Prevalence and natural history of tree nut allergy

Ann Allergy Asthma Immunol. 2020 May;124(5):466-472. doi: 10.1016/j.anai.2020.01.024. Epub 2020 Feb 7.


Objective: Tree nuts are common causes of food-related allergic reactions and anaphylaxis. Resolution of tree nut allergy is thought to be low, yet studies of the natural history of tree nut allergy are limited. This review summarizes the available literature regarding tree nut allergy prevalence and natural history and discusses emerging diagnostic and prognostic developments that will inform clinical management of tree nut allergy.

Data sources: A comprehensive literature search using PubMed was performed.

Study selections: Peer-reviewed publications relating to tree nut allergy prevalence, resolution, and diagnosis were selected, and findings were summarized using a narrative approach.

Results: Tree nut allergy prevalence varies by age, region, and food allergy definition, and ranges from less than 1% to approximately 3% worldwide. Reports on the natural history of tree nut allergy data are limited to retrospective clinical data or cross-sectional survey data of self-reported food allergy, with reported resolution ranging from 9% to 14%. Component-resolved diagnostics and basophil activation testing offer the potential to improve the diagnostic accuracy and predicted prognosis of specific tree nut allergy, but studies are limited.

Conclusion: Tree nut allergy remains an understudied area of food allergy research with limited region-specific studies based on robust food allergy measures in population cohorts with longitudinal follow-up. This currently limits our understanding of tree nut allergy prognosis.

Publication types

  • Review

MeSH terms

  • Allergens / immunology
  • Anaphylaxis / diagnosis
  • Anaphylaxis / epidemiology*
  • Antigens, Plant / immunology
  • Humans
  • Nut Hypersensitivity / diagnosis
  • Nut Hypersensitivity / epidemiology*
  • Nuts / immunology
  • Prevalence
  • Prognosis


  • Allergens
  • Antigens, Plant