Abstract

Introduction. Tree nut allergy is often a lifelong condition impacting children’s quality of life due to avoidance recommendations. Despite low cross-reactivity between pine nuts and other tree nuts, many children are advised to avoid pine nuts without proper diagnostic evaluation.

Materials and Methods. This case series retrospectively analyzed 35 children with tree nut allergies from Imola’s Hospital, focusing on the diagnosis of pine nut allergy. Patients were divided into two groups based on pine nut consumption. Diagnostic tests included prick-byprick, specific IgE, and oral food challenges.

Results. The diagnostic process led to a significant increase in pine nut consumption, from 23% to 66% (p = 0.0006). Most children who introduced pine nuts into their diet did not experience any clinically significant reactions.

Discussion. The findings suggest that many children with tree nut allergies may tolerate pine nuts, highlighting the importance of specific diagnostics for pine nut allergy.

Conclusion. Assessing pine nut sensitization before exclusion from the diet is important for children with tree nut allergies

References

  1. McWilliam V, Koplin J, Lodge C, et al. The Prevalence of Tree Nut Allergy: a Systematic Review. Curr Allergy Asthma Rep 2015;15:54. https://doi.org/10.1007/s11882-015-0555-8
  2. Novembre E, Gelsomino M, Liotti L, et al. Fatal food anaphylaxis in adults and children. Ital J Pediatr 2024;50:40. https://doi.org/10.1186/s13052-024-01608-x
  3. Borres MP, Sato S, Ebisawa M. Recent advances in diagnosing and managing Nut allergies with focus on hazelnuts, walnuts and cashew nuts. World Allergy Organ J 2022;15:100641. http://doi.org/10.1016/j.waojou.2022.100641
  4. Dramburg S, Hilger C, Santos AF, et al. EAACI Molecular Allergology User’s Guide 2.0. Pediatr Allergy Immunol 2023;34(Suppl 28):e13854. https://doi.org/10.1111/pai.13854
  5. Stiefel G, Anagnostou K, Boyle RJ, et al. BSACI guideline for the diagnosis and management of peanut and tree nut allergy. Clin Exp Allergy 2017;47:719-739. https://doi.org/10.1111/cea.12957
  6. Cummings AJ, Knibb RC, Erlewyn-Lajeunesse M, et al. Management of nut allergy influences quality of life and anxiety in children and their mothers. Pediatr Allergy Immunol 2010;21:586-594. https://doi.org/10.1111/j.1399-3038.2009.00975.x
  7. Stensgaard A, Bindslev-Jensen C, Nielsen D, et al. Quality of life in childhood, adolescence and adult food allergy: Patient and parent perspectives. Clin Exp Allergy 2017;47:530-539. https://doi.org/10.1111/cea.12849
  8. Midun E, Radulovic S, Brough H, et al. Recent advances in the management of nut allergy. World Allergy Organ J 2021;14:100491. http://doi.org/10.1016/j.waojou.2020.100491
  9. Cabanillas B, Novak N. Allergic Reactions to Pine Nut: a Review. J Investig Allergol Clin Immunol 2015;25:329-333.
  10. Ibáñez MD, Lombardero M, San Ireneo MM, et al. Anaphylaxis induced by pine nuts in two young girls. Pediatr Allergy Immunol 2003;14:317-319. https://doi.org/10.1034/j.1399-3038.2003.00044.x
  11. Rubira N, Botey J, Eseverri JL, et al. Allergy to pine nuts in children. Allerg Immunol (Paris) 1998;30:212-216.
  12. Barbarroja-Escudero J, Antolin-Amerigo D, Sanchez-Gonzalez MJ, et al. Pine nut anaphylaxis: a proteomic study. Allergol Int 2014;63:125-126. https://doi.org/10.2332/allergolint.13-LE-0584
  13. Tosca MA, Olcese R, Ciprandi G, et al. Acute anaphylactic reaction after prick-by-prick testing for pine nut in a child. Allergol Immunopathol (Madr) 2013;41:67. https://doi.org/10.1016/j.aller.2012.01.009
