How Well Do You Understand Your Walnut, Cashew, Brazil Nut, and/or Hazelnut Allergy? A positive blood or skin prick test to a tree nut means that a person Hazelnut is among the top is sensitized to that tree nut. But sensitization to tree nuts isn’t the whole 5 causes of serious food story. To truly understand your allergy, it helps to understand the tree nut allergic reactions¹ component proteins that your body may be reacting to. What proteins in tree nuts are causing your symptoms? A certain subset of tree nut proteins “look” so much like proteins found in other foods and pollens that the body mistakes these tree nut proteins for their “look-alike” family members such as cross-reactive carbohydrate determinants (CCD) or Profilin. This is called cross-reactivity. If your body is reacting to only these tree nut proteins, you are less likely to be at risk for a severe clinical reaction.2 Alternatively, if you are reactive to the LTP or storage protein family component members, you are more at risk for a severe reaction.2-5 Cross-reactivity Risk Decreasing levels of cross-reactivity Increasing risk to cause a serious allergic reaction Storage CCD Profilin PR-10 LTP Proteins Hazelnut Cor a 1 Cor a 8 Cor a 9, 14 Walnut Jug r 3 Jug r 1 Brazil nut Ber e 1 Cashew nut Ana o 3 What does your specific IgE sensitization mean? KEY: +Sensitized -Non-sensitized Depending on which family of component proteins you’re sensitized to, you’ll have a better idea of how to manage your tree nut allergy. This handy chart breaks it down for you.2,6-9 CCD, Profilin, PR-10 LTP Storage Proteins Oral food challenge (OFC) with a specialist may be recommended. High likelihood that patient may pass OFC. If patient passes an OFC: + - - • Foods prepared with or around the specific tree nut may be consumed. • Patient can consume the specific tree nut as guided by their healthcare provider. • If there is no clinical history of symptoms, please see considerations above. +/- + - • If there is a clinical history of symptoms, please see considerations below. 1. Nicolaou N, Poorafshar M, Murray C, et al. Allergy or tolerance• in children Choose sensitized to peanut: nut-free prevalence and differentiationzones using for component-resolved patient’s diagnostics. safety. J Allergy Clin Immunol. 2010;125(1):191-197. 2. Bradshaw N, A Clinical Reference Guide to Molecular Allergy. Go Molecular! Molecular Allergy –The Basics, 2014. 3. Katelaris CH: Food allergy and oral allergy or pollen-food syndrome. Curr Opin Allergy Clin Immunol 2010, 10:246–251. 4. Asarnoj A, Nilsson C, Lidholm J, et al. Peanut component Ara h 8 sensitization and tolerance to peanut. 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Int Arch of Allergy allergy Immunol. 2011;156(3):282-290. and have 10. Peeters a KA,plan. Koppelman SJ, van Hoffen E, et al. Does skin prick test reactivity to purified allergens correlate with clinical severity of peanut allergy? Clin Exp Allergy. 2007;37(1):108-115. 11. Asarnoj A, Movérare R, Östblom E, et al. IgE to peanut allergen components: relation to peanut symptoms and pollen sensitization in 8-year-olds. Allergy. 2010;65(9):1189-1195. 12. Dang, Thanh, et al. Increasing the accuracy of peanut allergy diagnosis by using Ara H 2. J Allergy Clin Immunol. 2012;129(4):1056-1063. 13. Nicolaou, N, et al. Quantification of specific IgE to whole peanut extract and peanut components in © 2020 Thermo Fisher Scientific Inc. All rights reserved. All predication of peanut allergy. J Allergy Clin Immunol. 2011:1-2. 14. Vereda, A, et al. Peanut allergy: Clinical and immunologic differences among patients from 3 different geographic regions. J Allergy Clin Immunol. 2010;3(2):1-5. 15. Lange L, Beyer K, Kleine-Tebbe J. Benefits and limitations of Astrademarks in all are diagnostic the property of Thermo testing, Fisher Scientificany diagnosis and its or treatmentmolecular diagnostics plan in peanut must allergy. Allergo be J madeInt. 2014;23:158–63. by the 16. clinicianPedrosa, M, et al. basedUtility of specific on IgE testto Ara h results,6 in peanut allergy individual diagnosis. Ann Allergy patient Asthma Immunol. history, 2015;115:108-112. the clinician’s 17. van der Valk, JP,knowledge et al. Mono-sensitisation of to thepeanut patient,component Ara h as6: a casewell series assubsidiaries their unlessclinical otherwise judgment. specified. 100833.AL.US.EN.v1.2019. of five children and literature review. Eur J Pediatr. 2016;175:1227–1234. 18. Sicherer SH, Sampson HA. Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol. 2014;133(2):291-307. 1. Flinterman AE et al. 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Anaphylaxis from Brazil nut. Allergy 54, 1999 / 1004-1013. 9. Schussler E et al. Allergen component testing in the diagnosis of food allergy. Curr Allergy Asthma Rep 2015; 15:55. © 2020 Thermo Fisher Scientific Inc. All rights reserved. All trademarks are the property of Thermo Fisher Scientific and its subsidiaries unless otherwise specified. .