Cashew Leads Tree Nut-Induced Anaphylaxis in Children
In over 1000 cases of physician-diagnosed episodes of tree nut-induced anaphylaxis (TIA), tree nuts accounted for 23% of all reported episodes of food-induced anaphylaxis, establishing their role as major food allergens. Cashew emerged as the most frequent elicitor of TIA in children, whereas hazelnut was the leading cause of TIA in adults.
METHODOLOGY:
Researchers collected data from the European Anaphylaxis Registry between 2007 and April 2024, involving 142 specialized allergy centers across Brazil and 13 countries in Europe.
A total of 1389 cases of TIA were documented, with the specific elicitor confirmed in 1083 cases: 845 children (median age, 4 years; 61% boys) and 238 adults (median age, 38 years; 60% women).
Phenotype-specific features characterized by age distributions, symptoms, and the severity of the reaction and the presence of potential cofactors and comorbidities were identified, and time trends and regional patterns of TIA were analyzed.
TAKEAWAY:
Among children, cashew elicited 40% of TIA cases, followed by hazelnut (25%) and walnut (17%). In adults, hazelnut (44%) was the leading cause, followed by walnut (20%) and almond (15%).
Children reacted to smaller amounts than adults, with 76% of children and 20% of adults reacting to less than a tablespoon of cashew ( P = .015). Similar patterns were observed for hazelnut, walnut, and other tree nuts.
= .015). Similar patterns were observed for hazelnut, walnut, and other tree nuts. Previous reactions to the allergen that caused TIA were reported in 25% of children and 33% of adults, yet only 23% of children and 21% of adults were aware of their tree nut allergy beforehand.
Only 13% of children and 3% of adults received adrenaline during lay treatment compared with 42% of children and 39% of adults who received it during professional treatment.
IN PRACTICE:
'Primary prevention to avoid tree nut allergy in general is necessary, followed by the education of patients about the potential role of cofactors, which were present in up to 50% of affected adults and which might have increased the reaction severity from otherwise mild to anaphylactic reactions,' the authors of this study wrote.
SOURCE:
Margitta Worm, with Charité – Universitätsmedizin Berlin, Berlin, Germany, was the corresponding author of the study, which was published online on June 13 in Allergy .
LIMITATIONS:
This study was limited by the under-representation of adults, missing data on fatal cases, and the prevalence of TIA in general. Additionally, the data derived from specialized allergy centers might have led to a bias toward more severe or initial reactions.
DISCLOSURES:
This work was supported by NORA e.V., Deutsche Forschungsgemeinschaft, Bundesministerium für Bildung und Forschung, the Swiss National Science Foundation, the Swiss Cancer Research Foundation, and the EU-H2020-MSCA-COFUND EURIdoc program. Some authors reported providing consultation and speaker/advisor services or receiving grants, research funding, honoraria or consultation fees, or payment for presentations from various pharmaceutical and other companies. One author reported holding stocks in EssilorLuxottica.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Medscape
an hour ago
- Medscape
Intensive Bevacizumab Boosts Vision in Macular Degeneration
Dutch patients with neovascular age-related macular degeneration (AMD) who initiated bevacizumab achieved greater long-term improvements in visual acuity than patients in socioeconomically similar countries in which patients started ranibizumab or aflibercept — likely because of early and more intensive treatment in the Netherlands. METHODOLOGY: Researchers evaluated the long-term outcomes of anti-VEGF therapy for neovascular AMD in the Netherlands — where bevacizumab is the mandated first-line drug — to assess if improvements in vision were superior to those in socioeconomically similar countries using ranibizumab or aflibercept. They analyzed 5-year data from the Fight Retinal Blindness! registry, comparing outcomes for 1473 eyes in 1229 patients treated with bevacizumab (Dutch cohort) with those for 7144 eyes in 5884 patients receiving aflibercept or ranibizumab (reference cohort). Patients enrolled in the registry after January 1, 2016, with at least 6 months of follow-up and no prior history of treatment with an anti-VEGF agent were included in the analysis. Primary outcome measures were mean visual acuity at yearly intervals until 60 months, and secondary outcomes included injection frequency and rates of switching to alternative anti-VEGF agents. TAKEAWAY: At 60 months, mean visual acuity among patients in the Dutch cohort was 2.3 letters higher than that of patients in reference cohort; eyes with poor baseline vision in the Dutch cohort showed sustained improvements through month 60, whereas their counterparts in the reference cohort regressed to poor vision within 3 years. Patients in the Dutch cohort received 14.5 more injections over 5 years than those in the reference cohort, indicating a more aggressive treatment approach. At 60 months, the Dutch cohort also showed higher rates of switching to alternative anti-VEGF agents than the reference cohort (70.9% vs 51.9%), with a shorter median time to switching (11.9 vs 17.7 months), suggesting ophthalmologists in the Netherlands were quicker to change therapy when patients exhibited a poor response to treatment. IN PRACTICE: 'There is little evidence to suggest that the higher visual outcomes for the Dutch group are due to the choice of drug as bevacizumab has not been shown to be superior to other anti-VEGF drugs,' the researchers wrote. 