For a study, researchers sought to investigate the distribution of clinical symptoms and their intensity in children during oral food challenges (OFC). Peanut (n=607), hazelnut (n=266), walnut (n=97), and cashew (n=43) were among the 1.013 positive OFCs that were prospectively reported. Immediate-type skin, gastrointestinal, upper and lower respiratory, cardiovascular, and eczema exacerbation symptoms were all classified. The intensity of the symptoms and how they were treated were documented. Skin complaints were reported by 78% of participants, followed by gastrointestinal (47%) and upper (42%) and lower respiratory (42%) symptoms (32%). Cardiovascular symptoms were reported by 6% of people. More than 1 organ was implicated in 3-quarters of the reactions. Severe reactions occurred at all dose levels, which was significant. Patients allergic to peanuts and cashews showed a higher relative risk of gastrointestinal symptoms than those allergic to hazelnuts and walnuts. Patients were 1.7 times more likely to experience immediate-type cutaneous and lower respiratory symptoms without vomiting. Only 10.5% of the OFCs reported increasing eczema, even though 3-quarters of the patients had previously experienced eczema. Organs affected, triggering dose, and intensity differed between allergens in people with multiple food allergies. Although comparing allergen groups with varying clinical histories, severity, comorbidities, and test data were difficult and potentially biased, the findings indicated peanut and tree nut allergic potential. The rarity of worsening eczema underscores that peanut and tree nut avoidance diets to treat eczema appear unnecessary and might impede tolerance maintenance.

Source:onlinelibrary.wiley.com/doi/10.1111/pai.13778