**5. Conclusions**

In conclusion, from our experience, the majority of children with an OFC-confirmed nut allergy have a familial history of allergy (75%) and/or concomitant allergic disorders (68%). Moreover, anaphylaxis is the first manifestation of nut allergy in a high percentage of children (48%), and the presence of anaphylaxis or severe reactions as the first clinical manifestation of a nut allergy does not differ among the various nuts. The clinical and allergological characteristics of children with nut allergies described in our study are similar to other international studies: hazelnut is the most frequent nut for referral. Over three out of four subjects have a single nut allergy. Finally, during the OFCs, the signs and symptoms involved mainly the gastrointestinal system (73%), with cases resolved spontaneously in most cases and infrequent severe reactions (19%), confirming the safety of OFCs in children with suspected food allergies. These results appear important to define a comprehensive characterization of children with nut allergies in Italy. However, the results should be confirmed by extensive data from international cohorts.

**Author Contributions:** S.T., S.B., T.A. and E.P. collected the data. S.T., S.B., M.G., G.L., L.S., G.P., C.A., E.N. and F.M. performed the investigations. S.T. and S.B. analyzed the data. S.T. and S.B. drafted the initial manuscript. S.T., S.B., M.G., G.L., L.S., G.P., C.A., E.N. and F.M. interpreted the data and reviewed the manuscript. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** The code of the event report issued by Meyer Children's University Hospital is: IR904-18-26854.

**Informed Consent Statement:** Written informed consent was obtained from the children's parents for all procedures performed.

**Data Availability Statement:** Aggregate analyses are available on reasonable request to the corresponding author.

**Conflicts of Interest:** The authors declare no conflict of interest.
