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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.
