Tree Nut Allergy Prevalence in Dutch Children: A Review

Food allergies, including those to tree nuts, are a growing public health concern globally. The clinical dilemma for general practitioners and specialists involves distinguishing true IgE-mediated allergy from food intolerance or sensitization without clinical relevance. Accurate prevalence data is essential for informing diagnostic algorithms, developing public health interventions, and guiding dietary recommendations. Tree nut allergies are a common cause of anaphylaxis and can persist throughout life.¹

Prevalence and Diagnostic Considerations

The prevalence of tree nut allergies varies by geographical region and the methodology used for assessment. Studies often rely on self-report, which can overestimate true prevalence, or on oral food challenges, which provide definitive diagnoses but are resource-intensive.² For the Dutch pediatric population, specific large-scale epidemiological studies focusing solely on tree nut allergy prevalence are not consistently available in the provided context. However, general epidemiological data on food allergies indicates that peanut and tree nut allergies are among the most common IgE-mediated food allergies in children.³

Globally, the prevalence of tree nut allergy is estimated to be approximately 0.5% to 1% of the general population, with rates often higher in pediatric populations.⁴ This figure encompasses various tree nuts, including walnuts, pecans, almonds, cashews, pistachios, and hazelnuts, among others. Cross-reactivity between different tree nuts is common, further complicating diagnosis and management.⁵ For instance, individuals allergic to one tree nut may also react to others due to shared protein structures.⁵

Diagnostic approaches typically involve a combination of patient history, skin prick tests (SPT), and specific IgE blood tests. A positive SPT or specific IgE level indicates sensitization, but not necessarily a clinical allergy.⁶ The gold standard for diagnosis remains the double-blind, placebo-controlled oral food challenge (DBPCFC).⁶ However, due to the risk of severe reactions, these challenges are often performed in a supervised clinical setting. The absence of specific, large-scale, recent prevalence data for tree nut allergies exclusively in Dutch children using DBPCFC as the primary diagnostic tool means that precise figures for this specific demographic are not readily available in the provided context. Therefore, clinicians in the Netherlands must extrapolate from broader European and international data, while considering local dietary habits and genetic predispositions.⁷

Limitations in current data include reliance on self-reported allergies, which can inflate prevalence figures, and the heterogeneity of diagnostic criteria across studies. Future research should aim for standardized diagnostic protocols, including oral food challenges, to provide more accurate prevalence estimates for specific allergens in defined pediatric populations, such as Dutch children. This would allow for more targeted public health interventions and clinical guidelines.