Japanese

Title	木の実類アレルギー
Subtitle	総説
Authors	堀向健太
Authors (kana)
Organization	東京慈恵会医科大学葛飾医療センター 小児科
Journal	日本環境アレルギー学会雑誌
Volume	32
Number	2
Page	19-28
Year/Month	2025 / 5
Article	報告
Publisher	日本環境アレルギー学会
Abstract	「要旨」木の実アレルギーは, 近年, その報告数と社会的関心が増加している食物アレルギーである. 植物学的にナッツと異なる場合があるため, 食物アレルギー診療ガイドライン2021から「木の実類アレルギー」と分類された. 日本においてはクルミやカシューナッツが頻度の高い原因アレルゲンとなっており, クルミは鶏卵に次ぐ第2位の原因食物となった. 正確な診断には, 病歴に加えて, 特異的IgE抗体検査やコンポーネント検査を活用し, 必要に応じて経口負荷試験(oral food challenge; OFC)を行うことが重要である. 近年, ピーナッツを中心に経口免疫療法(oral immunotherapy; OIT)や舌下免疫療法(SLIT), 経皮免疫療法(epicutaneous immunotherapy; EPIT)が検討されており, 木の実類への応用も一部で始まっている. しかし, 有害事象と維持の問題は依然として課題であり, 慎重な適応判断と長期的なフォローアップが求められる. さらに, 食生活の多様化とともに誤食やコンタミネーションリスクも増しており, 負荷試験や環境調整の重要性がいっそう高まっている. 今後は, 安全性と長期的な免疫寛容の両立を目指した免疫療法の確立と, 早期導入を含めた予防戦略の検討が重要である.
Practice	臨床医学：内科系
Keywords	アナフィラキシー, 木の実類アレルギー, 経口免疫療法, 交差抗原性, コンポーネント検査, Anaphylaxis, tree nut allergies, oral immunotherapy, cross-reactivity, component-resolved diagnostics

English

Title	Tree Nut Allergies
Subtitle	REVIEWS
Authors	Kenta Horimukai
Authors (kana)
Organization	Department of Pediatrics, Jikei University Katsushika Medical Center
Journal	Journal of the Japanese Society of Environmental Allergy
Volume	32
Number	2
Page	19-28
Year/Month	2025 / 5
Article	Report
Publisher	JAPANESE SOCIETY OF ENVIRONMENTAL ALLERGY
Abstract	[Abstracts] Tree nut allergies have risen notably in both reported cases and public concern. Among the various allergens commonly referred to as "nuts, "peanuts are in fact legumes, unlike true tree nuts such as walnuts or cashews. In Japan, walnuts have emerged as the second most frequent cause of immediate-type food allergy, while tree nut allergies collectively account for 24.6% of all such cases. Accurate diagnosis hinges on specific IgE testing, including component-resolved diagnostics (e.g., Jug r 1, Ana o 3), although oral food challenges remain the gold standard. While subclinical cross-reactivity and the risk of anaphylaxis from trace exposure persist as clinical challenges, several immunotherapeutic approaches - oral (OIT), sublingual (SLIT), and epicutaneous (EPIT) - are under investigation, drawing in part on insights gained from peanut allergy studies. However, factors such as patient age, timing of allergen introduction, adverse reactions, and the pursuit of sustained tolerance remain significant hurdles. Although early introduction and proper skin care have been suggested as preventive measures, further research is essential to develop safer, longer lasting strategies that address the growing prevalence and complexity of tree nut allergies.
Practice	Clinical internal medicine
Keywords	Anaphylaxis, tree nut allergies, oral immunotherapy, cross-reactivity, component-resolved diagnostics

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