Walnut, cashew, and Brazil nut allergens by the numbers

Walnut, cashew, and Brazil nut allergen component testing

Jug

r1

Ber

e1

Ana

o3

Jug

r3

Detect sensitizations to the whole nut to create personalized management plans for your patients.

One of the most common causes of allergic reactions to tree nuts.1,2

• Estimated prevalence of walnut allergy in the general population is up to 0.7%.2

• Potentially life-threatening, increasing in prevalence and rarely outgrown.2,3

ALLERGEN COMPONENTS

WHOLE ALLERGEN

Positive whole walnut with negative Jug r1 and Jug r3 results may be explained by sensitization to6:• Other walnut storage proteins

• Pollen proteins like profilin or PR-10 proteins

• CCD (cross-reacting carbohydrate determinants)

Jug

r1

Walnut

Allergen component testing Measurement of specific IgE by blood test that provides objective assessment of sensitization to the whole nut protein is the first step in discovering the likelihood of a systemic reaction and the necessary precautions that may be prescribed.

Walnut

Knowing which protein your patient is sensitized to can help you develop a management plan.

Jug

r3

Associated with systemic reactions2

• Storage protein (2s albumin) 3,4

• Heat and digestion stable4

• Highly abundant in walnut

Associated with local and systemic reactions2

• Lipid transfer protein (LTP)1,4

• Heat and digestion stable

TC 3489

Allergy on the rise with increased consumption in snack foods, Asian foods, baked goods, nut butters and pestos.8,9

• Sensitized patients have a risk of experiencing severe allergic reactions; the risk has been reported to be even higher than for peanut allergic patients (74% vs. 30%).7

• Potentially life-threatening, can start early in life and is rarely outgrown.1,9

Hidden allergen often found in cookies, insect repellent and beauty products.12

• Extensive cross-reactivity within the family can be expected.13

• Generally persists and is potentially life-threatening.14

Positive 2608 with negative Ana o3 results may be explained by sensitization to6:• Other cashew nut storage proteins or lipid

transfer protein (LTP)

• Pollen proteins like profilin or PR-10 proteins

• CCD (cross-reacting carbohydrate determinants)

Positive 2818 with negative Ber e1 results may be explained by sensitization to6:• Other Brazil nut storage proteins or lipid

transfer protein (LTP)

• Pollen proteins like profilin or PR-10 proteins

• CCD (cross-reacting carbohydrate determinants)

Ana

o3

Ber

e1

Brazil

Cashew nut Brazil nut

Associated with systemic reactions8

• Storage protein (2s albumin)8

• Heat and digestion stable1,4

• Highly abundant in cashew nut

Associated with systemic reactions15

• Storage protein (2s albumin)12

• Resistant to digestion by pepsin, and a major allergen12

• Very stable to gastric digestion12

• Major allergen in Brazil nut12

TC 2818

Cashew

TC 2608

Test Name Test Code

Brazil Nut w/Reflexes - Brazil nut, f18; IgE with reflex to

component94464

Cashew Nut w/Reflexes - Cashew nut, f202; IgE with reflex to

component94465

Childhood Allergy Profile - D. pteronyssinus (House mite), (NTC-

2721) d1; D. farinae (House mite), (NTC-2722) d2; Cat dander, (NTC-2601) e1; Dog dander, (NTC-2605) e5; Egg white, (NTC-2801) f1; Milk, (NTC-2802) f2; Codfish, (NTC-2803) f3; Wheat, (NTC-2804) f4; Peanut, (NTC-2813) f13; Soybean, (NTC-2814) f14; Shrimp, (NTC-2824) f24; Walnut, f256; Cockroach, (NTC-2736) i6; Cladosporium herbarum, (NTC-2702) m2; Alternaria alternata, (NTC-2706) m6; Total IgE

10659

Childhood Allergy Profile w/Reflexes - Contains all components of the

Childhood Allergy Profile (NTC-10659) with reflex to the following components, Egg Component Panel, (NTC-91372); Ovomucoid, (NTC-3046) f233; Ovalbumin, (NTC-2719) f232; Milk Component Panel, (NTC-91403); Casein, (NTC-2853) f78; Alpha-lactalbumin, (NTC-2851) f76; Beta-lactoglobulin, (NTC-2852) f77; Peanut Component Panel, (NTC-91681) Ara h1, f422; Ara h2, f423; Ara h3, f424; Ara h8, f352; Ara h9

91683

Food Allergy Panel - Milk, (NTC-2802) f2; IgE Egg white, (NTC-

2801) f1; IgE Peanut, (NTC-2813) f13; IgE Walnut, f256; IgE Corn, (NTC-2808) f8; IgE Wheat, (NTC-2804) f4; IgE Soybean, (NTC-2814) f14; IgE Codfish, (NTC-2803) f3; IgE Clam, (NTC-8929) f207; IgE Shrimp, (NTC-2824) f24; Total IgE

38767

Food Allergy Profile - Egg white, (NTC-2801) f1; Milk, (NTC-

2802) f2; Codfish, (NTC-2803) f3; Wheat, (NTC-2804) f4; Corn, (NTC-2808) f8; Sesame seed, (NTC-2810) f10; Peanut, (NTC-2813) f13; Soybean, (NTC-2814) f14; Shrimp, (NTC-2824) f24; Clam, (NTC-8929) f207; Walnut, f256; Scallop, (NTC-273) f338

