Hazelnut allergen component testing Cor a1 Hazelnut Cor allergens a8 by the Cor numbers a9 Cor a14 Testing for whole allergen proteins can help you better diagnose allergies and prepare personalized management plans. High levels of hazelnut IgE can predict the likelihood of hazelnut sensitivity, but may not be solely predictive of reactions or allergic response.1 Hazelnut allergen component testing Measurement of specific IgE by blood Allergen components, in conjunction test that provides objective assessment with whole-allergen test results, help of sensitization to hazelnut is only the you better diagnose allergies, allowing first step in discovering the likelihood of you to prepare more comprehensive a systemic reaction and the necessary management plans. precautions that may be prescribed. Hazelnut allergen component test results can help determine which specific proteins your patient is sensitized to. Cor Cor Cor a1 a8 a9 Cor a14 LOWER RISK of VARIABLE RISK HIGHER RISK systemic reaction associated with local of systemic reaction primarily associated and systematic reactions including anaphylaxis1,2,8,9 2 2,5,6 with local reactions including anaphylaxis • Heat and digestion stabile10 3 7 • Heat and digestion labile • Heat and digestion stabile • Sensitization to these can • Cross-reactive with • Indicates cross-reactivity, appear early in life and indicates pollens (e.g., birch)1,4 often from a primary peach a primary hazelnut allergy1 sensitization5 Take the diagnosis and management of hazelnut-sensitized patients to a whole new level. RISK ASSESSMENT TEST INTERPRETATIONS AND NEXT STEPS IgE antibodies for Indication Patient Suggestions Test for sensitization to a14 Cor a14 Associated with systemic peanuts and other tree nuts and/or reactions in hazelnut- (e.g., walnuts and Brazil 1,2,8,9 Cor a9 sensitized patients. nuts), as cross-reactivity may If both, avoid raw a9 10,12 occur. as well as roasted/ heated hazelnuts.7 Both local oral symptoms a8 Cor a8 and systemic reactions may occur. 2,6 Typically associated with local reactions although Cor a1 systemic reactions to raw a1 Often tolerate roasted or heated hazelnuts.7 Mono-sensitization hazelnuts may occur in some cases, especially in adults.2 As in all diagnostic testing, a diagnosis must be made by the physician based on test results, individual patient history, the physician’s knowledge of the patient, and the physician’s clinical judgment. Test Name Test Code Test Name Test Code Food Allergy Panel Hazelnut w/Reflexes - Milk, (NTC-2802) f2; IgE Egg white, - Hazelnut f17 IgE with reflex to 94468 (NTC-2801) f1; IgE Peanut, (NTC- component panel 2813) f13; IgE Walnut, (NTC-3489) f256; IgE Corn, (NTC-2808) f8; Nut Mix Group 18 38767 IgE Wheat, (NTC-2804) f4; IgE - IgE allergy testing for: Almond, Soybean, (NTC-2814) f14; IgE (NTC-2820) f20; Cashew nut, (NTC-2608) f202; Coconut, (NTC- Codfish, (NTC-2803) f3; IgE Clam, 7918 (NTC-8929) f207; IgE Shrimp, 2836) f36; Hazelnut, f17; Peanut, (NTC-2824) f24; Total IgE (NTC-2813) f13; Pecan, (NTC- 2864) f201; Sesame seed, (NTC- Food Allergy Profile 2810) f10 - Egg white, (NTC-2801) f1; Milk, (NTC-2802) f2; Codfish, (NTC- Nut Panel 2803) f3; Wheat, (NTC-2804) f4; - Macadamia nut, (NTC-38475); Corn, (NTC-2808) f8; Sesame Pecan, (NTC-2864); Brazil nut, (NTC-2818); Walnut, (NTC- seed, (NTC-2810) f10; Peanut, 10715 94462 (NTC-2813) f13; Soybean, (NTC- 3489); Cashew nut, (NTC-2608); 2814) f14; Shrimp, (NTC-2824) f24; Pistachio, (NTC-2726); Hazelnut; Clam, (NTC-8929) f207; Walnut, Almond, (NTC-2820); Peanut, (NTC-3489) f256; Scallop, (NTC- (NTC-2813)—no