Clinical features of cashew allergy

2. CHAPMAN MD, HAYMANN PW, WILKINS SR, BROWN MB, PLATTS-MILLS TAE. Monoclonal immunoassay for the major dust mite (Dermatophagoides) allergens, Der p I and Der f I, and quantitative analysis of the allergen content of mite and house dust extracts. J Allergy Clin Immunol 1987;80:184±194. 3. KHARITONOV SA, BARNES PJ. Exhaled nitric oxide: a marker of airway in¯ammation? Curr Opin Anesthesiol 1996;9:542±548. Clinical features of cashew allergy Figure 1. Relationship between difference in ENO level at T0±T1 and HDM group I antigens in study group. J. O'B Hourihane*, H. Harris, S. Langton-Hewer, S. A. Kilburn, J. O. Warner Key words: allergy; cashew nut; fatal reactions. the beginning of the study (T0). The regular The results of this study reinforce the idea . CASHEW has recently become widely treatment with inhaled steroids was that the environmental control measures available in the form of butter spreads. gradually withdrawn in all the subjects. need to be made as effective as possible to Cashew causes symptoms in formal food None of the subjects had received inhaled achieve the most complete reduction of challenges (1) and has caused death (2). A steroid treatment for at least 1 month before HDM in the environment of allergic report found 0.08% of British 4-year-olds to T1. asthmatic patients, particularly their beds. be allergic to The study was approved by the Istituto Pio XII ethics committee, and both children and their parents gave informed consent. The correlations between the differences cashew (3), and *Clinica Pediatrica Policlinico Borgo Roma 37134 Verona Italy 40% of 142 French peanut- A potentially lifethreatening disorder. allergic subjects of ENO levels at T0 and T1 (T0±T1) and the Tel. +39 45 8074615 were found to be sensitized to cashew (4). levels of HDM antigens in the beds of the Fax: +39 45 8200993 We report here the clinical features of patients before T0 were tested by E-mail: boner@borgoroma.univr.it cashew allergy in 29 paediatric and adult Spearman's rank correlation test. The correlation between these values showed a value of r=0.618 (P=0.026) (Fig. 1). In this study, we con®rm that ENO subjects whose history of reaction was Accepted for publication 2 November 2000 Allergy 2001: 56:251±252 Copyright # Munksgaard 2001 cashew or a raised serum level of cashew- ISSN 0105-4538 speci®c IgE. Two subjects had positive open measurement is a sensitive means to monitor avoidance of antigen exposure in asthmatic children allergic to HDM. The relevance of the effect of the original level of exposure to supported by a positive skin prick test to challenges to cashew. This study was References 1. PIACENTINI GL, BODINI A, COSTELLA S, et al. Allergen avoidance is associated with a fall in exhaled nitric oxide in asthmatic children. approved by the Southampton Joint Ethics Subcommittee. The age range of the 29 subjects was 1±30 HDM on ENO reduction after HDM J Allergy Clin Immunol years (median 7.5 years). Nineteen (65%) of avoidance is even more evident if it 1999;104:1323±1324. the subjects were female. Twenty-six (89%) considered that this statistically signi®cant subjects were children (under 16 years). The level of correlation was achieved in a small median age of onset was 49 months (range 2 group of patients. months±27 years), and 96% of subjects had 252 not knowingly been exposed to cashew London WC1N 1EH before the exposure causing the ®rst UK reaction. Fourteen subjects (48%) reacted to Accepted for publication 31 October 2000 Complete blood count and coagulation assay revealed hemoglobin, 13.8 g/dl; white blood cells, 18.53109/l with 40% minimal contact with cashew; that is, Allergy 2001: 56:252±253 eosinophils; platelets, 803109/l; smelling, touching, or tasting, but not Copyright # Munksgaard 2001 prothrombin time 16 s (control 12 s); eating, cashew. No one reported more than ISSN 0105-4538 activated partial four reactions. Twenty-one subjects (72%) had suffered only one reaction to cashew, ®ve (17%) had suffered two reactions, and only three had experienced more than two reactions. Fourteen subjects (48%) reported wheeze after ®rst exposure, and 11 (38%) reported collapse or feeling faint. This series describes features of nonfatal reactions to cashew. These features include References 1. BOCK SA, ATKINS FM. The natural history of peanut allergy. J Allergy Clin Immunol 1989;83:900±904. 