Walnut, cashew, and Brazil nut allergen component testing

Jug r1 Walnut, Jug cashew, and r3 Brazil nut allergens by Ana o3 the numbers

Ber e1

Detect sensitizations to the whole nut to create personalized management plans for your patients. Allergen component testing

Measurement of specific IgE by blood test that provides objective assessment of sensitization to the whole nut protein is the first step in discovering the likelihood of a systemic reaction and the necessary precautions that may be prescribed.

Walnut TC 3489 One of the most common causes WHOLE of allergic reactions to tree nuts.1,2 Walnut ALLERGEN • Estimated prevalence of walnut allergy in the general population is up to 0.7%.2

• Potentially life-threatening, increasing in prevalence and rarely outgrown.2,3

Associated with systemic Jug reactions2 r1 • Storage protein (2s albumin) 3,4

4 ALLERGEN • Heat and digestion stable COMPONENTS • Highly abundant in walnut

Associated with local and Jug systemic reactions2 r3 • Lipid transfer protein (LTP)1,4 • Heat and digestion stable

Knowing which Positive whole walnut with negative protein your patient is Jug r1 and Jug r3 results may be explained by sensitization to6: sensitized to can help • Other walnut storage proteins you develop a • Pollen proteins like profilin or PR-10 proteins management plan. • CCD (cross-reacting carbohydrate determinants) Cashew nut Brazil nut TC 2608 TC 2818 Allergy on the rise with increased Hidden allergen often found Cashew consumption in snack foods, Asian Brazil in cookies, insect repellent foods, baked goods, nut butters and and beauty products.12 pestos.8,9 • Extensive cross-reactivity within • Sensitized patients have a risk of experiencing the family can be expected.13 severe allergic reactions; the risk has been • Generally persists and is potentially reported to be even higher than for peanut life-threatening.14 allergic patients (74% vs. 30%).7

• Potentially life-threatening, can start early in 1,9 life and is rarely outgrown. Associated with systemic Ber reactions15 e1 • Storage protein (2s albumin)12 • Resistant to digestion by pepsin, Associated with systemic and a major allergen12 Ana 8 reactions • Very stable to gastric digestion12 o3 8 • Storage protein (2s albumin) • Major allergen in Brazil nut12 • Heat and digestion stable1,4 • Highly abundant in cashew nut

Positive 2608 with negative Ana o3 Positive 2818 with negative Ber e1 results may be explained by results may be explained by sensitization to6: sensitization to6: • Other cashew nut storage proteins or lipid • Other Brazil nut storage proteins or lipid transfer protein (LTP) transfer protein (LTP) • Pollen proteins like profilin or PR-10 proteins • Pollen proteins like profilin or PR-10 proteins • CCD (cross-reacting carbohydrate • CCD (cross-reacting carbohydrate determinants) determinants) Test Name Test Code Test Name Test Code

