Investigating peanut and tree nut allergy resolution

It is estimated that about 20% of young people with peanut allergy will outgrow their condition as they get older, although up to 8% may suffer a recurrence. Approximately 10% of young patients outgrow their tree nut allergies and recurrent tree nut allergy has not been reported to date. Researchers in the USA have looked at ways in which allergy resolution can be determined and what factors may contribute to preventing recurrence of the allergy.

Oral food challenge is the best means for determining resolution of food allergy. However, these must only be undertaken in a clinical setting so a reliable screening tool would be useful. Research has previously shown the likelihood of allergy resolution in a patient has a direct correlation with weal size in a skin test and levels of allergen-specific IgE at the time of diagnosis but these indicators cannot be used to conclusively determine when resolution has occurred. Development of tolerance to an allergen has been shown to be associated with increasing circulating regulatory T cells and reduced production of allergen-specific IgE. Despite these discoveries, there are not yet any reliable predictors of allergy resolution.

Oral immunotherapy studies have shown that some peanut-allergic individuals can be desensitised to peanut, but it has been suggested that infrequent ingestion of peanut may be related to the re-emergence of the allergy. Ongoing studies are required to determine whether tolerance can be achieved long term and under what conditions.

Reference: Byrne et al. 2010. Clinical and Experimental Allergy. Vol 40 (9). pp. 1303-1311. DOI: 10.1111/j.1365-2222.2010.03554.x