Following Mixed Tree Nut Biscuit Challenge, Are the Nuts Still Included in the Diet?
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MEDICINE
Following Mixed Tree Nut Biscuit Challenge, Are the Nuts Still Included in the Diet? Benedicta Itotoh 1
&
Ingrid Roche 1 & Catherine Power 1
Accepted: 24 August 2020 # The Author(s) 2020
Abstract We studied the introduction rate after a negative challenge to mixed tree nut biscuit. This is a retrospective review of patients who underwent and passed mixed tree nut biscuit challenges performed at Princess Margaret Hospital (PMH) between 2016 and 2018. Follow-up phone calls were made to families to ascertain if the tree nuts included in the tree nut biscuit were still included in the child’s diet 1 to 3 years following negative oral food challenge (OFC). A total of 162 children underwent mixed tree nut biscuit challenge between 2016 and 2018 at Princess Margaret Hospital, Perth, Western Australia. A total of 141 (87%) passed mixed tree nut biscuit challenge. Of the 133 children that were contacted (8 children could not be contacted), 104 children still included some or all of the challenge nuts in the child’s diet; with 24 children completely eliminating the challenge nuts (18%), 5 children eliminated some of the challenge nuts (3.5%). We found a high introduction rate (82%); however, some families may require more support to maintain the tree nuts in the child’s diet following a negative OFC. Keywords Mixed tree nut challenge
To the Editor Undiagnosed food allergy without known reaction to the avoided food could result in elimination of the suspected food from a child’s diet [1]. Performing OFC to individual tree nuts is time consuming and impractical. Following a negative OFC children need to regularly include that food in their diet with evidence showing this may help to maintain tolerance to that food [2].
Introduction We studied the dietary introduction rate of tree nuts following a negative OFC. Most of the children avoided tree nuts because they were allergic to other foods or sensitized to tree nuts with no known clinical reaction. Some were avoiding tree nuts because another family member has a nut allergy. This article is part of the Topical Collection on Medicine * Benedicta Itotoh [email protected] 1
Department of Immunology, Perth Children’s Hospital, Nedlands, Western Australia, Australia
Materials and Methods The patients in this study are from a retrospective review of patients with a negative OFC to mixed tree nut biscuit performed at Princess Margaret Hospital (PMH), Western Australia between 2016 and 2018. The tree nuts used in the OFC are almond, Brazil nut, macadamia, cashew, pistachio, walnut, pecan, hazel nut, pine nut, and coconut. Mixed tree nut biscuit OFC included at least 2 of the above nuts. The cohort of patients had predominantly negative or low positive skin prick test (< 6-mm mean skin prick test weal diameter). Although most of the patients had a negative skin prick test (SPT), the challenge was done in hospital as families were anxious or reluctant to introduce the nuts at home. The SPT was performed and read as per the published guidelines of the Au
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