'The head-to-head trials against ranibizumab, IVAN and CATT, only demonstrated that bevacizumab was not inferior. The higher visual gain is likely to result from a more aggressive injection frequency' as well as a higher visual acuity at baseline. SOURCE: The study was led by H. Mhmud and J. P. Vermeulen, of the Department of Ophthalmology at Erasmus Medical Center in Rotterdam, the Netherlands. It was published online on June 15, 2025, in Ophthalmology and Therapy . LIMITATIONS: A key limitation noted by the researchers was the lack of information about specific treatment regimens used. Decisions about treatment were made by the individual clinicians, and little is known about the reason behind their choices. Reasons for loss to follow-up were recorded for less than 20% of patients. DISCLOSURES: This study did not receive any funding. The authors declared having no conflicts of interest.
Medscape
an hour ago
- Medscape
Common Psychiatric Meds Tied to Increased ALS Risk
Prescribed use of anxiolytics, hypnotics and sedatives, or antidepressants was associated with a significantly increased risk for future development of amyotrophic lateral sclerosis (ALS) and a worse prognosis after diagnosis compared to nonuse, a large case-control study showed. METHODOLOGY: This nested case-control study included data from the Swedish Motor Neuron Disease Quality Registry for more than 1000 patients with ALS (mean age at index date, 67.5 years; 53% men) diagnosed between 2015 and 2023. The patients were matched for age and sex with more than 5000 population control individuals. Researchers examined the prescribed use, defined as having at least two prescriptions of psychiatric medications prior to ALS diagnosis, including anxiolytics, hypnotics and sedatives, and antidepressants. Disease progression rate was calculated at diagnosis, and functional decline was calculated at diagnosis and over a median follow-up duration of 1.3 years using ALS Functional Rating Scale-Revised (ALSFRS-R) scores. Covariates included age, sex, socioeconomic status, country of birth, and educational level. TAKEAWAY: After adjusting for covariates, the prescribed use of psychiatric medications overall was significantly associated with increased risk for ALS across all time windows before diagnosis. Odds ratios (ORs) for ALS among individuals prescribed hypnotics and sedatives 0-1 years before diagnosis, those prescribed anxiolytics 1-5 years before diagnosis, and those prescribed antidepressants more than 5 years before diagnosis were 6.1, 1.6, and 1.2, respectively. After excluding the year before ALS diagnosis, use of antidepressants (OR, 1.3), anxiolytics (OR, 1.3), or hypnotics and sedatives (OR, 1.2) was still linked to increased ALS risk. Compared with nonuse, use of anxiolytics (adjusted hazard ratio [HR], 1.5) or antidepressants (HR, 1.72) before ALS diagnosis was associated with shorter survival in patients with ALS. After multiple adjustments, patients with ALS who used antidepressants before diagnosis had significantly lower ALSFRS-R scores at diagnosis and a faster rate of functional decline (β = -2.5). IN PRACTICE: 'These findings suggest a potential link between psychiatric medications, or their indications (ie, psychiatric disorders), and the risk and progression of ALS,' the investigators wrote. Still, Ammar Al-Chalabi, PhD, professor of neurology and complex disease genetics, King's College London, London, England, said in a statement from the Science Media Centre that the associated effect on disease risk was small 'except in the year immediately before diagnosis,' when there are already symptoms of motor neuron disease. 'At most it represents a 25% increase in relative risk, which for a condition with a 1 in 300 lifetime risk, is not a big change,' added Al-Chalabi, who was not involved with the research. SOURCE: This study was led by Charilaos Chourpiliadis, MD, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. It was published online on June 04 in JAMA Network Open . LIMITATIONS: Psychiatric medications were prescribed for overlapping conditions, limiting indication specificity. Exposure misclassification was possible because of the lack of data on continuous use after the first prescription, and potential risks for overmatching in relative comparisons and residual confounding existed. Additionally, genetic data, including the statusof the C9orf72 variant, were incomplete and may have affected the findings' generalizability. The analyses of ALS progression may have also lacked generalizability because they were restricted to regions with complete clinical data. DISCLOSURES: The study was funded by the European Research Council Starting Grant, CDC, and Swedish Research Council. Two of the seven investigators reported having consulting and other roles with or receiving grant support from various pharmaceutical companies and research organizations outside the submitted work. Full details are provided in the original article.
