Abstract
Background Tree nut-allergic individuals are often sensitised towards multiple nuts and seeds. The underlying cause behind a multi-sensitisation for cashew nut, hazelnut, peanut and birch pollen is not always clear. We investigated whether immunoglobulin E antibody (IgE) cross-reactivity between cashew nut, hazelnut and peanut proteins exists in children who are multi-allergic to these foods using a novel IMMULITE®-based inhibition methodology, and investigated which allergens might be responsible. In addition, we explored if an allergy to birch pollen might play a role in this co-sensitisation for cashew nut, hazelnut and peanut. Methods Serum of five children with a confirmed cashew nut allergy and suffering from allergic symptoms after eating peanut and hazelnut were subjected to inhibition immunoassays using the IMMULITE® 2000 XPi. Serum-specific IgE (sIgE) to seed storage allergens and pathogenesis-related protein 10 (PR10) allergens were determined and used for molecular multicomponent allergen correlation analyses with observed clinical symptoms and obtained inhibition data. Results IgE cross-reactivity was observed in all patients. Hazelnut extract was a strong inhibitor of cashew nut sIgE (46.8%), while cashew nut extract was less able to inhibit hazelnut extract (22.8%). Peanut extract showed the least inhibition potency. Moreover, there are strong indications that a birch pollen sensitisation to Bet v 1 might play a role in the observed symptoms provoked upon ingestion of cashew nut and hazelnut. Conclusions By applying an adjusted working protocol, the IMMULITE® technology can be used to perform inhibition assays to determine the risk of sIgE cross-reactivity between very different food components.
Highlights
Among food allergies, an allergy to tree nuts is relatively common affecting ~0.05–7.3% of the population and its prevalence seems to be increasing, especially in children [1,2,3]
Case histories including clinical symptoms after eating hazelnut and peanut were collected from the registered electronic patient files and questionnaires in the Improvement of Diagnostic mEthods for ALlergy assessment (IDEAL) study, as well as the result of the double-blind placebo-controlled food challenge (DBPCFC) with cashew nut, skin prick test (SPT) and immunoglobulin E antibody (IgE) data specific for whole cashew nut (f220), hazelnut (f17), peanut (f13) and birch pollen (t3) [6]
Of the 179 children included in the IDEAL study [6], five children with a confirmed DBPCFC test against cashew nut plus a positive history of allergic symptoms after hazelnut and peanut ingestion were selected for this small follow-up study to investigate possible IgE cross- and/or co-reactivity between cashew nut, hazelnut and peanut allergens
Summary
An allergy to tree nuts is relatively common affecting ~0.05–7.3% of the population and its prevalence seems to be increasing, especially in children [1,2,3]. We investigated whether immunoglobulin E antibody (IgE) cross-reactivity between cashew nut, hazelnut and peanut proteins exists in children who are multi-allergic to these foods using a novel IMMULITE®-based inhibition methodology, and investigated which allergens might be responsible. Methods: Serum of five children with a confirmed cashew nut allergy and suffering from allergic symptoms after eating peanut and hazelnut were subjected to inhibition immunoassays using the IMMULITE® 2000 XPi. Serum-specific IgE (sIgE) to seed storage allergens and pathogenesis-related protein 10 (PR10) allergens were determined and used for molecular multicomponent allergen correlation analyses with observed clinical symptoms and obtained inhibition data. There are strong indications that a birch pollen sensitisation to Bet v 1 might play a role in the observed symptoms provoked upon ingestion of cashew nut and hazelnut. Conclusions: By applying an adjusted working protocol, the IMMULITE® technology can be used to perform inhibition assays to determine the risk of sIgE cross-reactivity between very different food components
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