The body of evidence about nuts and allergies continues to grow, with new local and international research papers regularly published.

Key studies: systematic literature reviews and meta-analyses

Oral immunotherapy for peanut allergy (PACE): a systematic review and meta-analysis of efficacy and safety. (2019).

A recent systematic review and meta-analysis shows that it may increase allergic and anaphylactic reactions, despite inducing desensitisation.

Other evidence

Has the prevalence of peanut allergy changed following earlier introduction of peanut? The EarlyNuts Study. (2021).
The Australian-based EarlyNuts study found that peanut allergy has fallen in Australia since children have been introduced to peanuts earlier in life. It notes that Australian infant feeding guidelines changed in 2016 to recommend starting children on peanuts and other allergenic foods earlier (by age 12 months). The research suggests parents have embraced this advice, and the earlier introduction of peanuts has led to a 16% decrease in peanut allergy. Despite this promising data, the researchers note the overall prevalence of peanut allergy is still high.

Prevalence and early-life risk factors for tree nut sensitization and allergy in young adults. (2021)
This population-based cohort study (the Swedish birth cohort BAMSE) gauged the prevalence of tree nut sensitisation and reported symptoms at age 24 years, and also assessed early-life factors linked with the development of tree nut allergy. In this Swedish cohort, prevalence of tree nut sensitisation was found to be common (21.2%), but usually asymptomatic. Egg allergy, eczema and asthma at pre-school age were linked with future development of tree nut symptoms and storage protein sensitization.

The influence of cultural attitudes to nut exposure on reported nut allergy: A pilot cross sectional study (2020).
Kayale LB. et al.
The development of peanut and almond allergy through tolerance induction could be prevented by frequent and early ingestion of a moderate quantity of nuts during infancy and by maternal ingestion during pregnancy or lactation.

Real-world tree nut consumption in peanut-allergic individuals. (2019).
In summary, the data supports previous work showing that peanut-allergic individuals are commonly sensitized to tree nuts. It highlights important differences between individual tree nuts, challenging the common practice of categorical management recommendations for tree nuts as a whole group rather than by individual tree nut. The authors conclude the potential for safe introduction of tree nuts in peanut-allergic individuals and indicate that peanut-allergic individuals who consume foods with precautionary labelling are most likely to consume tree nuts.

The Australasian Society of Clinical Immunology and Allergy infant feeding for allergy prevention guidelines. (2019).
The guidelines reinforce the importance of introducing peanut and egg in the first year of life. The optimal timing of introducing other allergens (including tree nuts) is not well understood, although it is still recommended not to delay their introduction.

Asian children living in Australia have a different profile of allergy and anaphylaxis than Australian-born children: A State-wide survey. (2018).
Study reveals surprising patterns of allergy/anaphylaxis risk, suggesting that genetics and environment may be an important factor.

Effect of diet and maternal education on allergies among preschool children: a case-control study. (2017).
The consumption of nuts was also associated with a lower 61% risk of eczema among 4-6 years old children. The results indicated a beneficial effect of a frequent consumption of fresh fruit and nuts on the prevalence of allergies among children. These results might have important implications for children’s health.