花生坚果和树坚果过敏的特征在于IgE介导的对坚果蛋白的反应。坚果过敏是一种全球性疾病。有限的流行病学数据表明,不同地理区域的患病率各不相同。在英国,主要的坚果过敏影响超过2%的儿童和0.5%的成年人。患有严重湿疹和/或鸡蛋过敏的婴儿患花生过敏的风险更高。原发性坚果过敏最常见于生命的前五年,通常在首次已知的摄入后出现典型的快速发作的IgE介导的症状。原发性坚果过敏的临床诊断可以通过结合典型的临床表现和阳性皮肤点刺试验(SPT)或特异性IgE(sIgE)试验显示的坚果特异性IgE的证据来进行。花粉食物综合症是一种独特的疾病,通常温和,有口腔/咽部症状,在花粉热或花粉致敏的情况下,可以由坚果触发。它通常可以在临床上与原发性坚果过敏区分开来。SPT或sIgE的大小与临床过敏的可能性有关,但与临床严重程度无关。SPT≥8mm或sIgE≥15KU/L对花生是临床过敏的高度预测。树坚果的截断值不可用。测试结果必须在临床病史的背景下进行解释。诊断性食物挑战通常是不必要的,但可用于确认或反驳冲突的历史和测试结果。因为坚果过敏可能是一种长期存在的疾病,避免坚果的建议是管理的基石。应向患者提供全面的管理计划,包括回避建议,患者特定的紧急药物以及紧急治疗计划和紧急药物管理培训。需要定期再培训。
Peanut nut and tree nut allergy are characterised by IgE mediated reactions to nut proteins. Nut allergy is a global disease. Limited epidemiological data suggest varying prevalence in different geographical areas. Primary nut allergy affects over 2% of children and 0.5% of adults in the UK. Infants with severe eczema and/or egg allergy have a higher risk of peanut allergy. Primary nut allergy presents most commonly in the first five years of life, often after the first known ingestion with typical rapid onset IgE-mediated symptoms. The clinical diagnosis of primary nut allergy can be made by the combination of a typical clinical presentation and evidence of nut specifc IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test. Pollen food syndrome is a distinct disorder, usually mild, with oral/pharyngeal symptoms, in the context of hay fever or pollen sensitisation, which can be triggered by nuts. It can usually be distinguish clinically from primary nut allergy. The magnitude of a SPT or sIgE relates to the probability of clinical allergy, but does not relate to clinical severity. SPT of ≥ 8 mm or sIgE ≥ 15 KU/L to peanut is highly predictive of clinical allergy. Cut off values are not available for tree nuts. Test results must be interpreted in the context of the clinical history. Diagnostic food challenges are usually not necessary but may be used to confirm or refute a conflicting history and test result. As nut allergy is likely to be a long-lived disease, nut avoidance advice is the cornerstone of management. Patients should be provided with a comprehensive management plan including avoidance advice, patient specific emergency medication and an emergency treatment plan and training in administration of emergency medication. Regular re-training is required.