Two systematic reviews defined the prevalence of TN allergy while taking these limitations into account. 11 Another barrier to interpreting prevalence studies is that many evaluate allergy generically, querying about “nuts” without specifying which nut, and may include peanut in this category. ![]() 9, 10 In addition, studies regarding TN allergy often include pollen food allergy syndrome (PFS), otherwise known as oral allergy syndrome, which is characterized by mild oral symptoms, and patients may ingest the TN. Prevalence reports are often based on self-reported allergy, rather than objective measures, which is often an overestimate. There are numerous limitations to quantifying the prevalence of TN allergy. ![]() 8 For the purpose of this review, we will focus on the nine most common TNs that cause allergic reactions, and we do not extensively discuss peanut allergy (a legume). 7 A report from the National Academies of Sciences recommends that these nuts be removed from this list since there are little data on them and they uncommonly cause allergic reactions. 6 For the purpose of labeling laws, the US Food and Drug Administration (FDA) additionally considers the following to be TNs: beechnut, butternut, chestnut, chinquapin, coconut, ginkgo nut, hickory nut, lychee nut, pili nut, and shea nut. Nine nuts account for the majority of allergies to TNs, including walnut, almond, pistachio, cashew, pecan, hazelnut, macadamia, Brazil nut, and pine nut. 6 However, the term “TN” is commonly used to describe any nut coming from a tree, and this includes foods that do not meet the botanical definition. 4, 5īotanically, TNs are defined as a dry fruit composed of an inedible hard shell and a seed. 3 Research has shown that the consumption of nuts has positive cardiovascular effects, such as decreasing cholesterol, triglycerides, and fasting blood glucose, and this has encouraged consumption. 2 TN availability has increased both in the raw form and within processed foods and bakery products TN utilization has increased by 2.3 pounds per capita from 1980 to 2015. 1 TNs, as a group, are one of the eight most common allergens, and allergic reactions to them can be severe. Treatment strategies are being evaluated.Īllergies to tree nuts (TNs) are common and have become an important health concern as availability has increased. There are currently no data on the primary or secondary prevention of TN allergy. ![]() A specific consideration with regard to the management of TN allergy is the decision to avoid all TNs or only the TNs to which a patient is clinically allergic. Management consists of strict avoidance of the causal nut(s) and prompt treatment of symptoms upon accidental exposure. Component-resolved diagnostic tests are being increasingly utilized and may improve accuracy. TN-specific skin tests and serum immunoglobulin E levels can help aid in the diagnosis of TN allergy, but a careful medical history is important because a positive test in isolation is not typically diagnostic. Unfortunately, there is a lower likelihood of resolution of TN allergy, roughly 10%. Prevalence varies by age and geographic region and appears to have increased in children. It has become an important health concern as availability and consumption have increased. Tree nut (TN) allergy is common and often severe.
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