The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy

doi:10.1016/j.jaci.2008.04.014

Journal of Allergy and Clinical Immunology

Volume 122, Issue 1, July 2008, Pages 145-151

https://doi.org/10.1016/j.jaci.2008.04.014 Get rights and content

Background

The gold standard for diagnosing food allergy is the double-blind, placebo-controlled food challenge. Diagnostic food-specific IgE levels might assist in diagnosing food allergies and circumventing the need for food challenges.

Objectives

The purpose of this study was to determine the utility of food-specific IgE measurements for identifying symptomatic peanut, tree nut, and seed allergies and to augment what is known about the relationships among these foods.

Methods

Patients referred for suspected peanut or tree nut allergies answered a questionnaire about their perceived food allergies. Allergen-specific diagnoses were based on questionnaire, medical history, and, when relevant, skin prick tests and serum specific IgE levels. Sera from the patients were analyzed for specific IgE antibodies to peanuts, tree nuts, and seeds by using ImmunoCAP Specific IgE (Phadia, Inc, Uppsala, Sweden).

Results

Three hundred twenty-four patients (61% male; median age, 6.1 years; range, 0.2-40.2 years) were evaluated. The patients were highly atopic (57% with atopic dermatitis and 58% with asthma). The majority of patients with peanut allergy were sensitized to tree nuts (86%), and 34% had documented clinical allergy. The relationship between diagnosis and allergen-specific IgE levels were estimated by using logistic regression. Diagnostic decision points are suggested for peanut and walnut. Probability curves were drawn for peanut, sesame, and several tree nuts. High correlations were found between cashew and pistachio and between pecan and walnut.

Conclusions

Quantification of food-specific IgE is a valuable tool that will aid in the diagnosis of symptomatic food allergy and might decrease the need for double-blind, placebo-controlled food challenges.

Section snippets

Methods

Children, adolescents, and adults referred to the Mount Sinai Pediatric Allergy Clinic and the Boulder Valley Asthma and Allergy Clinic in Boulder, Colorado, for evaluation of suspected IgE-mediated peanut, tree nut, or seed (sesame, mustard, poppy, rape, and cotton seed) hypersensitivity were enrolled in the study. The Mount Sinai informed consent procedure was used for all patients enrolled in the study. The physicians involved in the study protocol determined the diagnosis of food allergy. A

Results

Three hundred twenty-four patients with suspected peanut, tree nut, and/or seed allergies were enrolled in the study. The patients ranged in age from 2.4 months to 40.2 years (median, 6.1 years), and the majority of patients were male (male/female ratio, 198:126). Fifty-seven percent of patients had atopic dermatitis at some point in their lifetimes, and 58% had asthma. Many patients had other food allergies (either “outgrown” or present at the time of inclusion in the study), which occurred

Discussion

Peanut and tree nut allergies are common, affecting more than 1% of the US population.2, 3, 21 Reactions to these foods are often severe¹⁸ and frequently occur on the first known ingestion of the food.6, 20 These food allergies are typically lifelong, although there are small percentages of patients who do outgrow them.5, 13 Less is known about seed hypersensitivity; however, the rate of sesame seed allergy seems to be increasing.¹¹ Reactions to sesame can be severe, and one study reported that

