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Clinical and Molecular Characterization of Walnut and Pecan Allergy (NUT CRACKER Study).

Authors
  • Elizur, Arnon1
  • Appel, Michael Y2
  • Nachshon, Liat3
  • Levy, Michael B2
  • Epstein-Rigbi, Naama2
  • Pontoppidan, Bo4
  • Lidholm, Jonas4
  • Goldberg, Michael R2
  • 1 Institute of Allergy, Immunology and Pediatric Pulmonology and Department of Pediatrics, Yitzhak Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: [email protected] , (Israel)
  • 2 Institute of Allergy, Immunology and Pediatric Pulmonology and Department of Pediatrics, Yitzhak Shamir Medical Center, Zerifin, Israel. , (Israel)
  • 3 Institute of Allergy, Immunology and Pediatric Pulmonology and Department of Pediatrics, Yitzhak Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. , (Israel)
  • 4 Thermo Fisher Scientific, Uppsala, Sweden. , (Sweden)
Type
Published Article
Journal
The journal of allergy and clinical immunology. In practice
Publication Date
Jan 01, 2020
Volume
8
Issue
1
Identifiers
DOI: 10.1016/j.jaip.2019.08.038
PMID: 31513892
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Diagnostic methods for distinguishing walnut-allergic patients from walnut-sensitized but walnut-tolerant individuals are limited. Furthermore, characteristics of single walnut versus dual walnut-pecan allergy are lacking. To provide clinical and molecular characteristics of walnut- and pecan-allergic patients. A prospective cohort study of 76 walnut-sensitized patients was performed. Walnut skin prick test and serum measurements of specific IgE to walnut and its components were performed. Patients were challenged to walnut and pecan unless they regularly consumed walnut and pecan. Of the 76 patients studied, 61 were diagnosed as walnut-allergic and 15 as walnut-tolerant. IgE levels greater than or equal to 0.35 kUA/L to Jug r 1 or 4 provided the best diagnostic method for identifying walnut-allergic patients (accuracy, 0.93). Of the 61 walnut-allergic patients, 49 were pecan-allergic whereas 12 were pecan-tolerant. None of the walnut-tolerant patients was allergic to pecan. Dual allergic patients had significantly lower walnut reaction dose (median, 100 mg vs 1230 mg; P < .001). IgE levels greater than or equal to 0.35 kUA/L to Jug r 4, low-molecular-weight vicilins, or high-molecular-weight vicilins best segregated dual walnut-pecan-allergic patients from single walnut-allergic patients. Inhibition studies demonstrated that walnut pretreatment completely blocked IgE binding to pecan, whereas in some patients, pecan incubation only partially blocked IgE binding to walnut. Walnut components are helpful in diagnosing walnut allergy and in identifying patients with pecan coallergy. Competitive ELISA indicates that pecan comprises a subset of the allergenic determinants of walnut. Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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