title: Sensitization to Cor a 9 and Cor a 14 is highly specific for a hazelnut allergy with objective symptoms in Dutch children and adults.
abstract: BACKGROUND
  Component-resolved diagnosis has been shown to improve the diagnosis of food allergy.
  
  
  OBJECTIVE
  We sought to evaluate whether component-resolved diagnosis might help to identify patients at risk of objective allergic reactions to hazelnut.
  
  
  METHODS
  A total of 161 hazelnut-sensitized patients were included: 40 children and 15 adults with objective symptoms on double-blind, placebo-controlled food challenges (DBPCFCs) and 24 adults with a convincing objective history were compared with 41 children and 41 adults with no or subjective symptoms on DBPCFCs (grouped together). IgE levels to hazelnut extract and single components were analyzed with ImmunoCAP.
  
  
  RESULTS
  IgE levels to hazelnut extract were significantly higher in children with objective than with no or subjective symptoms. In 13% of children and 49% of adults with hazelnut allergy with objective symptoms, only sensitization to rCor a 1.04 was observed and not to other water-soluble allergens. Sensitization to rCor a 8 was rare, which is in contrast to rCor a 1. Sensitization to nCor a 9, rCor a 14, or both was strongly associated with hazelnut allergy with objective symptoms. By using adapted cutoff levels, a diagnostic discrimination between severity groups was obtained. IgE levels to either nCor a 9 of 1 kUA/L or greater or rCor a 14 of 5 kUA/L or greater (children) and IgE levels to either nCor a 9 of 1 kUA/L or greater or rCor a 14 of 1 kUA/L or greater (adults) had a specificity of greater than 90% and accounted for 83% of children and 44% of adults with hazelnut allergy with objective symptoms.
  
  
  CONCLUSIONS
  Sensitization to Cor a 9 and Cor a 14 is highly specific for patients with objective symptoms in DBPCFCs as a marker for a more severe hazelnut allergic phenotype.
authors.affiliation: Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands. L.J.N.Masthoff@umcutrecht.nl
authors.forename: Laury J N
authors.initials: LJ
authors.lastname: Masthoff
authors.forename: Lars
authors.initials: L
authors.lastname: Mattsson
authors.forename: Laurian
authors.initials: L
authors.lastname: Zuidmeer-Jongejan
authors.forename: Jonas
authors.initials: J
authors.lastname: Lidholm
authors.forename: Kerstin
authors.initials: K
authors.lastname: Andersson
authors.forename: Jaap H
authors.initials: JH
authors.lastname: Akkerdaas
authors.forename: Serge A
authors.initials: SA
authors.lastname: Versteeg
authors.forename: Cristiano
authors.initials: C
authors.lastname: Garino
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Meijer
authors.forename: Petra
authors.initials: P
authors.lastname: Kentie
authors.forename: Astrid
authors.initials: A
authors.lastname: Versluis
authors.forename: Constance F
authors.initials: CF
authors.lastname: den Hartog Jager
authors.forename: Carla A F M
authors.initials: CA
authors.lastname: Bruijnzeel-Koomen
authors.forename: André C
authors.initials: AC
authors.lastname: Knulst
authors.forename: Ronald
authors.initials: R
authors.lastname: van Ree
authors.forename: Els
authors.initials: E
authors.lastname: van Hoffen
authors.forename: Suzanne G M A
authors.initials: SG
authors.lastname: Pasmans
mesh_terms: D000485:Allergens / Q000009:adverse effects / Q000276:immunology*; D052179:Antigens, Plant / Q000009:adverse effects / Q000276:immunology*; D002648:Child; D031211:Corylus / Q000009:adverse effects / Q000276:immunology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D021184:Nut Hypersensitivity / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology*; D010940:Plant Proteins / Q000009:adverse effects / Q000276:immunology*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012882:Skin Tests; D055815:Young Adult
chemical_list: D000485:Allergens; D052179:Antigens, Plant; C000594310:Cor a 14 allergen, hazelnut; D010940:Plant Proteins; D007073:Immunoglobulin E
keywords: AUC; Area under the curve; CCD; Component-resolved diagnosis; Cross-reactive carbohydrate determinant; DBPCFC; Double-blind, placebo-controlled food challenge; diagnostics; double-blind; food allergy; hazelnut allergy; placebo-controlled food challenge; severity