Abstract
BackgroundFew studies with a limited number of patients have provided indications that cashew-allergic patients may experience severe allergic reactions to minimal amounts of cashew nut. The objectives of this multicentre study were to assess the clinical relevance of cashew nut sensitisation, to study the clinical reaction patterns in double-blind placebo-controlled food challenge tests and to establish the amount of cashew nuts that can elicit an allergic reaction.Methods and FindingsA total of 179 children were included (median age 9.0 years; range 2–17 years) with cashew nut sensitisation and a clinical history of reactions to cashew nuts or unknown exposure. Sensitised children who could tolerate cashew nuts were excluded. The study included three clinical visits and a telephone consultation. During the first visit, the medical history was evaluated, physical examinations were conducted, blood samples were drawn and skin prick tests were performed. The children underwent a double-blind placebo-controlled food challenge test with cashew nut during the second and third visits. The study showed that 137 (76.5%) of the sensitised children suspected of allergy to cashew nut had a positive double-blind placebo-controlled food challenge test, with 46% (63) manifesting subjective symptoms to the lowest dose of 1 mg cashew nut protein and 11% (15) developing objective symptoms to the lowest dose. Children most frequently had gastro-intestinal symptoms, followed by oral allergy and skin symptoms. A total of 36% (49/137) of the children experienced an anaphylactic reaction and 6% (8/137) of the children were treated with epinephrine.ConclusionThis prospective study demonstrated a strikingly high percentage of clinical reactions to cashew nut in this third line population. Severe allergic reactions, including anaphylaxis requiring epinephrine, were observed. These reactions were to minimal amounts of cashew nut, demonstrated the high potency of this allergens.Trial Registrationwww.ncbi.nlm.nih.gov/pubmed NTR3572
Highlights
A limited number of clinical studies have been published on cashew nut allergy
The objectives of this study were to assess the clinical relevance of cashew nut sensitisation, to study the clinical reaction patterns and the severity of symptoms during the double-blind placebo-controlled food challenge (DBPCFC) tests with cashew nut and to establish the amount of cashew nut that can elicit an allergic reaction
In 112 children (63%) consumption of, or contact with cashew nuts had elicited an allergic reaction before study entrance
Summary
A limited number of clinical studies have been published on cashew nut allergy. Five relevant studies have been performed examining clinical symptoms [1]. In this study, 5 of 27 patients with cashew nut allergy experienced an allergic reaction after only skin or mucosal contact. One of these five patients developed anaphylaxis [2]. Few studies with a limited number of patients have provided indications that cashew-allergic patients may experience severe allergic reactions to minimal amounts of cashew nut The objectives of this multicentre study were to assess the clinical relevance of cashew nut sensitisation, to study the clinical reaction patterns in double-blind placebo-controlled food challenge tests and to establish the amount of cashew nuts that can elicit an allergic reaction
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