, the majority of patients with peanut allergy had negative SPTs and food challenges to certain tree nuts, especially macadamia, pine nut, and coconut. This pattern was seen despite most patients having multiple nut sensitizations.
花生过敏的儿童通常被要求避免食用所有坚果。然而，花生过敏的儿童可能并非对所有坚果都过敏。在我们的花生过敏并接受口服免疫疗法的患者队列中，我们试图确定坚果的皮肤点刺试验（SPT）结果与成功通过坚果激发试验可能性之间的相关性。对27名已知花生过敏的患者进行了花生和坚果（澳洲坚果、松子、椰子、榛子、巴西坚果、腰果、山核桃、核桃、开心果、杏仁）的SPT。确定了每种坚果SPT结果为阴性（风团<3毫米）的概率。所有患者在SPT、成分检测或食物激发试验中的花生过敏诊断均呈阳性。只有15.4%的患者仅对花生的SPT结果呈阳性。澳洲坚果、松子和椰子SPT结果为阴性的概率分别为0.97、0.97和0.91。该组SPT结果为阴性的优势比为46.22。对于榛子、巴西坚果和腰果，SPT结果为阴性的概率分别为0.81、0.77和0.73。山核桃、核桃和开心果的优势比分别为0.68、0.68和0.64。所有澳洲坚果、松子和椰子SPT结果为阴性的患者随后在未进行口服免疫疗法的情况下通过了9克食物激发试验。尽管目前建议花生过敏患者避免食用所有坚果，但大多数花生过敏患者对某些坚果（尤其是澳洲坚果、松子和椰子）的SPT和食物激发试验结果为阴性。尽管大多数患者对多种坚果敏感，但仍出现了这种模式。