Brazil Nut w/Reflexes Food Allergy Profile w/Reflexes - Brazil nut, f18; IgE with reflex to 94464 - Contains all components of the Food component Allergy Profile (NTC-10715) with reflex to the following components, with reflex to Egg Component Panel, (NTC-91372); Cashew Nut w/Reflexes Ovomucoid, (NTC-3046) f233; Ovalbumin, - Cashew nut, f202; IgE with reflex to 94465 (NTC-2719) f232; Milk Component Panel, 91682 component (NTC-91403); Casein, (NTC-2853) f78; Alpha-lactalbumin, (NTC-2851) f76; Beta- Childhood Allergy Profile lactoglobulin, (NTC-2852) f77; Peanut - D. pteronyssinus (House mite), (NTC- Component Panel, (NTC-91681); Ara h1, 2721) d1; D. farinae (House mite), (NTC- f422; Ara h2, f423; Ara h3, f424; Ara h8, 2722) d2; Cat dander, (NTC-2601) e1; Dog f352; Ara h9 dander, (NTC-2605) e5; Egg white, (NTC- 2801) f1; Milk, (NTC-2802) f2; Codfish, Nut Mix Group 18 (NTC-2803) f3; Wheat, (NTC-2804) 10659 - IgE allergy testing for: Almond, (NTC- f4; Peanut, (NTC-2813) f13; Soybean, 2820) f20; Cashew nut, f202; Coconut, 7918 (NTC-2814) f14; Shrimp, (NTC-2824) f24; (NTC-2836) f36; Hazelnut, (NTC-2817) f17; Walnut, f256; Cockroach, (NTC-2736) i6; Peanut, (NTC-2813) f13; Pecan, (NTC- Cladosporium herbarum, (NTC-2702) m2; 2864) f201; Sesame seed, (NTC-2810) f10 Alternaria alternata, (NTC-2706) m6; Total IgE Nut Panel - Macadamia nut, (NTC-38475); Pecan, Childhood Allergy Profile w/Reflexes (NTC-2864); Brazil nut; Walnut; Cashew 94462 - Contains all components of the nut; Pistachio, (NTC-2726); Hazelnut, Childhood Allergy Profile (NTC-10659) (NTC-2817); Almond, (NTC-2820); Peanut, with reflex to the following components, (NTC-2813) Egg Component Panel, (NTC-91372); Ovomucoid, (NTC-3046) f233; Ovalbumin, (NTC-2719) f232; Milk Component Panel, 91683 Nut Panel w/Reflexes (NTC-91403); Casein, (NTC-2853) f78; - Macadamia nut, (NTC-38475); Pecan nut, Alpha-lactalbumin, (NTC-2851) f76; Beta- (NTC-2864); Brazil nut, (with reflexes) lactoglobulin, (NTC-2852) f77; Peanut (NTC-94464); Walnut, (with reflexes) Component Panel, (NTC-91681) Ara h1, (NTC-94467); Cashew nut, (with reflexes) 94463 f422; Ara h2, f423; Ara h3, f424; Ara h8, (NTC-94465); Pistachio, (NTC-2726); f352; Ara h9 Hazelnut, (with reflexes) (NTC-94468); Almond, (NTC-2820); Peanut, (with reflex) (NTC-91747) Food Allergy Panel - Milk, (NTC-2802) f2; IgE Egg white, (NTC- 2801) f1; IgE Peanut, (NTC-2813) f13; IgE Walnut w/Reflexes Walnut, f256; IgE Corn, (NTC-2808) f8; - Walnut, f256; IgE with reflex to 94467 38767 IgE Wheat, (NTC-2804) f4; IgE Soybean, component panel (NTC-2814) f14; IgE Codfish, (NTC-2803) f3; IgE Clam, (NTC-8929) f207; IgE Shrimp, Brazil nut 2818 (NTC-2824) f24; Total IgE Cashew nut 2608 Food Allergy Profile - Egg white, (NTC-2801) f1; Milk, (NTC- Walnut 3489 2802) f2; Codfish, (NTC-2803) f3; Wheat, (NTC-2804) f4; Corn, (NTC-2808) f8; Sesame seed, (NTC-2810) f10; Peanut, 10715 (NTC-2813) f13; Soybean, (NTC-2814) f14; Shrimp, (NTC-2824) f24; Clam, (NTC- 8929) f207; Walnut, f256; Scallop, (NTC- 273) f338

Multiple test codes are available. Refer to the Quest Diagnostics Directory of Services or the online Test Center (QuestDiagnostics.com/testcenter) for test information. NTC = National test code Diagnose by the numbers.

Assess risks for systemic reactions and cross-reactivity.

Address anxiety with individualized management plans.

Enable confidence in dietary and lifestyle choices. For more information about walnut, cashew, and Brazil nut component testing, contact your local sales representative.

References

1. Roux K, et al. Tree nut allergens. Int Arch Allergy Immunology. 2003; 131: 234-244. 2. Pastorello E, et al. Lipid transfer protein and vicilin are important walnut allergens in patients not allergic to pollen. J Allergy Clin Immunol. 2004; 114(4): 908-914. 3. Rosenfeld L, et al. Walnut allergy in peanut-allergic patients: significance of sequential epitopes of walnut homologous to linear epitopes of Ara h 1, 2 and 3 in relation to clinical reactivity. Int Arch Allergy Immunol. 2012; 157:238-245. 4. Masthoff L, et al. A systematic review of the effect of thermal processing on the allergenicity of tree nuts. Allergy. 2013; 68: 983-993. 5. Egger M, et al. The role of lipid transfer proteins in allergic diseases. Curr Allergy Asthma Rep. 2010; 10:326-335. 6. www.phadia.com 7. Davoren M, et al. Cashew nut allergy is associated with a high risk of anaphylaxis. Arch Dis Child. 2005; 90(10): 1084-1085. 8. Robotham J, et al. Ana o 3, an important cashew nut (Anacardium occidentale L.) allergen of the 2S albumin family. J Allergy Clin Immunol. 2005; 115(6): 1284-1290. 9. Clark A, et al. Cashew nut causes more severe reactions than peanut: case-matched comparison in 141 children. Allergy. 2007; 62(8): 913-916. 10. Wang F, et al. Ana o 2, a major cashew (Anacardium occidentale L.) nut allergen of the legumin family. Int Arch Allergy Immunol. 2003 Sep; 132(1): 27-39. 11. Borja J, et al. Anaphylaxis from Brazil nut. Allergy. 54, 1999 / 1004-1013. 12. www.phadia.com/en/Products/Allergy-testing-products/ImmunoCAP-Allergen-Information/Food-of-Plant-Origin/Seeds--Nuts/Brazil-nut-/ 13. Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala, Sweden. 1982: ISBN 91-970475-09. 14. Bartolome B, Mendez JD, Armentia A, Vallverdu A, Palacios R. Allergens from Brazil nut: immunochemical characterization. Allergol Immunopathol (Madr) 1997;25(3):135-144. 15. Sicherer SH, Sampson HA. Peanut and tree nut allergy. Curr Opin Pediatr 2000;12(6):567-573.

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