10715

Test Name Test CodeFood Allergy Profile w/Reflexes - Contains all components of the Food

Allergy Profile (NTC-10715) with reflex to the following components, with reflex to Egg Component Panel, (NTC-91372); Ovomucoid, (NTC-3046) f233; Ovalbumin, (NTC-2719) f232; Milk Component Panel, (NTC-91403); Casein, (NTC-2853) f78; Alpha-lactalbumin, (NTC-2851) f76; Beta-lactoglobulin, (NTC-2852) f77; Peanut Component Panel, (NTC-91681); Ara h1, f422; Ara h2, f423; Ara h3, f424; Ara h8, f352; Ara h9

91682

Nut Mix Group 18 - IgE allergy testing for: Almond, (NTC-

2820) f20; Cashew nut, f202; Coconut, (NTC-2836) f36; Hazelnut, (NTC-2817) f17; Peanut, (NTC-2813) f13; Pecan, (NTC-2864) f201; Sesame seed, (NTC-2810) f10

7918

Nut Panel - Macadamia nut, (NTC-38475); Pecan,

(NTC-2864); Brazil nut; Walnut; Cashew nut; Pistachio, (NTC-2726); Hazelnut, (NTC-2817); Almond, (NTC-2820); Peanut, (NTC-2813)

94462

Nut Panel w/Reflexes - Macadamia nut, (NTC-38475); Pecan nut,

(NTC-2864); Brazil nut, (with reflexes) (NTC-94464); Walnut, (with reflexes) (NTC-94467); Cashew nut, (with reflexes) (NTC-94465); Pistachio, (NTC-2726); Hazelnut, (with reflexes) (NTC-94468); Almond, (NTC-2820); Peanut, (with reflex) (NTC-91747)

94463

Walnut w/Reflexes - Walnut, f256; IgE with reflex to

component panel94467

Brazil nut 2818

Cashew nut 2608

Walnut 3489

Multiple test codes are available. Refer to the Quest Diagnostics Directory of Services or the online Test Center (QuestDiagnostics.com/testcenter) for test information.

NTC = National test code

Assess risks for systemic reactions and cross-reactivity.

Address anxiety with individualized management plans.

Enable confidence in dietary and lifestyle choices.

Diagnose by the numbers.

References

1. Roux K, et al. Tree nut allergens. Int Arch Allergy Immunology. 2003; 131: 234-244.

2. Pastorello E, et al. Lipid transfer protein and vicilin are important walnut allergens in patients not allergic to pollen. J Allergy Clin Immunol. 2004; 114(4): 908-914.

3. Rosenfeld L, et al. Walnut allergy in peanut-allergic patients: significance of sequential epitopes of walnut homologous to linear epitopes of Ara h 1, 2 and 3 in relation to clinical reactivity. Int Arch Allergy Immunol. 2012; 157:238-245.

4. Masthoff L, et al. A systematic review of the effect of thermal processing on the allergenicity of tree nuts. Allergy. 2013; 68: 983-993.

5. Egger M, et al. The role of lipid transfer proteins in allergic diseases. Curr Allergy Asthma Rep. 2010; 10:326-335.

6. www.phadia.com

7. Davoren M, et al. Cashew nut allergy is associated with a high risk of anaphylaxis. Arch Dis Child. 2005; 90(10): 1084-1085.

8. Robotham J, et al. Ana o 3, an important cashew nut (Anacardium occidentale L.) allergen of the 2S albumin family. J Allergy Clin Immunol. 2005; 115(6): 1284-1290.

9. Clark A, et al. Cashew nut causes more severe reactions than peanut: case-matched comparison in 141 children. Allergy. 2007; 62(8): 913-916.

10. Wang F, et al. Ana o 2, a major cashew (Anacardium occidentale L.) nut allergen of the legumin family. Int Arch Allergy Immunol. 2003 Sep; 132(1): 27-39.

11. Borja J, et al. Anaphylaxis from Brazil nut. Allergy. 54, 1999 / 1004-1013.

12. www.phadia.com/en/Products/Allergy-testing-products/ImmunoCAP-Allergen-Information/Food-of-Plant-Origin/Seeds--Nuts/Brazil-nut-/

13. Yman L. Botanical relations and immunological cross-reactions in pollen allergy. 2nd ed. Pharmacia Diagnostics AB. Uppsala, Sweden. 1982: ISBN 91-970475-09.

14. Bartolome B, Mendez JD, Armentia A, Vallverdu A, Palacios R. Allergens from Brazil nut: immunochemical characterization. Allergol Immunopathol (Madr) 1997;25(3):135-144.

15. Sicherer SH, Sampson HA. Peanut and tree nut allergy. Curr Opin Pediatr 2000;12(6):567-573.

QuestDiagnostics.comQuest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics. All third-party marks—® and ™—are the property of their respective owners. © 2017 Quest Diagnostics Incorporated. All rights reserved. SB5994 05/2017

For more information about walnut, cashew, and Brazil nut component testing, contact your local sales representative.