BSACI guideline for the diagnosis and management of peanut and tree nut allergy

NICE Accredited

British Society for Allergy and Clinical Immunology - BSACI
British Society for Allergy and Clinical Immunology (BSACI)
Publication date:
01 June 2018


Clinical & Experimental Allergy. Volume 47, Issue 6, June 2017, Pages: 719-739

Peanut, nut and tree nut allergy are characterised by IgE mediated reactions to nut proteins. Nut allergy is a global disease. Limited epidemiological data suggest varying prevalence in different geographical areas. Primary nut allergy affects over 2% of children and 0.5% of adults in the UK. Infants with severe eczema and/or egg allergy have a higher risk of peanut allergy. Primary nut allergy presents most commonly in the first five years of life, often after the first known ingestion with typical rapid onset of IgE-mediated symptoms. The clinical diagnosis of primary nut allergy can be made by the combination of typical clinical presentation and evidence of nut specific IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test. Pollen food syndrome is a distinct disorder, usually mild, with oral/pharyngeal symptoms, in the context of hay fever or pollen sensitisation, which can be triggered by nuts.