Nut Allergy

 

British Society for Allergy and Clinical Immunology (BSACI) guidelines for peanut and tree nut allergy are a useful reference and can be found at www.bsaci.org

Peanut Allergy:

• Peanut Allergy now affects some 1 in 50 children and only around 20% grow out of it.
• The majority of severe non-fatal or fatal accidental reactions occur in teenagers and young adults. The severity often correlates to the amount eaten and whether or not the patient has asthma.
• Severe reactions after contact without ingestion are rare
• Cross -reactivity with other legumes is rare and there is no need to automatically avoid other legumes, particularly if they have been tolerated before
• Around half of children with peanut allergy are positive to at least one tree nut, but if they are already tolerant to certain tree nuts these can be continued with care
• If there is isolated peanut allergy in a young child who may not have tried tree nuts, the family may wish to see us in allergy clinic before trying any for the first time.
• Please note that desensitisation immunotherapy to peanut is cropping up in more conversations and has been approved by NICE, but is not yet available locally on the NHS.

 

Tree Nut Allergy:

• Tree nut allergy can be to one or more tree nuts. It is worth noting that many cashew-allergic children are pistachio allergic and vice-vera. The same is true of walnut and pecan
• Tree nut allergy usually persists in childhood

 

Sesame Allergy:

• Sesame allergy has become more common and sesame can be a dangerous allergen.
• If a patient is being referred with a peanut or tree nut allergy, has had anaphylaxis / asthma and has not yet eaten sesame, then it is best to wait until allergy clinic assessment
• The natural history is less well known, but usually persists in childhood.

 

Refer:

Any child with peanut, tree nut or sesame allergy.

• Please signpost family to Allergy UK website [https://www.allergyuk.org/]
• Please prescribe PRN oral cetirizine (or chlorphenamine if infant <1 year of age)
• Please give family a BSACI action plan available from https: www.bsaci.org/professional-resources/resources/paediatric-allergy-action-plans
• Adrenaline autoinjectors x2 if required due to anaphylaxis or a history of asthma.

 

 

Date                            January 2022

Review Date              January 2023

Authors:                     Simon Bedwani, Consultant Paediatrician, RCHT

                                    Dr S Burns GP RMS

 

 

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