2. SAMPSON HA, MENDELSON L, ROSEN JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med 1992;327:380±384. 3. TARIQ SM, STEVENS M, MATTHEWS S, thromboplastin A case of transient time 32 s hypereosinophilia and (control: 28 s); embolism. and D-dimers, 4000 (normal range: 0±200). Oxygen saturation was 90%. Chest radiography demonstrated diffuse bilateral in®ltrates. A diagnosis of bilateral pulmonary RIDOUT S, TWISELTON R, HIDE DW. Cohort study of peanut and tree nut sensitisation by embolism was con®rmed by both the severity of cashew allergy (at least equal to that of peanut allergy), the importance of age of 4 years. BMJ angiography. Additional thrombi at the left which is counterbalanced by the relative 1996;313(7056):514±517. rarity of accidental exposure to cashew, compared to peanut (1, 5), and the later age of onset of cashew allergy (5, 6). The young age of onset of peanut allergy has been attributed to the availability and convenience of peanut butter as a spread. By anecdotal evidence, parents have started to 4. MONERET VD, RANCE F, KANNY G, et al. Food allergy to peanuts in France ± pulmonary perfusion scintigraphy and deep femoral, anterior tibial, and right hepatic veins were detected by ultrasound evaluation of 142 observations. Clin Exp Doppler. Because of worsening hemoptysis Allergy 1998;28:1113±1119. and dyspnea, along with the life-threatening 5. HOURIHANE JO'B, KILBURN SA, DEAN P, WARNER JO. Clinical characteristics of peanut allergy. Clin Exp Allergy 1997;27:634±639. 6. SICHERER SH, BURKS AW, SAMPSON HA. throboembolic phenomena, a titanium Green®eld ®lter was implanted in the inferior vena cava to prevent further emboli, followed by IV heparin and avoid peanut butter, in line with UK Clinical features of acute allergic reactions glucocorticosteroids. Subsequently, there government advice, especially if there is a to peanut and tree nuts in children. was gradual fever resolution, respiratory positive family history of allergy. We have Pediatrics 1998;102:e6. improvement, and normalization of blood seen cashew-allergic families who had been tests within the following week. After 2 avoiding peanut butter and started using cashew butter instead, unaware of the potential for reactions of at least equivalent weeks, the patient was discharged with Widespread thromboembolism in allergy severity to peanut-allergic reactions. Cashew K. Sade*, I. Schwartz, E. Lev, S. Kivity, Y. Levo decrease in age of onset of cashew allergy may become evident over time. Allergists and other physicians must be Further examinations revealed no other underlying immunologic or thrombotic butter is now widely available in the UK, and it is reasonable to speculate that a warfarin and prednisone treatment. Key words: allergy; asthma; Aureobasidium pullulans; eosinophilia; pulmonary embolism; thromboembolism. aware that although cashew avoidance is diathesis conditions. Blood, urine, and stool cultures were all negative, but sputum obtained from the patient on the day of admission grew black yeast identi®ed as Aureobasidium pullulans. After 1-year follow-up and without easier than peanut avoidance, cashew . A 19-year-old man was referred to our further complication, warfarin was allergy represents a threat to life that is at department with fever of 388C, dyspnea, and discontinued. Prednisone was stopped least as severe as that posed to peanut- or pleuritic chest pain lasting over 10 days. His gradually after 6 weeks, and the eosinophilia past medical history was signi®cant only for did not return. tree-nut-allergic subjects by the respective allergenic foods. mild intermittent asthma, occasionally Allergic reaction to saprophytic fungi treated with salbutamol. His physical may cause three pulmonary manifestations Institute of Child Health condition was normal except for tachycardia of clinical relevance: hypersensitivity 30 Guilford Street (120/min) and tachypnea (26/min). pneumonitis, IgE-mediated asthma, and *Immunobiology Unit 253