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Onset of nut allergy in a pediatric cohort: clinical and molecular patterns. AFRUSEN study

Ibáñez-Sandin MD1,2*, Rodríguez del Río P1,2*, Alvarado MI3, García BE4, Garriga-Baraut T5,6, Reche Frutos M7, Escudero C1,2, Ramirez A8, Vila L9, Lasa EM10, Blasco C11, Marchán-Martin E12, Martorell A13, Sanchez-García S1,2, Rodríguez-Álvarez M14, Infante S15, Rodríguez Vazquez V16, Olaguibel JM17, Labrador-Horrillo M18, Carrillo T19, AFRUSEN task force, Pediatric Allergy Committee, Spanish Society of Allergy and Clinical Immunology (SEAIC)

1Allergy Department, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
2Health Research Institute Princesa, Madrid; cARADyAL RD16/0006/0026
3Servicio de Alergología, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain
4Service of Alergology, Complejo Hospitalario de Navarra, Pamplona, Spain
5Unitat d'Al·lergologia Pediàtrica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
6Grup d’Investigació “Creixement i Desenvolupament”, Institut de Recerca de l’Hospital Universitari Vall d’Hebron (VHIR), Barcelona, Spain
7Servicio de Alergología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
8Unidad de Alergia alimentaria, Unidad de Alergología, Hospital Universitario Virgen Macarena, Sevilla, Spain
9Complexo Hospitalario Universitario A Coruña, Spain
10Unidad de Alergología Infantil, Servicio de Alergología, Hospital Universitario Donostia, Spain
11Unidad de Alergología Pediátrica, Hospital Universitario Vall d'Hebron de Barcelona, Spain
12Complejo Hospitalario Universitario de Toledo, Servicio de Alergología, Toledo, Spain
13Allergy Service, University General Hospital, Valencia, Spain
14Allergy Department, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
15Paediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
16C. H. Universitario de Santiago de Compostela, Spain
17Servicio de Alergología, Complejo Hospitalario de Navarra, Pamplona, Spain
18Sección de Alergia, Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d’Hebron Institut de Recerca (VHIR), Barcelona Spain, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain, ARADyAL research network, Instituto de Salud Carlos III (ISCIII), Spain
19Servicio de Alergología, Hospital Universitario de Gran Canaria Dr. Negrin, Spain
*Joint first authors 

J Investig Allergol Clin Immunol 2022; Vol. 32(4)
doi: 10.18176/jiaci.0696

Background: Nut allergy is a growing problem, but little is known about its onset in children.
Objective: Characterize the onset of nut allergy in Southern European children.
Methods: Consecutive patients up to 14years of age who presented to allergy departments with an initial allergic reaction to peanut, tree nut, or seed were included. An allergy workup including clinical history, food challenge, SPT, and whole-extract sIgE and ImmunoCAP 112-ISAC assay were performed.
Results: Of the 271 children included, 260 were first diagnosed with nut allergy at age 6.5years, 11.8(±21.2SD) months after the index reaction. The most common culprit nuts at onset were walnut (36.5%), peanut (28.5%), cashew(10.4%), hazelnut (8.5%), pistachio (5.4%), and almond (5%). Peanut-allergy onset was more frequent in children ≤6y.o. and walnut in those >6y.o. (p=0.032). In 65% of cases, the allergic reaction occurred the first time the patient consumed the nut, and 35% of reactions were anaphylactic. Overall, nut polysensitization was detected by SPT in 64.9% of patients, though this rate was lower among walnut- (54.7%) and peanut (54.1%)-allergic children (p<0.0001). Sensitization to 2S albumins was predominant (75%), specially Jug r1 (52.8%), whereas LTPs was less relevant (37%).
Conclusion: In our population, the onset of nut allergy occured around 6years of age, slightly later than that reported in Anglo-Saxon countries. Walnut was the main trigger, followed by peanut and 2S albumins storage proteins, especially Jug r1, are the most relevant allergens. This study will help guide management and may contribute to preventive strategies in pediatric nut allergy.

Key words: Nut Allergy, Peanut, Walnut, Allergy Onset, Sensitization Profile, Component Resolved Diagnosis, Anaphylaxis, Food Allergy

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