{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T07:39:36Z","timestamp":1773041976665,"version":"3.50.1"},"reference-count":40,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T00:00:00Z","timestamp":1636934400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Nut allergies are an increasingly frequent health issue in the pediatric population. Tree nuts (TN) and peanuts are the second cause of food anaphylaxis in Italy. Unfortunately, knowledge of the clinical characteristics of a TN allergy in Italian children is limited. Our study aimed to identify the clinical and allergological characteristics of Italian children with a nut allergy (TN and peanut). Methods: A retrospective observational analysis was performed on the clinical charts of children with a history of nut reaction referred to the allergy unit of the hospital from 2015 to 2019. The studied population was represented by children with a confirmed nut allergy based on positive prick by prick and\/or serum-specific IgE to nut plus a positive nut oral food challenge. Demographic, clinical, and allergological features were studied and compared among different nuts. Results: In total, 318 clinical charts were reviewed. Nut allergy was confirmed in 113 patients. Most patients (85\/113, 75%) had a familial history of allergy and\/or a concomitant allergic disorder (77\/113, 68%). Hazelnut and walnut were the more common culprit nuts observed in allergic children. Anaphylaxis was the first clinical manifestation of nut allergy in a high percentage of children (54\/113, 48%). The mean age of the first nut reaction was statistically higher with pine nuts. Over 75% of children reported a single nut reaction. During the OFCs, the signs and symptoms involved mainly the gastrointestinal system (82\/113, 73%) and resolved spontaneously in most cases. Severe reactions were not frequent (22\/113, 19%). Conclusion: To our knowledge, this is the first Italian study that provided a comprehensive characterization of children with a nut allergy. These results are important for clinicians treating children with a nut allergy.<\/jats:p>","DOI":"10.3390\/nu13114076","type":"journal-article","created":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T08:19:20Z","timestamp":1636964360000},"page":"4076","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Nut Allergy: Clinical and Allergological Features in Italian Children"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7628-1863","authenticated-orcid":false,"given":"Sylvie","family":"Tagliati","sequence":"first","affiliation":[{"name":"Pediatric Unit, Sant\u2019Anna University Hospital of Ferrara, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5598-2740","authenticated-orcid":false,"given":"Simona","family":"Barni","sequence":"additional","affiliation":[{"name":"Allergy Unit, Department of Pediatrics, Meyer Children\u2019s University Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9568-6882","authenticated-orcid":false,"given":"Mattia","family":"Giovannini","sequence":"additional","affiliation":[{"name":"Allergy Unit, Department of Pediatrics, Meyer Children\u2019s University Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Liccioli","sequence":"additional","affiliation":[{"name":"Allergy Unit, Department of Pediatrics, Meyer Children\u2019s University Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucrezia","family":"Sarti","sequence":"additional","affiliation":[{"name":"Allergy Unit, Department of Pediatrics, Meyer Children\u2019s University Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2689-4095","authenticated-orcid":false,"given":"Tatiana","family":"Alicandro","sequence":"additional","affiliation":[{"name":"Division of Allergy and Clinical Immunology, Dermatology Unit, Surgical, Medical and Dental Department of Morphological Science Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika","family":"Paladini","sequence":"additional","affiliation":[{"name":"Pediatric Respiratory and Allergy Unit, Women\u2019s and Children\u2019s Health Department, University of Padua, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giancarlo","family":"Perferi","sequence":"additional","affiliation":[{"name":"Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children\u2019s Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Azzari","sequence":"additional","affiliation":[{"name":"Section of Pediatrics, Department of Health Sciences, University of Florence and Meyer Children\u2019s Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elio","family":"Novembre","sequence":"additional","affiliation":[{"name":"Allergy Unit, Department of Pediatrics, Meyer Children\u2019s University Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Mori","sequence":"additional","affiliation":[{"name":"Allergy Unit, Department of Pediatrics, Meyer Children\u2019s University Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e20181235","DOI":"10.1542\/peds.2018-1235","article-title":"The public health impact of parent-reported childhood food allergies in the United