aeroallergens at 5 years (P 5,.01 and .01), compared METHODS: At entry, all subjects underwent skin prick with nonsensitized children. Being sensitized ($0.35 kU/L) testing (SPT) to egg, peanut, and sesame. At age 1 year, to egg or milk at 6 months was significantly associated with egg and peanut allergy were determined by oral food sensitization to the food at 1 and 2 years of age and to any challenge. SPT to tree nuts (almond, cashew, hazelnut) food allergen, but it was not associated with aeroallergen was performed, and parental history of symptoms with sensitization at 5 years as compared with those with low tree nut ingestion was obtained. Those with negative SPT sensitization (P 5 .69). Approximately 50% of children results were advised to introduce tree nuts at home; with low sensitization to milk or egg at 6 months had IgE avoidance was recommended for those with positive SPT that declined to nonsensitized levels at 2 years of age. For results. At age 6 years, a questionnaire was administered, peanut, low sensitization at 6 months was only signifi- SPT was performed, and tree nut allergy was assessed by cantly associated with being sensitized to aeroallergens at 5 food challenge. years of age (P 5 .04). Low-level sensitization to egg was RESULTS: associated with higher rates of eczema (P , .01). Five thousand two hundred seventy-sixchil- dren participated in the HealthNuts study at age 1. CONCLUSIONS: fi Speci c IgE to milk, egg, and peanut in the One thousand one hundred fourteen (21%) un- range of 0.1 to 0.34 kU/L at 6 months appeared to decrease derwent additional evaluation, including SPT for tree over time. However, low-level sensitization at 6 months nuts. At age 1 year, 6 parents (0.1%) reported a appeared to increase the likelihood of sensitization to history consistent with tree nut allergy. Among those aeroallergens at 5 years. Compared with those who were with challenge-confirmed egg or peanut allergy at age nonsensitized at 6 months, children with low sensitization 1 year, 41% were already sensitized to 1 or more tree to milk or egg had higher rates of sensitization to that nuts, with an even higher rate in those with both allergen at 1 year of age. Having low sensitization to egg at allergies. At age 6, the prevalence of tree nut allergy 6 months was associated with the development of eczema. was 3.3%, with cashew being the most common REVIEWER COMMENTS: Researchers in this study evaluated trigger, followed by hazelnut and almond. Forty-three whether specific IgE at 6 months was associated with percent of those with any tree nut allergy had peanut further IgE sensitization and allergy-related diagnosis. allergy. Of those with peanut allergy, 45% reacted to 1 The strengths of the study include that it was population or more tree nuts, most commonly cashew. In ex- based and managed children over the course of 5 years. amining predictors of tree nut allergy, 14% of those The study does not provide any data about the devel- with egg allergy at age 1 year, 27% of those with opment of clinical food allergy. This study suggests that peanut allergy at age 1, and 37% of those with both children with low sensitization at 6 months can be egg and peanut allergy at age 1 had tree nut allergy at counseled that ∼50% had undetectable IgE to the rele- age 6 years. vant allergen at 2 years, but the low sensitization could CONCLUSIONS: suggest a higher risk of future aeroallergen sensitization as There is a low parent-reported rate of tree nut well as potentially eczema for those with egg-specificIgE. allergy at age 1 year, likely due to low tree nut con- sumption in the first year of life. However, 33% of those URL: www.pediatrics.org/cgi/doi/10.1542/peds.2019–2461NN with peanut allergy and 41% of those with peanut or egg Suzanne Kochis, MD allergy are already sensitized to 1 or more tree nuts at age Jennifer Dantzer, MD 1, with a higher rate in those with allergy to both foods. Baltimore, Maryland More than one-third of those with tree nut sensitization at age 1 are allergic to 1 or more tree nuts at age 6. Almost half of those with both peanut and egg allergy at age 1 Patterns of Tree Nut Sensitization and Allergy have tree nut allergy at age 6. The prevalence of tree nut in the First 6 Years of Life in a Population– allergy at age 6 (3.3%) is similar to that of peanut allergy Based Cohort (2.8%), with cashew being the most common tree nut McWilliam V, Peters R, Tang MLK, et al; HealthNuts allergen. investigators. J Allergy Clin Immunol. 2019;143(2):644– REVIEWER COMMENTS: 650.e5 This study reports a high rate of tree nut sensitization and potential for allergy in those with PURPOSE OF THE STUDY: To determine the prevalence of tree egg and/or peanut allergy at age 1 and highlights the need nut allergy at age 6 years and investigate the relationship to investigate the best approach to tree nut evaluation in between egg and peanut allergy at age 1 year and tree nut those with known food allergy as well as strategies to allergy at age 6 years to guide testing and introduction prevent tree nut allergy in this at-risk population. advice. STUDY POPULATION: This study included infants recruited URL: www.pediatrics.org/cgi/doi/10.1542/peds.2019–2461OO between 11 and 15 months for the longitudinal Health- Pooja Varshney, MD Nuts study in Melbourne, Australia. Austin, Texas

PEDIATRICS Volume 144, Supplement 1, December 2019 S27 Downloaded from www.aappublications.org/news by guest on September 23, 2021 Patterns of Tree Nut Sensitization and Allergy in the First 6 Years of Life in a Population−Based Cohort Pooja Varshney Pediatrics 2019;144;S27 DOI: 10.1542/peds.2019-2461OO

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Downloaded from www.aappublications.org/news by guest on September 23, 2021 Patterns of Tree Nut Sensitization and Allergy in the First 6 Years of Life in a Population−Based Cohort Pooja Varshney Pediatrics 2019;144;S27 DOI: 10.1542/peds.2019-2461OO

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