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This prospective 1-year study followed 0–18-year-old children with physician-diagnosed peanut and/or tree nut allergy at a tertiary care center in Lille, France, assessing incidence and characteristics of AAR. Regular follow-up and structured questionnaires captured severity (WAO 2020), culprit allergens, product details, cofactors, location, and management.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/children-allergic-to-peanut-andor-tree-nuts-are-at-risk-of-accidental-allergic-reactions/446985/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/children-allergic-to-peanut-andor-tree-nuts-are-at-risk-of-accidental-allergic-reactions/446985.png","ImageObject",300,407,{"name":92,"@type":93},"Muffet","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the purpose of this prospective study?","Question",{"text":112,"@type":113},"To determine the incidence of accidental allergic reactions related to peanut and tree nut ingestion in children with physician-diagnosed allergies, and to describe AAR characteristics.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were accidental reactions identified and documented?",{"text":117,"@type":113},"Families were contacted every three months, and if an AAR occurred, data were collected using a structured questionnaire covering WAO 2020 severity, culprit allergens, food product and amount, location, cofactors, and management.",{"name":119,"@type":110,"acceptedAnswer":120},"What information was used to support peanut and/or tree nut allergy diagnosis?",{"text":121,"@type":113},"Diagnosis was based on a history of accidental reaction in most children, and by positive OFC in the remaining participants.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},446985,1790926464,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},962090768927,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Clinical & Experimental Allergy  \nRESEARCH LETTER  OPEN ACCESS   \nChildren Allergic to Peanut and/or Tree Nuts Are at Risk of Accidental Allergic Reactions  \nMarina Vasse1  | Marie Moyart1  | Camille Cisterne1  | Caroline Thumerelle1  | Elodie Drumez2  | Hélène Béhal2  | Guillaume Pouessel1,3,4  | Stéphanie Lejeune1,5  | Antoine Deschildre1,5   \n1Pediatric Pulmonology and Allergy Department, CHU Lille, Lille, France | 2Department of Biostatistics, CHU Lille, Lille, France | 3Department of Paediatrics, Children's Hospital, Roubaix, France | 4Univ Lille, ULR 2694: METRICS, Lille, France | 5Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019—UMR 9017—CIIL—Center for Infection and Immunity of Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, Lille, France  \nCorrespondence: Antoine Deschildre ([antoine.deschildre@chu-lille.fr](antoine.deschildre@chu-lille.fr))  \nReceived: 26 January 2025 | Revised: 28 July 2025 | Accepted: 1 August 2025  \nFunding: The authors received no specific funding for this study.  \nTo the Editor,  \nDespite improvements in food allergy (FA) management, the risk of accidental allergic reaction (AAR) including life-threatening anaphylaxis and fatalities, is remaining with consequences on quality of life [1, 2] . It has been estimated as roughly 10% to 12% per year for peanut allergy [3, 4] . In France, the risk of recurrent accidental allergic reaction to food was confirmed in 39 children with a history of FA admission to a paediatric intensive care unit for anaphylaxis. In all, 70% of these children experienced at least one recurrent reaction during a follow-up period from 4 to 14.1 years [5]. Another prospective study followed 196 children with various FA (peanut N = 62%; TN N = 60%) over a year and found that 31.1% experienced at least one accidental ingestion (peanut N = 9; TNN = 7), with some reporting up to nine. 31.6% of reactions led to anaphylaxis—highlighting the value of regular monitoring and education [6] . However, real-life data in peanut and/or TN allergic children on accidental reactions and risk factors remain scarce. Better knowledge is needed to improve management, including prevention and new treatment strategies. The aim of this study was to determine the incidence of AAR related to peanut and tree nut (TN) ingestion in children (aged 0–18 years) with a physician-diagnosed peanut and/ or TN allergy, followed at the Lille University paediatric allergy tertiary care centre (France), and to describe the characteristics of these AAR. This prospective study with a 1-year follow-up was approved by an ethics committee (SUD EST VI, reference: 2021-A00746-35) and patients provided consent.  \nThe patients were enrolled in the study during a scheduled follow-up visit. Patients' characteristics were recorded, including where appropriate data on treatment with peanut oral immunotherapy (OIT) in patients with peanut allergy. The objective of the study was explained in detail to parents when their children were enrolled in order to obtain all data in the event of an AAR. The families were then contacted every 3 months by email and/ or phone. If an accidental reaction had occurred, data were collected using a structured questionnaire: severity of the allergic reaction according to the World Allergy Organisation (WAO) 2020 grading system, culprit allergen, details on food products, food amount, location of the AAR, cofactors, and management.  \nOf the 191 children initially enrolled in our study, 44 were excluded because of no or incomplete follow-up. In the 147 included patients, the diagnosis of PN and/or TN allergy was based on a history of accidental reaction in 105 or by positive OFC in the remaining 42. In all, 81 had peanut allergy (55%), 34 TN allergy (23%), and 32 both allergies (22%). Forty-eight peanut allergic patients (42%) were treated with peanut OIT. Twentysix reactions were recorded in 25 patients. Two AAR triggered two times by hazelnut inge","cbCaiqVmaDfQ6pYD","https://ap.wps.com/l/cbCaiqVmaDfQ6pYD","pdf",203697,"English","# Background\n# Study Aim and Design\n## Participant Follow-up and Data Collection\n# Results and Reaction Characteristics\n## Incidence and Triggers\n## Severity and Management\n# Conclusions","[{\"question\":\"What was the purpose of this prospective study?\",\"answer\":\"To determine the incidence of accidental allergic reactions related to peanut and tree nut ingestion in children with physician-diagnosed allergies, and to describe AAR characteristics.\"},{\"question\":\"How were accidental reactions identified and documented?\",\"answer\":\"Families were contacted every three months, and if an AAR occurred, data were collected using a structured questionnaire covering WAO 2020 severity, culprit allergens, food product and amount, location, cofactors, and management.\"},{\"question\":\"What information was used to support peanut and/or tree nut allergy diagnosis?\",\"answer\":\"Diagnosis was based on a history of accidental reaction in most children, and by positive OFC in the remaining participants.\"}]","Children Allergic to Peanut and/or Tree Nuts Are at Risk of Accidental Allergic Reactions | PDF",1790718067]