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A recent Turkish study has found children with multiple nut allergies face a significantly higher risk of anaphylaxis—a severe, potentially life-threatening allergic reaction—compared to those allergic to a single type of nut. The findings, published in 2025, emphasize the importance of vigilant management, close monitoring, and tailored care for affected children, especially those sensitized to aeroallergens like pollen, which may reduce the likelihood of developing tolerance to certain nuts.
Key Findings and Study Overview
The study analyzed 121 children with tree nut or peanut allergies, averaging nearly seven years old, at a tertiary allergy center in Türkiye over a median follow-up of 43 months. Researchers tested allergies to various foods, including nuts like pistachio, almond, hazelnut, cashew, and pecan, alongside peanut, dairy, egg, and aeroallergens such as pollen.
Results showed that children allergic to multiple nuts had a statistically higher risk of experiencing anaphylaxis than those with a single nut allergy. For instance, multiple nut allergies were particularly common in cases involving pistachio, almond, hazelnut, or cashew allergies. During the study, about 13% of children continued to suffer from anaphylaxis episodes. Notably, hazelnut and pistachio were the most frequent triggers of allergic reactions.
The researchers also found that smaller wheal sizes on skin prick tests were predictors of tolerance acquisition for some nuts, meaning children with milder skin test reactions were more likely to outgrow certain allergies over time. However, children sensitized to airborne allergens such as pollens had a lower rate of developing tolerance to almond and walnut allergies, indicating a complex interplay between environmental and food allergens.
Expert Perspectives
Dr. Sinem Akgül, an allergist not involved in the study, highlights the importance of these findings: “This research underlines that the risk of severe allergic reactions varies not just by the presence of nut allergies, but also by the number and type of nut allergies a child has. It stresses the need for personalized allergy management and vigilant follow-up, especially in children with multiple nut sensitizations.” She advises parents and caregivers to work closely with allergists to manage allergies safely.
Background on Anaphylaxis and Food Allergies
Anaphylaxis is an acute, potentially fatal allergic reaction that occurs rapidly after exposure to an allergen such as nuts. It involves multiple organ systems and is characterized by symptoms like difficulty breathing, swelling of the throat, drop in blood pressure, pale or bluish skin, and loss of consciousness. Immediate treatment with epinephrine (adrenaline) is critical to prevent fatal outcomes.
Food allergies, especially to peanuts and tree nuts, are among the most common causes of anaphylaxis in children. These allergies have increased in prevalence worldwide, prompting updated clinical guidelines aiming to prevent and manage them. For example, early introduction of peanut-containing foods in infants at high risk for allergies has been shown to reduce the development of peanut allergy.
Public Health Implications
These findings bear considerable public health importance. They emphasize that children with multiple nut allergies require enhanced risk assessment and personalized management plans. Clinicians should incorporate detailed allergy profiling, including skin prick testing and evaluation of environmental sensitizations, to better predict anaphylaxis risk and tolerance development.
For families, the study advocates maintaining careful avoidance strategies for identified nuts and having emergency treatment plans in place, including immediate access to epinephrine auto-injectors. Increased awareness and education about recognizing and responding to anaphylaxis are critical components of improving outcomes.
Limitations and Considerations
While the study offers valuable insights, it is retrospective and limited to one geographic region, which may affect the generalizability of findings. Additionally, the role of aeroallergen sensitization requires further exploration to understand underlying mechanisms influencing tolerance development.
Experts caution that allergy testing and diagnosis should always be conducted by trained allergists, who consider clinical history and confirmatory tests to avoid overdiagnosis or unnecessary dietary restrictions.
Practical Takeaways for Families
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Children with multiple nut allergies have a higher likelihood of severe allergic reactions.
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Regular consultation with allergy specialists is essential for tailored management.
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Keeping epinephrine auto-injectors accessible is crucial and can save lives during anaphylaxis.
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Educating family members and caregivers on recognizing symptoms of anaphylaxis and proper response is vital.
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Early introduction of allergenic foods, under medical guidance, may reduce risk in some infants.
Medical Disclaimer
This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.
References
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Akgül et al. Multiple Nut Allergies May Predict Anaphylaxis Risk in Children. Study at a tertiary allergy center in Türkiye; Medscape, September 19, 2025.
