Diagnostic evaluation of allergy to tree nuts and seeds

Doctoral Dissertation uoadl:2779212 934 Read counter

Τομέας Υγείας - Μητέρας - Παιδιού
Library of the School of Health Sciences
Deposit date:
Savvatianos Savvas
Dissertation committee:
Μαρία Τσολιά, Καθηγήτρια, Ιατρική, ΕΚΠΑ
Νικόλαος Παπαδόπουλος, Καθηγητής, Ιατρική, ΕΚΠΑ
Δάφνη-Λορέττα Θωμαϊδου,Αναπληρώτρια Καθηγήτρια, Ιατρική, ΕΚΠΑ
Αρτεμισία Τσίτσικα, Επίκουρη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Παρασκευή Ξεπαπαδάκη, Επίκουρη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Νικόλαος Σπυρίδης, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Αλεξάνδρα Σολδάτου, Επίκουρη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Original Title:
Διερεύνηση αλλεργίας σε ξηρούς καρπούς και σπόρους
Translated title:
Diagnostic evaluation of allergy to tree nuts and seeds
Cashew and pistachio are closely related species and food allergies to these two tree nuts are strongly associated. Conventional extract-based IgE-testing is suboptimally diagnostic, as there is considerable overlap between allergic and tolerant patients with respect to IgE levels, and no clear decision points. We therefore sought to determine the added value of component based testing in the diagnosis of cashew and pistachio allergy by analyzing sera from 100 children with recently documented clinical allergy to cashew and/or pistachio for IgE against recombinant cashew 2S albumin rAna o 3, conventional cashew/pistachio extracts and selected tree-nut components by ImmunoCAP. Sera from 64 children with proven tolerance to cashew/pistachio were used as controls.
The rAna o 3 assay demonstrated the best diagnostic characteristics for both cashew and pistachio allergy, yielding a near-perfect area under the ROC curve (98% for both). At the 0.35 kUA/L cut-off, Ana o 3 ImmunoCAP demonstrated similar sensitivity as the cashew ImmunoCAP (94% vs. 95%), but with greatly improved specificity (97% vs. 63%) for diagnosis of cashew allergy. Due to extensive cross-reactivity confirmed by IgE-inhibition experiments, the assay performed equally well when discriminating pistachio-allergic from pistachio-tolerant children, with a sensitivity and specificity of 92% and 97%, respectively.
Furthermore, by analyzing sera from a large group of children allergic to cashew/pistachio, citrus fruit (lemon, orange) seeds and other tree nuts, a high degree of IgE cross-reactivity between proteins of Rutaceae fruit seeds and those of closely related Anacardiaceae family nuts (cashew, pistachio) was documented, to a significant extent mediated by cashew 2S albumin Ana o 3 and its homologous citrus seed allergen. With the use of reciprocal IgEbinding inhibition studies, we identified cashew and/or pistachio nut protein as the primary sensitizing source in the large majority of orange/lemon seed allergy cases, while providing valuable mechanistic and clinical insight into the under-recognized entity of IgE-mediated citrus fruit seed allergy.
Main subject category:
Health Sciences
Ana o 3, Cashew, Food allergy, Pistachio, Tree nut
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