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The Prevalence of Tree Nut Allergy: A Systematic Review

  • Vicki McWilliam
  • Jennifer Koplin
  • Caroline Lodge
  • Mimi Tang
  • Shyamali Dharmage
  • Katrina AllenEmail author
Food Allergy (T Green, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Food Allergy

Abstract

Tree nuts are one of the most common foods causing acute allergic reactions and nearly all tree nuts have been associated with fatal allergic reactions. Despite their clinical importance, tree nut allergy epidemiology remains understudied and the prevalence of tree nut allergy in different regions of the world has not yet been well characterised. We aimed to systematically review the population prevalence of tree nut allergy in children and adults. We searched three electronic databases (OVID MEDLINE, EMBASE and PubMed) from January 1996 to December 2014. Eligible studies were categorised by age, region and method of assessment of tree nut allergy. Of the 36 studies identified most were in children (n = 24) and from Europe (n = 18), UK (n = 8) or USA (n = 5). Challenge-confirmed IgE-mediated tree nut allergy prevalence was less than 2 % (although only seven studies used this gold standard) while probable tree nut allergy prevalence ranged from 0.05 to 4.9 %. Prevalence estimates that included oral allergy syndrome (OAS) reactions to tree nut were significantly higher (8–11.4 %) and were predominantly from Europe. Prevalence of individual tree nut allergies varied significantly by region with hazelnut the most common tree nut allergy in Europe, walnut and cashew in the USA and Brazil nut, almond and walnut most commonly reported in the UK. Monitoring time trends of tree nut allergy prevalence (both overall and by individual nuts) as well as the prevalence of OAS should be considered given the context of the overall recent rise in IgE-mediated food allergy prevalence in the developed world.

Keywords

Tree nut allergy Systematic review Prevalence Epidemiology 

Abbreviations

Primary tree nut allergy

IgE-mediated allergic reaction upon exposure to tree nuts that is due to a specific immune response directed against tree nut allergens

Secondary tree nut allergy

IgE-mediated allergic reaction upon exposure to tree nuts that is due to cross-reactivity of specific IgE directed against non-tree nut allergens

Tree nut sensitisation

Presence of tree nut allergen-specific IgE measured by skin prick test (SPT) or specific IgE blood testing (sIgE)

Oral allergy syndrome (OAS)

A secondary tree nut allergy that occurs predominantly in pollen-sensitised individuals, mediated by cross-reactive IgE responses to allergens present in pollen and other plants. Presents with oral pharyngeal symptoms (itching mouth/tongue)

Pollen food syndrome (PFS)

Another term for oral allergy syndrome

Notes

Acknowledgement

This review forms work as part of VMc PhD, funded by the Centre for Food and Allergy Research (CFAR).

Compliance with Ethics Guidelines

Conflict of Interest

Drs McWilliam, Koplin, Lodge, Tang, Dharmage and Allen declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Vicki McWilliam
    • 1
    • 2
    • 4
  • Jennifer Koplin
    • 1
    • 3
  • Caroline Lodge
    • 3
  • Mimi Tang
    • 1
    • 2
    • 4
  • Shyamali Dharmage
    • 1
    • 3
  • Katrina Allen
    • 1
    • 2
    • 4
    • 5
    Email author
  1. 1.Murdoch Childrens Research InstituteRoyal Children’s HospitalParkvilleAustralia
  2. 2.Department of PaediatricsUniversity of MelbourneParkvilleAustralia
  3. 3.Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsThe University of MelbourneMelbourneAustralia
  4. 4.Department of Allergy and ImmunologyThe Royal Children’s HospitalParkvilleAustralia
  5. 5.Institute of Inflammation and RepairUniversity of ManchesterManchesterUK

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