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Peanut, tree nut, and seed allergy: Clinical features

Hugh A Sampson, MD
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Elizabeth TePas, MD, MS


Peanut, tree nut, and seed allergies are some of most common food allergies in both children and adults. These allergies tend to cause severe reactions and usually persist over time.

The epidemiology, pathogenesis, and clinical features of peanut, tree nut, and seed allergies are presented in this topic review. Diagnosis and management of these allergies are discussed separately as is treatment for food-induced anaphylaxis. General discussions of food allergy are presented separately in appropriate topic reviews. (See "Peanut, tree nut, and seed allergy: Diagnosis" and "Peanut, tree nut, and seed allergy: Management" and "Food-induced anaphylaxis".)


The prevalence of peanut allergy is variable worldwide. The highest rates are seen in westernized countries such as the United States, the United Kingdom, Canada, and Australia, where the prevalence is approximately 1 to 2 percent [1-10]. However, rates are lower in other westernized countries such as France (0.3 to 0.7 percent) [11], Denmark (0.2 to 0.6 percent) [12,13], and Israel (0.04 to 0.17 percent) [6,14]. Peanut allergy is rare in Asian countries, where peanut is often not found on the list of most common allergenic foods [15-17]. Regional dietary habits and pollen exposure may influence the epidemiology of allergy to legumes, such as peanut [6,18-20]. (See "Food allergens: Overview of clinical features and cross-reactivity" and 'Pathogenesis' below and "Food allergy in children: Prevalence, natural history, and monitoring for resolution".)

Data suggest that the rate of peanut allergy is increasing in some countries [1,2,21], although it may be leveling off [22]. The rate appears stable in other countries [5]. Hypotheses regarding the apparent increase in prevalence of food allergies are discussed in detail separately [23]. (See "Pathogenesis of food allergy", section on 'Prevalence'.)

Tree nuts and seeds are also common food allergens [1,24-28]. Sesame and mustard are the most common seed allergies reported, but allergy to other seeds can occur [26]. The prevalence of tree nut allergy was similar to that of peanut allergy in a general population survey in the United States [1]. Walnut was the most commonly reported tree nut allergy, followed by cashew and almond. In this same study, about one-third of patients with peanut allergy reported coexisting tree nut allergy, and similarly one-third with tree nut allergy had concomitant peanut allergy. The reported prevalence of sesame seed allergy in France, based upon data from the national databank, was 2 percent in children and 5 percent in adults [29]. However, patient-reported food allergy typically exceeds challenge-proven symptomatic allergy.


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Literature review current through: Sep 2016. | This topic last updated: Sep 19, 2014.
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