A clinical study of nut allergy

Objectives. To examine the criteria for provision of self-injectable adrenaline in children at risk of anaphylaxis from nut allergy. Design. A retrospective case note review of 45 children with confirmed peanut or tree nut allergy seen in the Children's Allergy Clinic between February 1994 and December 1996. Outcome measures. Number of nut allergy patients prescribed adrenaline with reference to clinical history and immunological investigations results. Results. Twenty-five of 45 patients had peanut allergy alone, 13/45 had multiple nut allergies which included peanut allergy, 2/45 had multiple nut allergies which did not include allergy to peanuts, four had brazil nut allergy, and one patient had cashew nut allergy. Thirty-six of 45 (80.0%) of patients seen in the clinic had been prescribed self-injectable adrenaline by their general practitioner or after hospital assessment. Of patients allergic to peanuts, 31/38 (81.6%) were prescribed adrenaline, although only 11/31 (35.5%) of these had developed respiratory symptoms, and none had experienced collapse during a clinical episode. Conclusions. The majority of children with reactions to ingested nuts were prescribed self-injectable adrenaline despite an attempt to apply more objective criteria to confirm the diagnosis of Type 1 immediate hypersensitivity. As the vast majority of cases of peanut allergy are life-long, the requirement that adrenaline should be always available in the event of a reaction will also be life-long. Our data suggest that adrenaline may be over-prescribed and there is a need for clearer prognostic indicators in those presenting with nut allergy.