Medscape
2 hours ago
- Medscape
Post-Acute COVID Biomarker Patterns Vary by Symptom and Time
In patients with post-acute sequelae of SARS-CoV-2 infection (PASC), biomarker profiles varied according to symptom type and time since infection, and levels of inflammatory biomarkers (IFN gamma and CD163) and vascular activation biomarkers (VCAM-1 and ICAM-1) showed strong correlations with specific long-COVID symptoms. METHODOLOGY: PASC affects a considerable number of people after mild acute SARS-CoV-2 infection, but data on its pathophysiologic mechanisms remain limited. In this study, researchers explored symptoms associated with PASC and examined its association with a range of blood biomarkers. They included participants with prior SARS-CoV-2 infection either asymptomatic or without persistent symptoms categorized into recovered (n = 490) and PASC (n = 311) groups, using data from three French population-based cohorts collected between February 2020 and October 2021. Participants received two home visits at baseline and 6 months for biological sample collection and completed questionnaires covering medical history, infection status, vaccination status, symptoms, and mental health. Researchers assessed 14 blood biomarkers, including cytokines, chemokines, immune checkpoints, cell adhesion molecules, and markers of macrophage activation and vascular damage, which are known to be involved in the pathophysiologic mechanisms of SARS-CoV-2 infection. TAKEAWAY: Participants with PASC commonly reported persistent fatigue, breathlessness, cough, and sleep disorders, along with higher rates of depression and anxiety. Inflammatory biomarkers linked to COVID-19 severity (IFN gamma and CD163) and vascular activation markers (VCAM-1 and ICAM-1) showed significant correlations with specific PASC symptoms, particularly among participants infected within the past year; however, these associations largely disappeared over time. Viral activation markers (PD-L1 and IP-10) were positively associated with acute-phase symptoms such as anosmia/ageusia and cough, particularly in recent infections. Complete symptom resolution was more common among participants with recent infections (< 1 year ago) than among those infected a year ago, occurring in 38% vs 20% of cases ( P = .04). Overall, 74% of individuals experienced a resolution of at least one symptom. IN PRACTICE: 'Biomarker profiles appear to vary according to symptom type and the time elapsed since infection. Consequently, research efforts and treatment strategies should take these parameters into account,' the authors wrote. SOURCE: This study was led by Olivier Robineau, Sorbonne Université, Inserm, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, Paris, France. It was published online on May 30, 2025, in eBioMedicine . LIMITATIONS: Individuals with more severe symptoms may have been particularly motivated to participate, introducing selection bias. Additionally, as most biomarker measurements were taken long after participants' initial infection and only a few participants had recent infections, the ability to identify associations specific to the acute phase was likely diminished. DISCLOSURES: This study received funding from the French Ministry of Health and Prevention and the French Ministry of Higher Education, Research and Innovation. Two authors disclosed receiving financial support from Gilead, ViiV, MSD, Moderna, or Pfizer or nonfinancial support from Nordic Pharma France.
