Phenotypical characterization of peanut allergic children with differences in cross‐allergy to tree nuts and other legumes

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Peanut allergy (PA) – a widely studied allergy in the pediatric population with an estimated prevalence of 1.3% in Europe 1 – and tree nut (TN) allergy – with a prevalence ranging from 0.05 to 4.9 % 2 – are clinically similar conditions, often coexisting 3 even though peanuts do not belong to the TN family, but to the legumes one. Children suffering from these allergy often experience an impaired health‐related quality of life (HRQL), as their caregivers might do as well 4. In facts, these allergies are quite complexes: TN allergy is a long‐lasting condition, with fatal reactions being reported for nearly all TNs 3. When evaluating a patient with a suspected food allergy, many parameters need to be considered, including the clinical background and history, and the type of symptoms possibly elicited by the food and cross‐reactions to other allergens.
Legumes and TNs contain seed storage protein which are orthologs of peanut globulins (rAra h1, rAra h 3) and 2S albumins (rAra h 2), and that may possibly provoke allergic reactions 7, but cross‐reactivity between peanuts and TN and other legumes may also result from primary sensitization in PA patients 9. Because of potential IgE‐binding cross‐reactions, clinicians might advise PA children to avoid eating new TNs and other legumes. Nevertheless, to distinguish sensitization from allergy, the only gold standard remains the oral food challenge (OFC), possibly a double‐blind placebo‐controlled food challenge (DBPCFC), which also allow to assess the threshold dose to which patients react and the severity of clinical symptoms 10.
Considering the relatively high prevalence of PA, the assessment of cross‐allergy to every single allergenic TN and legume requiring a full allergy workup may therefore take even a few years to be completed. Even though rates of cross‐allergy to TN have been reported to range from 28% to 50% in PA 11, very few studies have characterized these cross‐allergic patients. Therefore, targeting patients with severe or cross‐allergic phenotypes would be highly useful for allergists when determining appropriate management and follow‐up practices for PA patients.
The aim of this study was to analyze in cluster a cohort of children allergic to peanuts and to identify possible different phenotypes. This statistical approach has not been previously used to identify cross‐allergic phenotypes. We also tried to describe cross‐allergy patterns in PA children and to identify possible risk factors for cross‐allergy to TN and legumes.
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