Diagnosis Of Tree Nut Allergy Research Articles

Evaluation of Testing and Diagnosis of Tree Nut Allergy in Infants Undergoing Screening for Peanut Allergy

Current guidelines recommend early introduction of peanuts (PN) to all infants with an option of performing screening testing before introduction in those at highest risk for PN allergy. Specific guidelines on screening for tree nut (TN) allergy prior to introduction do not exist and the rate of PN/TN co-sensitization and allergy in this population is not known.

A practical focus on oral immunotherapy to tree nuts

Tree nut (TN) allergy is common, with a global prevalence of up to 4.9%. TN allergy is persistent in most patients, and accidental reactions are common. There is considerable clinical cross-reactivity between cashew and pistachio, and between walnut and pecan. A diagnosis of TN allergy is based on a history of clinical reaction on ingestion, along with confirmed sensitization through either skin-prick or serum immunoglobulin E (IgE) testing. Component testing and food challenges may be required in patients with birch pollinosis to distinguish between IgE-mediated allergy to a heat-stable protein and pollen food allergy syndrome. There is available evidence that TN oral immunotherapy (OIT) is reasonably safe and effective. There are numerous nonpharmaceutical food products to facilitate TN-OIT dosing. TN OIT should be offered as a treatment option for patients with TN allergy.

Multiplex component-based allergen macroarray test is useful to predict clinical reactivity to tree nuts in children

BackgroundIn tree nut (TN) allergy, singleplex tests showed the diagnostic utility of rAna o 3, rCor a 14/nCor a 9, and nJug r 1/nJug r 4 for cashew/pistachio, hazelnut, and walnut allergies, respectively. However, disadvantages of the tests include high costs and excessive blood sampling in multi-sensitized patients, and a limited number of components. We investigated the utility of a multiplex macroarray (i.e., the ALEX2 test) in TN allergy. MethodsIn 169 children, skin prick test, the component- and extract-specific IgEs of TNs were investigated for clinical reactivity and tolerance. ResultsThe predictors (AUC = 0.962–0.749) of clinical reactivity to cashew, pistachio, hazelnut, and walnut were rPis v 1/rAna o 3, rPis v 1/rAna o 3/nPis v 2/nPis v 3, rCor a 14/nCor a 11/nCor a 9, and nJug r 1/nJug r 2/nJug r 6/nJug r 4, respectively. More than 93% of the patients with clinical reactivity to pistachio/cashew, hazelnut and walnut had positivity of (≥0.3 kUA/L) rPis v 1/rAna o 3, rCor a 14 and nJug r 1/nJug r 2, respectively. The highest accuracies of clinical reactivity to culprit nut were obtained with combination of rPis v 1, sIgE and SPT positivities for cashew/pistachio, rPis v 1 ≥ 1.0 kUA/L for pistachio, rCor a 14 ≥ 1.0 kUA/L for hazelnut and combination of nJug r 1 and nJug r 2 positivities for walnut, respectively. Also, higher concentrations of rPis v 1 (≥15.0 kUA/L), rCor a 14 (≥5.0 kUA/L) and nJug r 1/nJug r 2 (≥15.0 kUA/L) had %100 specificity and PPV in predicting clinical reactivity to cashew, hazelnut and walnut, respectively. ConclusionsMultiplex macroarray test is useful and reliable in the diagnosis of TN allergy in children, confirms and expands existing knowledge, and can be used as a stand-alone tool in the bottom-up diagnostic approach.

Current perspectives on tree nut allergy: a review.

Tree nut (TN) allergy is common and often severe. It has become an important health concern as availability and consumption have increased. Prevalence varies by age and geographic region and appears to have increased in children. Accidental ingestion of TNs is common. Unfortunately, there is a lower likelihood of resolution of TN allergy, roughly 10%. TN-specific skin tests and serum immunoglobulin E levels can help aid in the diagnosis of TN allergy, but a careful medical history is important because a positive test in isolation is not typically diagnostic. Component-resolved diagnostic tests are being increasingly utilized and may improve accuracy. Management consists of strict avoidance of the causal nut(s) and prompt treatment of symptoms upon accidental exposure. A specific consideration with regard to the management of TN allergy is the decision to avoid all TNs or only the TNs to which a patient is clinically allergic. There are currently no data on the primary or secondary prevention of TN allergy. Treatment strategies are being evaluated.

NUT Co Reactivity - ACquiring Knowledge for Elimination Recommendations (NUT CRACKER) study.

Ambiguities exist regarding the diagnosis of tree-nut allergy, necessitating either their elimination or the performance of oral food challenges (OFCs). To examine the coincidences of allergies among tree-nuts and improve diagnostic testing to minimize the need for OFC. Eighty-three patients prospectively evaluated for walnut, pecan, cashew, pistachio, hazelnut, and almond allergy. A history of previous reactions was obtained, and standardized skin prick tests (SPTs) using finely ground tree-nut solution and basophil activation tests (BAT) were performed. Patients underwent OFC for each tree-nut they eliminated and to which a reaction in the previous 2years was not documented. While most patients were sensitized to 5-6 tree-nuts, over 50% were allergic to only 1-2 tree-nuts. The highest rate of allergy in sensitized patients was observed for walnut (74.6%) and cashew (65.6%). The rate of co-allergy for most tree-nuts was <30%. Two-thirds of walnut- and cashew-allergic patients were also allergic to pecan and pistachio, respectively, while all pecan- and pistachio-allergic patients were allergic to walnut and cashew, respectively. Receiver-operating characteristic analysis for SPT and BAT was tree-nut dependent and yielded area under the curve (AUC) values ranging from 0.75 to 0.94. Knowledge of coincident allergies in these pairs along with the combination of SPT and BAT correctly distinguished allergic from tolerant patients for walnut (87%), pecan (66%), cashew (71%), and pistachio (79%). The data presented here should assist in differentiating between allergic and tolerant patients, decrease the need for OFC, and allow for appropriate elimination recommendations.

Production and analysis of recombinant tree nut allergens

Allergic reactions to tree nuts are a growing global concern as the number of affected individuals continues to rise. Unlike some food allergies, tree nuts can cause severe reactions that persist throughout life. The tree nuts discussed in this review include those most commonly responsible for allergic reactions: cashew, almond, hazelnut, walnut, pecan, Brazil nut, pistachio, and chestnut. The native allergenic proteins derived from tree nuts are frequently difficult to isolate and purify and may not be adequately represented in aqueous nut protein extracts. Consequently, defined recombinant allergens have become useful reagents in a variety of immunoassays aimed at the diagnosis of tree nut allergy, assessing cross-reactivity between various nuts and other seeds, mapping of IgE binding epitopes, and analyzing the effects of the food matrix, food processing, and gastric digestion on allergenicity. This review describes the approaches that can be used for the production of recombinant tree nut allergens and addresses key issues associated with their production and downstream applications.