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.
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- 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
Papers of particular interest, published recently, have been highlighted as: • Of importance
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This review forms work as part of VMc PhD, funded by the Centre for Food and Allergy Research (CFAR).
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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.
This article is part of the Topical Collection on Food Allergy
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McWilliam, V., Koplin, J., Lodge, C. et al. The Prevalence of Tree Nut Allergy: A Systematic Review. Curr Allergy Asthma Rep 15, 54 (2015). https://doi.org/10.1007/s11882-015-0555-8
- Tree nut allergy
- Systematic review