  14. García-Menaya JM, Gonzalo-Garijo MA, Moneo I, et al. A 17-kDa allergen detected in pine nuts. Allergy 2000;55:291-293. https://doi.org/10.1034/j.1398-9995.2000.00291.x
  15. Commissione Allergie Alimentari della SIAIP, a cura della. Decimo F, Anania C, Cuomo B, et al. Gestione dell’anafilassi: aggiornamento pratico per il pediatra (con particolare riferimento alla anafilassi da alimenti). Rivista di Immunologia e Allergologia Pediatrica 2023;37(02):33-52. https://doi.org/10.53151/2531-3916/2023-99.
  16. Santos AF, Riggioni C, Agache I, et al. EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy 2023;78:3057-3076. https://doi.org/10.1111/all.15902
  17. Lee E, Jeong K, Lee J, et al. Pine nut allergy in Korean children: Clinical characteristics and diagnostic values of specific IgE against pine nuts. Allergol Immunopathol (Madr) 2018;46:247-252. https://doi.org/10.1016/j.aller.2017.09.027
  18. Mori F, Fazi C, Pertile R, et al. Pine nut allergy in children: a diagnostic test accuracy study. Clin Exp Allergy 2022;52:901-903. https://doi.org/10.1111/cea.14173
  19. Cabanillas B, Cheng H, Grimm CC, et al. Pine nut allergy: clinical features and major allergens characterization. Mol Nutr Food Res 2012;56:1884-1893. https://doi.org/10.1002/mnfr.201200245
  20. Scala E, Villalta D, Meneguzzi G, et al. Storage molecules from tree nuts, seeds and legumes: relationships and amino acid identity among homologue molecules. Eur Ann Allergy Clin Immunol 2018;50:148-155. https://doi.org/10.23822/EurAnnACI.1764-1489.54
  21. Arasi S, Mastrorilli C, Barni S, et al. Allergia alla frutta a guscio approccio diagnostico. Rivista di Immunologia ed Allergologia Pediatrica 2017;(1):23-26.
  22. Novembre E, Mori F, Barni S, et al. Children monosensitized to pine nuts have similar patterns of sensitization. Pediatr Allergy Immunol 2012;23:762-765. https://doi.org/10.1111/pai.12012
  23. Asero R, Bresciani M, Cervone M, et al. Analysis of the IgE response to pine nut allergens in Italian allergic patients. J Investig Allergol Clin Immunol 2014;24:204-206.
  24. Brough HA, Caubet JC, Mazon A, et al. Defining challenge-proven coexistent nut and sesame seed allergy: a prospective multicenter European study. J Allergy Clin Immunol 2020;145:1231-1239. https://doi.org/10.1016/j.jaci.2019.09.036
  25. Heinzerling L, Mari A, Bergmann KC, et al. The skin prick test - European standards. Clin Transl Allergy 2013;3:3. https://doi.org/10.1186/2045-7022-3-3
  26. Tagliati S, Barni S, Giovannini M, et al. Nut Allergy: Clinical and Allergological Features in Italian Children. Nutrients 2021;13:4076. https://doi.org/10.3390/nu13114076

Downloads

pdf
Authors

Aleksandra Zomerfeld - Pediatric and Neonatology Unit, Imola Hospital, Imola, Italy

Silvia Bettelli - Postgraduate School of Pediatrics, University of Bologna, Bologna, Italy

Maria Giulia Magliaro - Postgraduate School of Pediatrics, University of Bologna, Bologna, Italy

Clara Maccarone - Postgraduate School of Pediatrics, University of Bologna, Bologna, Italy

Paolo Bottau - Pediatric and Neonatology Unit, Imola Hospital, Imola, Italy

License

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright

Copyright (c) 2025 Italian Journal of Pediatric Allergy and Immunology

How to Cite
Aleksandra Zomerfeld, Silvia Bettelli, Maria Giulia Magliaro, Clara Maccarone, & Bottau, P. (2025). Assessment of pine nut tolerance in children with tree nut allergy: a case series. Italian Journal of Pediatric Allergy and Immunology, 38(4). https://doi.org/10.53151/2531-3916/2024-618
  • Abstract viewed - 334 times
  • pdf downloaded - 67 times