Background: Nut allergies are among the most common pediatric food allergies, often persisting into later life and posing significant clinical risks. The likelihood of developing tolerance varies, and identifying predictors of persistence or resolution is essential. This study evaluates clinical and laboratory features of children with nut allergy, comparing data at diagnosis and follow-up to identify factors influencing tolerance, anaphylaxis, and cross-reactivity. Methods: In this retrospective, cross-sectional study, 121 children (0–18 years) diagnosed with nut allergy at a tertiary allergy center between 2016 and 2024 were analyzed. Data included allergic reaction history, comorbidities, total IgE, eosinophil counts, and prick-to-prick test (PTP) wheal sizes. Tolerance was defined based on oral food challenge, absence of reactions upon re-exposure, and clinical follow-up. Results: Multiple nut allergy was present in 81% of patients, with hazelnut (67%) and pistachio (62%) being most common. IgE-mediated reactions were predominant (91%), including urticaria (79%) and anaphylaxis (36%). During follow-up, 25% of patients developed tolerance, while 13% continued to experience anaphylaxis. Aeroallergen sensitisation, particularly to pollens, was significantly associated with reduced tolerance in almond and walnut allergy (p < 0.05). Persistent multi-nut allergy correlated with higher anaphylaxis risk (p < 0.01). Strong cross-reactivity was observed between pistachio–cashew (r = 0.686) and peanut–legumes (r = 0.787). Importantly, smaller PTP wheal sizes at diagnosis were predictive of tolerance (p < 0.05). Conclusion: Tolerance in pediatric nut allergy remains limited, especially in children with multi-nut and aeroallergen sensitisation. Baseline PTP wheal size and aero-sensitisation status emerged as significant and practical predictors of long-term allergy outcomes. These findings emphasize the clinical value of early immunological profiling in risk stratification and support routine re-evaluation in sensitised children to prevent overt dietary restrictions.

Background: Cystic fibrosis (CF) is an inherited autosomal recessive disorder that causes chronic airway disease. In addition to genetic factors, environmental factors may affects the clinical phenotype of CF. In our study, the presence of aeroallergen sensitivity in our patients with CF and its effects on clinical findings were evaluated. Materials and Methods: Demographic characteristics, clinical and laboratory findings, skin prick test (SPT) results, and Modified Shwachman-Kulczycki (MSK) scores of patients diagnosed with CF followed in the Pediatric Respiratory and Allergy Clinic of Dokuz Eylul University Faculty of Medicine were evaluated. Results: We evaluated 51 patients with CF with a median age of 10 (6-18) years. The mean MSK score of the patients was 72.54±11.50, and the mean predictive value of forced expiratory volume (FEV1) in the first second of 41 patients was 80.43±19.50. According to SPT, aeroallergen sensitivity was detected in 17 (33.3%). The frequency of bacterial colonization and bronchiectasis was higher, MSK scores were lower in AF-sensitive patients (p≤0.01). However, there was no similar difference in other allergen sensitivities. MSK scores and predictive FEV1 values of 25 (49%) patients with bacterial colonization were significantly lower than those without colonization (p=0.001, p=0.005, respectively). Conclusion: Aeroallergen sensitivity was detected in approximately 1/3 of CF patients. Although it has been emphasized in studies that environmental factors may have an impact on lung functions and clinical conditions in CF, the effect of allergens other than AF sensitivity may be less important compared to other environmental factors such as the presence of bacterial colonization. Keywords: Cystic fibrosis, atopy, children, asthma, Aspergillus fumigatus, Pseudomonas aeruginosa