The Value of Specific Nut Challenges in Patients with Nut Allergy
Monday, March 5, 2018
South Hall A2 (Convention Center)
Jennifer A Dantzer, MD, Robert A. Wood, MD FAAAAI
RATIONALE: To identify baseline differences in nut allergic patients who decide to undergo tree nut (TN) challenges compared to those who decline specific nut challenges.

METHODS: Among subjects with suspected TN allergy, group 1 underwent or agreed to undergo a challenge to one or more TNs while group 2 elected to avoid all TNs. The groups were compared with regard to demographics, other food allergies, qualify of life (QOL), and reasons for wanting or declining TN challenges.

RESULTS: 35 patients age 3-17 years were included (Group 1: n=26, Group 2: n=9). Co-existent peanut allergy was diagnosed in 81% of group 1 and 89% of group 2 (p>0.1). Reasons for testing for TN allergy varied, but <25% were tested due to a TN reaction (Group 1: 15%, Group 2: 22%). Less than 50% of all participants had ever ingested a TN (prior to OFC). 54% of those in Group 1 had a non-nut food allergy compared to 67% in Group 2 (p>0.1). 16% in group 1 had ≥3 non-nut allergies compared to 0% in group 2, with a higher proportion of allergies to milk, egg, soy, and wheat. There was no difference in mean QOL parent form scores (p>0.1). Patients had a variety of reasons for wanting or declining a TN OFC.

CONCLUSIONS: The decision to undergo a TN challenge in patients with other nut or other food allergies appears complex, with multiple underlying factors determining those who prefer challenges or a complete nut avoidance diet. Management options are best personalized to each family.