States","volume":"142","author":"Gupta","year":"2018","journal-title":"Pediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1016\/j.jaci.2010.03.029","article-title":"US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up","volume":"125","author":"Sicherer","year":"2010","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1159\/000375106","article-title":"The Effects of Food Allergy on Quality of Life","volume":"101","author":"Dunngalvin","year":"2015","journal-title":"Chem. Immunol. Allergy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1046\/j.1365-2222.2000.00889.x","article-title":"The psychological burden of peanut allergy as perceived by adults with peanut allergy and the parents of peanut-allergic children","volume":"30","author":"Primeau","year":"2000","journal-title":"Clin. Exp. Allergy"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1146\/annurev-cellbio-100818-125346","article-title":"Pediatric Allergic Diseases, Food Allergy, and Oral Tolerance","volume":"36","author":"Logan","year":"2020","journal-title":"Annu. Rev. Cell Dev. Biol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"180","DOI":"10.2500\/aap.2019.40.4211","article-title":"Factors predicting anaphylaxis in children with tree nut allergies","volume":"40","author":"Cetinkaya","year":"2019","journal-title":"Allergy Asthma Proc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.jaip.2016.08.014","article-title":"Managing Nut Allergy: A Remaining Clinical Challenge","volume":"5","author":"Eigenmann","year":"2017","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s11882-015-0555-8","article-title":"The Prevalence of Tree Nut Allergy: A Systematic Review","volume":"15","author":"McWilliam","year":"2015","journal-title":"Curr. Allergy Asthma Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1067\/mai.2001.112031","article-title":"Fatalities due to anaphylactic reactions to foods","volume":"107","author":"Bock","year":"2001","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_10","first-page":"1","article-title":"The peanut allergy epidemic: Allergen molecular characterisation and prospects for specific therapy","volume":"9","author":"Rolland","year":"2007","journal-title":"Expert Rev. Mol. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/cea.12957","article-title":"BSACI guideline for the diagnosis and management of peanut and tree nut allergy","volume":"47","author":"Stiefel","year":"2017","journal-title":"Clin. Exp. Allergy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"473","DOI":"10.3399\/bjgp11X583498","article-title":"Diagnosis and assessment of food allergy in children and young people in primary care and community settings: NICE clinical guideline","volume":"61","author":"Walsh","year":"2011","journal-title":"Br. J. Gen. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"41","DOI":"10.2147\/JAA.S141636","article-title":"Current perspectives on tree nut allergy: A review","volume":"11","author":"Weinberger","year":"2018","journal-title":"J. Asthma Allergy"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1111\/all.13353","article-title":"NUT Co Reactivity\u2014ACquiring Knowledge for Elimination Recommendations (NUT CRACKER) study","volume":"73","author":"Elizur","year":"2018","journal-title":"Allergy"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.aller.2018.03.009","article-title":"Retrospective definition of reaction risk in Italian children with peanut, hazelnut and walnut allergy through component-resolved diagnosis","volume":"47","author":"Giovannini","year":"2018","journal-title":"Allergol. Immunopathol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/0091-6749(89)90083-3","article-title":"Comparison of results of skin prick tests (with fresh foods and commercial food extracts) and RAST in 100 patients with oral allergic syndrome","volume":"83","author":"Ortolani","year":"1989","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/2045-7022-3-3","article-title":"The skin prick test\u2014European standards","volume":"3","author":"Heinzerling","year":"2013","journal-title":"Clin. Transl. Allergy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1111\/all.12429","article-title":"EAACI Food Allergy and Anaphylaxis Guidelines: Diagnosis and management of food allergy","volume":"69","author":"Muraro","year":"2014","journal-title":"Allergy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1111\/all.12437","article-title":"Anaphylaxis: Guidelines from the European Academy of Allergy and Clinical Immunology","volume":"69","author":"Muraro","year":"2014","journal-title":"Allergy"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Barni, S., Liccioli, G., Sarti, L., Giovannini, M., Novembre, E., and Mori, F. (2020). Immunoglobulin E (IgE)-Mediated Food Allergy in Children: Epidemiology, Pathogenesis, Diagnosis, Prevention, and Management. Medicina, 56.","DOI":"10.3390\/medicina56030111"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1111\/all.12765","article-title":"Time for a new grading system for allergic reactions?","volume":"71","author":"Niggemann","year":"2016","journal-title":"Allergy"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.aller.2019.07.005","article-title":"Phenotypical