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Cashew Allergy Prevalence and Sensitization in 1-Year-Old Infants
2023, Journal of Allergy and Clinical Immunology: In Practice
Cashew allergy is the most common tree nut allergy in Australia, but there are limited data on the population-level prevalence and risk factors.
Describe the prevalence of cashew sensitization and allergy in 12-month-old infants and identify risk factors.
Data were from the EarlyNuts cohort, a population-based sample of infants recruited in Melbourne, Australia. Families completed a questionnaire and infants underwent a skin prick test (SPT) to cashew. Infants with positive SPTs were offered food challenges. Questionnaires collected demographic data and allergy risk factors. Allergy outcomes were determined by challenge outcomes or a convincing history of an allergic reaction. We used weights to adjust estimated prevalence to reflect the distribution of risk factors among the combined sample of participants and nonparticipants.
We recruited 1,933 participants and identified 1,414 cashew allergy outcomes. Of these, 1.96% (95% CI, 1.28-2.99) had an SPT result of 3 mm or greater and 1.49% (95% CI, 0.91-2.44) were allergic to cashew. Infants with eczema or peanut allergy in the first year of life were more likely to be allergic to cashew (adjusted odds ratio = 5.75; 95% CI, 2.08-15.88; P = .001; and adjusted odds ratio = 19.30; 95% CI, 5.44-68.43; P < .001, respectively). Twenty-five percent of participants had cashew introduced before 12 months (95% CI, 22.7-27.8). There was no association between the timing of cashew introduction and cashew allergy.
To our knowledge, this is the first study describing the prevalence of and risk factors for cashew allergy in a population-based infant cohort. Eczema and peanut allergy were associated with an increased risk of cashew allergy. Few infants were introduced to cashew before age 12 months, which suggests that infant feeding guidelines have not yet translated to the earlier introduction of all allergens.
Associations of early-life pet ownership with asthma and allergic sensitization: A meta-analysis of more than 77,000 children from the EU Child Cohort Network
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Studies examining associations of early-life cat and dog ownership with childhood asthma have reported inconsistent results. Several factors could explain these inconsistencies, including type of pet, timing, and degree of exposure.
Our aim was to study associations of early-life cat and dog ownership with asthma in school-aged children, including the role of type (cat vs dog), timing (never, prenatal, or early childhood), and degree of ownership (number of pets owned), and the role of allergic sensitization.
We used harmonized data from 77,434 mother-child dyads from 9 birth cohorts in the European Union Child Cohort Network when the child was 5 to 11 years old. Associations were examined through the DataSHIELD platform by using adjusted logistic regression models, which were fitted separately for each cohort and combined by using random effects meta-analysis.
The prevalence of early-life cat and dog ownership ranged from 12% to 45% and 7% to 47%, respectively, and the prevalence of asthma ranged from 2% to 20%. There was no overall association between either cat or dog ownership and asthma (odds ratio [OR] = 0.97 [95% CI = 0.87-1.09] and 0.92 [95% CI = 0.85-1.01], respectively). Timing and degree of ownership did not strongly influence associations. Cat and dog ownership were also not associated with cat- and dog-specific allergic sensitization (OR = 0.92 [95% CI = 0.75-1.13] and 0.93 [95% CI = 0.57-1.54], respectively). However, cat- and dog-specific allergic sensitization was strongly associated with school-age asthma (OR = 6.69 [95% CI = 4.91-9.10] and 5.98 [95% CI = 3.14-11.36], respectively). There was also some indication of an interaction between ownership and sensitization, suggesting that ownership may exacerbate the risks associated with pet-specific sensitization but offer some protection against asthma in the absence of sensitization.
Our findings do not support early-life cat and dog ownership in themselves increasing the risk of school-age asthma, but they do suggest that ownership may potentially exacerbate the risks associated with cat- and dog-specific allergic sensitization.
Recent advances in diagnosing and managing nut allergies with focus on hazelnuts, walnuts, and cashew nuts
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Tree nuts are a powerful and common source of food allergens that induce IgE-mediated allergic reactions. Health authorities endorse the intake of tree nuts because they are regarded as nutritious. Allergic reactions to nuts can lead to severe and occasionally lethal reactions. Allergies to tree nuts are observed worldwide and are found in up to 4.9% of people in unspecific populations.
