Tree nuts in a child allergic to peanuts

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In a child with a known peanut allergy who has never eaten tree nuts, is it safe for the parents to introduce tree nuts at home? Is it more advisable to skin-test first?—KELLY HERSH, FNP, Denver

This is a question for a pediatric allergy specialist. Because of the potential life-threatening severity of an allergic reaction to tree nuts that can occur in a child with known peanut allergy, an observed introduction in an allergist's office would seem prudent. For more information, see Pediatr Allergy Immunol. 2008;19:368-373 and Br J Nutr. 2006;96 Suppl 2:S95-102. — Julee B. Waldrop, DNP (148-9)

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