Abstract
Background and Objectives: Hazelnuts are frequently involved in IgE-mediated reactions and represent the main culprit of nut allergy in Europe. The clinical presentation varies from mild symptoms limited to the oropharynx [oral allergy syndrome (OAS)], due to the cross-reaction with homologues in pollen allergens and more severe events caused by the primary sensitization to highly stable molecules contained in hazelnuts. The aim of this review is to summarize the most relevant concepts in the field of hazelnut allergy and to provide a practical approach useful in the clinical practice Materials and Methods: References were identified by PubMed searches dating from January 2000 up to November 2020 using the search terms: “component resolved diagnosis” and “Hazelnut allergy. Results: The storage proteins Cor a 9 and Cor a 14 resulted highly specific for primary hazelnut allergy and strongly associated with severe reactions, while the cross reactive Cor a 1, an homolog of the birch Bet v1, were related to OAS. Any cut-off has shown a specificity and sensitivity pattern as high as to replace the oral food challenge (OFC), which still remains the gold standard in the diagnosis of hazelnut allergy. To date there is still no definitive treatment. Hazelnut free-diet and treatment of symptoms with emergency management, including the prescription of auto-injective epinephrine, still represent the main approach. Oral allergen immunotherapy (AIT) appears a promising therapeutic strategy and the definition of individual clinical threshold would be useful for sensitized individuals, caregivers, and physicians to reduce social limitation, anxiety, and better manage food allergy. Conclusions: An accurate diagnostic work-up including clinical history, in vivo and in vitro test including component resolved diagnosis and OFC are essential to confirm the diagnosis, to assess the risk of a severe reaction, and to prescribe an adequate diet and treatment.
Highlights
Hazelnuts are relevant culprits of food-induced allergy at any age [1]
Hazelnuts belong to the botanical family of Betulaceae, such as trees, and to genus Corylus, species Corylus avellana; they are native of Europe and Western Asia, but are cultivated in North America [1]
The aim of this review is to summarize the most recent data in the field of hazelnut allergy in order to give some practical indications useful in the clinical practice
Summary
Hazelnuts are relevant culprits of food-induced allergy at any age [1]. Hazelnuts belong to the botanical family of Betulaceae, such as trees (birch and adlers), and to genus Corylus, species Corylus avellana; they are native of Europe and Western Asia, but are cultivated in North America [1]. They are rich in nutrients and their regular consumption has shown to greatly improve the lipid profile, contributing to a decrease of cholesterol levels and, to a reduction in the risk of coronary heart disease [2,3] Their potential health benefits are related to their role in countering the inflammatory processes and oxidative stress, improving glycemic control [2,3]. Hazelnuts represent a significant source of allergens and their ingestion can induce hypersensitivity reactions in sensitized individuals, varying from mild to potentially life-threatening events [1] For this reason, hazelnuts with other tree nuts have been included among the potentially allergenic foods which must be labeled to emphasize their content from the rest of the ingredients, regardless of their amount [4,5]
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