reflexes 273) f338 Nut Panel w/Reflexes Food Allergy Profile w/Reflexes - Macadamia nut, (NTC-38475); - Contains all components of the Pecan, (NTC-2864); Brazil nut, Food Allergy Profile (NTC-10715) (with reflex) (NTC-94464); Walnut (with reflexes), (NTC-94467); with reflex to the following 94463 components, with reflex to Egg Cashew nut (with reflexes), (NTC- Component Panel, (NTC-91372); 94465); Pistachio, (NTC-2726); Ovomucoid, (NTC-3046) f233; Hazelnut (with reflexes), (NTC- Ovalbumin, (NTC-2719) f232; Milk 94468); Almond, (NTC-2820); 91682 Component Panel, (NTC-91403); Peanut (with reflex), (NTC-91747) Casein, (NTC-2853) f78; Alpha- Peanut Component Panel lactalbumin, (NTC-2851) f76; - Ara h1, f422; Ara h2, f423; Ara h3, 91681 Beta-lactoglobulin, (NTC-2852) f424; Ara h8, f352; Ara h9 f77; Peanut Component Panel, (NTC-91681) Ara h1, f422; Ara h2, Hazelnut 2817 f423; Ara h3, f424; Ara h8, f352; Ara h9 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 Hazelnut is among the top 5 causes of serious food allergic reactions.11 Optimize management Make a substantiated decision Better differentiation helps you distinguish between primary and cross-reactive sensitization. Make a precise assessment Allergen-component test results can help you asses your patient’s risk for systemic reactions. Make a difference Better differentiation gives relevant information that helps you determine optimal treatments. For more information about hazelnut component testing, contact your local sales representative. References 1. Masthoff L, et al. Sensitization to Cor a 9 and Cor a 14 is highly specific for a severe hazelnut allergy in Dutch children and adults. J Allergy Clin Immunol. 2013(In press). 2. De Knop KJ, et al. Age-related sensitization profiles for hazelnut (Corylus avellana) in a birch-endemic region. Pediatr Allergy Immunol. 2011 Feb; 22(1Pt 2): e139–49. 3. Hansen KS, et al. Roasted hazelnuts-allergenic activity evaluated by double-blind, placebo-controlled food challenge. Allergy. 2003 Feb; 58(2): 132-138. 4. Pastorello EA, et al. Identification of hazelnut major allergens in sensitive patients with positive double-blind, placebo-controlled food challenge results. J Allergy Clin Immunol. 2002; 109(3): 563-570. 5. Lauer I, et al. The non-specific lipid transfer protein, Ara h 9, is an important allergen in peanut. Clinical & Experimental Allergy. 39: 1427–1437. 6. Schocker F, et al. Recombinant lipid transfer protein Cor a 8 from hazelnut: A new tool for in vitro diagnosis of potentially severe hazelnut allergy. J Allergy Clin Immunol. 2004;113:141-7. 7. Masthoff L, et al. A systematic review of the effect of thermal processing on the allergenicity of tree nuts. Allergy. 2013; 68: 983–993. 8. Hansen KS, et al. Component-resolved in vitro diagnosis of hazelnut allergy in Europe. J Allergy Clin Immunol. 2009 Apr 1; 123(5): 1134-1141. 9. Garino C, et al. Isolation, cloning, and characterization of the 2S albumin: A new allergen from hazelnut. Mol Nutr Food Res. 2010; 54: 1257–1265. 10. Asero R, et al. Walnut-induced anaphylaxis with cross-reactivity to hazelnut and Brazil nut. J Allergy Clin Immunol. 2004 Feb; 113(2): 358-360. 11. Flinterman AE, et al. Hazelnut allergy: from pollen-associated mild allergy to severe anaphylactic reactions. Curr Opin Allergy Clin Immunol. 2008 Jun; 8(3): 261-265. 12. Verweij M, et al. Young infants with atopic dermatitis can display sensitization to Cor a 9, an 11S legumin-like seed-storage protein from hazelnut (Corylus avellana). Pediatric Allergy Immnol. 2011; 22: 196-201. 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