characterization of tree nuts and peanut allergies in east Mediterranean children","volume":"48","author":"Cetinkaya","year":"2020","journal-title":"Allergol. Immunopathol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e20192102","DOI":"10.1542\/peds.2019-2102","article-title":"Peanut allergy: New advances and ongoing controversies","volume":"145","author":"Abrams","year":"2020","journal-title":"Pediatrics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.jaip.2020.08.051","article-title":"Walnut Allergy Across Europe: Distribution of Allergen Sensitization Patterns and Prediction of Severity","volume":"9","author":"Lyons","year":"2021","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Calamelli, E., Trozzo, A., Di Blasi, E., Serra, L., and Bottau, P. (2021). Hazelnut allergy. Medicina, 57.","DOI":"10.3390\/medicina57010067"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1111\/cea.13163","article-title":"Tree nut allergies: Allergen homology, cross-reactivity, and implications for therapy","volume":"48","author":"Smeekens","year":"2018","journal-title":"Clin. Exp. Allergy"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Haroun-D\u00edaz, E., Azofra, J., Gonz\u00e1lez-Mancebo, E., de las Heras, M., Pastor-Vargas, C., Esteban, V., Villalba, M., D\u00edaz-Perales, A., and Cuesta-Herranz, J. (2017). Nut allergy in two different areas of Spain: Differences in clinical and molecular pattern. Nutrients, 9.","DOI":"10.3390\/nu9080909"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jaci.2010.10.008","article-title":"Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel","volume":"126","author":"Boyce","year":"2010","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/j.jaci.2019.09.036","article-title":"Defining challenge-proven coexistent nut and sesame seed allergy: A prospective multicenter European study","volume":"145","author":"Brough","year":"2020","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e6","DOI":"10.1542\/peds.102.1.e6","article-title":"Clinical Features of Acute Allergic Reactions to Peanut and Tree Nuts in Children","volume":"102","author":"Sicherer","year":"1998","journal-title":"Pediatrics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"100491","DOI":"10.1016\/j.waojou.2020.100491","article-title":"Recent advances in the management of nut allergy","volume":"14","author":"Midun","year":"2021","journal-title":"World Allergy Organ. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jaci.2008.04.014","article-title":"The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy","volume":"122","author":"Maloney","year":"2008","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1016\/j.jaci.2018.07.038","article-title":"Patterns of tree nut sensitization and allergy in the first 6 years of life in a population-based cohort","volume":"143","author":"McWilliam","year":"2019","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.jaci.2005.09.002","article-title":"The natural history of tree nut allergy","volume":"116","author":"Fleischer","year":"2005","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.anai.2017.02.010","article-title":"Characteristics of tree nut challenges in tree nut allergic and tree nut sensitized individuals","volume":"118","author":"Couch","year":"2017","journal-title":"Ann. Allergy, Asthma Immunol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Anagnostou, K. (2018). Safety of Oral Food Challenges in Early Life. Children, 5.","DOI":"10.3390\/children5060065"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13223-017-0215-8","article-title":"Oral food challenge outcomes in a pediatric tertiary care center","volume":"13","author":"Abrams","year":"2017","journal-title":"Allergy Asthma Clin. Immunol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1016\/j.jaci.2009.10.006","article-title":"Epinephrine treatment is infrequent and biphasic reactions are rare in food-induced reactions during oral food challenges in children","volume":"124","author":"Amalanayagam","year":"2009","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1016\/j.jaci.2011.07.012","article-title":"Outcomes of office-based, open food challenges in the management of food allergy","volume":"128","author":"Lieberman","year":"2011","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"120","DOI":"10.15586\/aei.v49i3.103","article-title":"Frequency of positive oral food challenges and their outcomes in the allergy unit of a tertiary-care pediatric hospital","volume":"49","author":"Ballini","year":"2021","journal-title":"Allergol. Immunopathol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/11\/4076\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:30:23Z","timestamp":1760167823000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/11\/4076"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,15]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["nu13114076"],"URL":"https:\/\/doi.org\/10.3390\/nu13114076","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,15]]}}}