The Ability of Children and Families With and Without Nut Allergy to Correctly Identify Nuts

Researchers examined if children with tree nut (TN) and peanut (PN) allergies, and their families, would be better at nut identification compared with the general public.This study recruited child and guardian pairs, separated into cases and matched controls. Inclusion criteria for cases included children ≥ 5 years of age with a TN or PN allergy and their guardians. The control group comprised children without TN or PN allergies, matched for age and sex as the cases, and their guardians.This cross-sectional study assessed child and guardian pairs on their ability to independently identify the contents of 22 jars, each containing 1 of 8 nut types (almond, Brazil, cashew, hazelnut, peanut, pecan, pistachio, and walnut) in 1 of 3 forms (chopped, in shell, and out of shell). Participants self-assessed their level of nut knowledge on a Linkert scale (1–10) before and after testing.A total of 126 child and guardian pairs (63 cases and 63 controls) underwent nut identification testing. No significant differences in median quiz score scores (MQS) were found between case and control groups for both guardians and children. Guardians scored higher than their children (P < .001), with an MQS of 12 and 10 for cases and controls versus an MQS of 3 and 3 for their children, respectively. For nut-allergic pairs, only 15.8% of guardians and 1.5% of children identified all forms of their index nut. No participants identified all nuts correctly, with chopped nuts being the most difficult. During follow-up, 83% reported an increased ability to identify nuts after testing, and 50% reported post-test behavioral changes, such as increased awareness of the difficulty in identifying chopped nuts.Child and guardian pairs with nut allergies were not better at identifying nuts than those from the control group. Although guardians recognized nuts more reliably than children, misidentification was common within both groups.PN or TN misidentification remains a common vulnerability for PN and TN allergic patients and families. Further research is needed to ascertain if targeted visual educational interventions focused on those types and forms with higher error rates, such as chopped nuts, could improve nut identification knowledge and real-world outcomes for patients.