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Onset of Nut Allergy in a Pediatric Cohort: Clinical and Molecular Patterns in the 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 Jiménez 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
2ARADyAL- RETICs-RD16/0006/0026, IIS-P, FibHNJ, Madrid, Spain
3Servicio de Alergología, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain RD16/0006/0015
4Allergology Department, Hospital Universitario 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 Gestión Clínica de Alergología, Hospital Universitario Virgen Macarena, Sevilla, Spain
9 Pediatric Allergy Unit, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
10Unidad de Alergología Infantil, Servicio de Alergología, Hospital Universitario Donostia, 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
15Pediatric Allergy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
16Servicio de Alergología, C. H. Universitario de Santiago de Compostela, La Coruña, Spain
17Servicio de Alergología, Hospital Universitario 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, Universidad de las Palmas de Gran Canaria, Gran Canaria, Spain
*Joint first authors

J Investig Allergol Clin Immunol 2022; Vol 32(4) : 270-281
doi: 10.18176/jiaci.0696

Background: Nut allergy is a growing problem, yet little is known about its onset in children.
Objective: To characterize the onset of nut allergy in children in southern Europe.
Methods: The study population comprised consecutive patients up to 14 years of age who visited allergy departments with an initial allergic reaction to peanut, tree nut, or seed. The allergy work-up included a clinical history, food challenge, skin prick testing, determination of whole-extract sIgE, and ImmunoCAP ISAC-112 assay.
Results: Of the 271 children included, 260 were first diagnosed with nut allergy at a mean age of 6.5 years and at a mean (SD) of 11.8 (21.2) 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%). Onset of peanut allergy was more frequent in children ≤6 years and walnut in those aged >6 years (P=.032). In 65% of cases, the allergic reaction occurred the first time the patient consumed the nut, and 35% of reactions were anaphylactic. Overall, polysensitization to nuts was detected by skin prick testing in 64.9% of patients, although this rate was lower among walnut-allergic children (54.7%) and peanut-allergic children (54.1%) (P<.0001). Sensitization to 2S albumins was predominant (75%), especially Jug r 1 (52.8%), whereas sensitization to lipid transfer proteins was less relevant (37%).
Conclusion: In the population we assessed, the onset of nut allergy occurred around 6 years of age, slightly later than that reported in English-speaking countries. Walnut was the main trigger, followed by peanut. 2S albumin storage proteins, especially Jug r 1, were the most relevant allergens. This study will help guide management and may contribute to preventive strategies in pediatric nut allergy.

Key words: Nut allergy, Walnut, Peanut, Allergy onset, Sensitization profile, Component-resolved diagnosis, Anaphylaxis, Food allergy

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