Authors (including presenting author) :
Wong LYH1, Chan CK1, Yee PY1, Au WSA 1, Leung TCR1, Leung HY1, Ngai AN1, Chan OM1, Leung TF1, Wong PS1, Leung SYA1,2
Affiliation :
¹ Department of Paediatrics, Prince of Wales Hospital ² HOPE, The Chinese University of Hong Kong
Keyword 1: :
Tree Nut Allergy
Keyword 3: :
Multidisciplinary Care
Keyword 4: :
Precise Diagnostic Screening
Keyword 5: :
Anaphylaxis Management
Keyword 6: :
Cross-Sensitization
Introduction :
Tree nut (TN) allergy is a leading cause of food induced anaphylaxis worldwide, while routine singleton allergen screening and strict, lifelong complete tree nut avoidance affect the quality of life of young paediatric patients. We aimed to implement precise diagnostic screening and related care in a multidisciplinary team to fill gaps in TN allergy management.
Objectives :
To refine diagnostic screening and integrate clinical input of allergists, dietitians, and nurses to improve patient safety and resource utilization.
Methodology :
Our unit transitioned from singleton screening (i.e. almond-only) to a comprehensive TN skin prick test (SPT) panel (walnut, pecan, almond, cashew, pistachio, hazelnut), followed by allergist-directed oral food challenges. The multidisciplinary care bundle integrated allergist-immunologists, with food counselling by dietitians, and education provided by nurses in Paediatric Day Ward. A clinical audit of this new service model (January 2024 - August 2025) was conducted, involving children under 18 years who attended PWH with reported TN allergy.
Result & Outcome :
A total of 108 children (median age 6.98 years; 60.6% male) were involved. Comorbid atopy was frequent (eczema 78.8%, allergic rhinitis 64.6%, asthma 18.2%); 78.8% reported coexisting food allergies, mainly peanut (47.5%) and egg (33.3%). Early onset of TN allergy was observed (median onset age 2.83 years [IQR 2-4]). TN-induced anaphylaxis was documented in 33.3% – predominantly cashew (11.1%) and pistachio (7.1%) – yet AAIs were prescribed to 76.8%. Cashew (44.4%) and pistachio (36.4%) were leading triggers. We identified that only 14 (13%) patients had allergies to all tested TNs, 85 (79%) were allergic to selective TNs, while 9 (8%) were found non-allergic to TNs. Almond (22.2%) and hazelnut (16.2%) were most commonly tolerated. Pattern of cross-sensitization was observed: strong correlation for walnut-pecan (r=0.83, 95% CI: 0.75-0.89) and cashew-pistachio (r=0.79, 95% CI: 0.70-0.89), moderate for almond-hazelnut (r=0.54, 95% CI: 0.37-0.67). Paediatric TN allergy is a severe condition with early onset and high anaphylaxis risk. Precise diagnosis, concise food modification, symptom management of atopies, and empowerment in emergency management alleviate pressure on children and families and reduce severe anaphylaxis risk long term.