Over the last 2 decades, the rates of allergic reactions and anaphylaxis have increased in different countries. Most proteins implicated in tree nut allergic reactions are members of the lipid transfer protein, 2S albumin, vicilin, legumin, and oleosin protein families. Bet v 1 homologs and profilins are involved in pollen-related tree nut allergies. Systematic literature reviews and meta-analyses on the diagnostic accuracy of specific immunoglobulin E (sIgE) for commercially available nut components have recently been published. IgE testing of the storage proteins Cor a 14, Cor a 9, Jug r 1, and Ana o 3 increases diagnostic specificity in assessing hazelnut, walnut, and cashew allergies in children, respectively. The resolution of tree nut allergies has been reported; however, only a few studies are available in this regard. Complete avoidance of nuts is the safest approach for nut-allergic subjects. However, this is difficult to achieve and can result in a severely restricted diet. Patients can eat nuts that they know are safe at home, but should avoid them when eating out because of the risk of cross-contamination.
Nuts have become part of a modern healthy diet, and this enhanced consumption is reflected in an increased prevalence of nut allergies.
Adverse events and labeling issues related to suspected sesame allergy reported in an online survey
2022, Annals of Allergy, Asthma and Immunology
Allergen avoidance is critical for those with immunoglobulin E–mediated food allergy, but can only be successful with accurate product information. Although the Food and Drug Administration maintains the Center for Food Safety and Nutrition Adverse Event Reporting System to collect adverse event (AE) reports related to foods, there is substantial underreporting, and information regarding product labeling issues is limited.
The purpose of this study was to describe allergic reactions associated with accidental oral exposure to sesame and the role of product labeling.
A questionnaire was developed and disseminated to online communities focused on sesame allergy. The questionnaire included questions on clinical characteristics, treatments, outcomes, and labeling issues.
A total of 360 clinical reactions related to sesame were reviewed in 327 individuals. Anaphylaxis occurred in 68.9% of reactions. Hospitalization occurred in 47.8% of events and epinephrine was administered in 36.4% of cases. Events involving a packaged food product occurred in 67.5% of AEs with only 43.8% of these using the term “sesame.” An alternative name was noted in 46.0% of products that did not include “sesame” on labeling, most of which was “tahini.”
We determined considerable sesame food allergy morbidity, in part owing to inconsistent allergen labeling. Our findings support the development of a more rapid process for the Food and Drug Administration to update the major allergen list and formulation of an improved system for reporting AEs related to foods.
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The incidence of cashew nut anaphylaxis is increasing and there is a need for accurate diagnostic tests. Age-specific cutoffs in children are lacking. Changes in serum tryptase levels are not well documented in pediatric food allergy, except in anaphylaxis.
To evaluate the ability of various tests to diagnose cashew nut allergy and to predict reaction severity. We also investigated changes in tryptase and their correlation to reaction severity.
We performed an open cashew nut challenge on 106 children (aged 1-16 years), who were sensitized to cashew nut with either previous allergic reaction to cashew nut or no known exposure. We analyzed the accuracy of Ana o 3 immunoglobulin E (IgE), cashew nut IgE, skin prick test, basophil activation test (BAT), and combinations thereof to diagnose cashew nut allergy and to predict reaction severity. Tryptase level was measured at the baseline and during an allergic reaction.
A total of 72 children had positive challenge outcomes. Ana o 3 IgE seemed to be the best single test to diagnose cashew allergy, with a 0.97 kU/L cutoff exhibiting 94.1% specificity and 61.1% sensitivity. Though BAT values of at least 22.8% best predicted reaction severity, with 91.7% specificity and 60.7% sensitivity, the cutoffs were age-specific. Tryptase levels increased substantially 1 to 2 hours after the first allergic symptoms compared with baseline.
Ana o 3 IgE seems to be the best diagnostic test in pediatric cashew nut allergy, and test combinations do not seem to improve the diagnostics. Cutoffs are age-specific. BAT is promising in predicting reaction severity. Tryptase levels should be measured 1 to 2 hours after initiation of an allergic reaction.
Diagnosis and Management of Food Allergy
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: Supported in part by a grant from Phadia and in part by a GCRC grant.

: Disclosure of potential conflict of interest: J. M. Maloney has declared that she has no conflict of interest. M. Rudengren and S. Ahlstedt are employed by Phadia. S. A. Bock is employed by Boulder Valley Asthma and Allergy Clinic and is on the speakers' bureau for Dey Pharmaceuticals. H. A. Sampson has consulting arrangements with Allertein and Pioneer International, has received research support from Phadia, and has served as a member of the American Academy of Allergy, Asthma & Immunology, the Food Allergy and Anaphylaxis Network Medical Advisory Board, and the Food Allergy Initiative Scientific Advisory Board.

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Food, drug, insect sting allergy, and anaphylaxisThe use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy

Background

Objectives

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

Food, drug, insect sting allergy, and anaphylaxis
The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy