Assessment of pine nut tolerance in children with tree nut allergy: a case series

Introduction. Tree nut allergy is often a lifelong condition impacting children’s quality of life due to avoidance recommendations. Despite low cross-reactivity between pine nuts and other tree nuts, many children are advised to avoid pine nuts without proper diagnostic evaluation. Materials and Methods. This case series retrospectively analyzed 35 children with tree nut allergies from Imola’s Hospital, focusing on the diagnosis of pine nut allergy. Patients were divided into two groups based on pine nut consumption. Diagnostic tests included prick-byprick, specific IgE, and oral food challenges. Results. The diagnostic process led to a significant increase in pine nut consumption, from 23% to 66% (p = 0.0006). Most children who introduced pine nuts into their diet did not experience any clinically significant reactions. Discussion. The findings suggest that many children with tree nut allergies may tolerate pine nuts, highlighting the importance of specific diagnostics for pine nut allergy. Conclusion. Assessing pine nut sensitization before exclusion from the diet is important for children with tree nut allergies