How do we know when peanut and tree nut allergy have resolved, and how do we keep it resolved?

Area of Science:

• Allergy and Immunology
• Clinical Nutrition
• Pediatric Medicine

Background:

• Peanut and tree nut allergies have risen significantly in Western countries.
• Food-allergic reactions cause over half of fatal anaphylaxis cases.
• Previously considered permanent, some young patients now outgrow peanut (20%) and tree nut (10%) allergies.

Purpose of the Study:

• To review current understanding of peanut and tree nut allergy resolution.
• To discuss predictors of allergy outgrowing and methods for determining resolution.
• To explore emerging strategies for inducing tolerance.

Main Methods:

• Literature review of studies on peanut and tree nut allergy prevalence, resolution, and treatment.
• Analysis of factors associated with tolerance, including T regulatory cells and IgE levels.
• Evaluation of diagnostic methods like skin prick testing, IgE analysis, and oral food challenges.

Main Results:

• Resolution of peanut and tree nut allergies is possible in a subset of young patients.
• Allergen-specific IgE and skin prick tests are unreliable for predicting resolution.
• Oral food challenge is the gold standard for confirming allergy resolution in a clinical setting.

Conclusions:

• While predictors are lacking, oral food challenges confirm resolution of peanut and tree nut allergies.
• Oral immunotherapy and sublingual immunotherapy are experimental but promising for inducing long-term tolerance.
• Recurrence of peanut allergy is possible, necessitating careful monitoring.