title: Hazelnut allergy across Europe dissected molecularly: A EuroPrevall outpatient clinic survey.
abstract: BACKGROUND
  Hazelnut allergy is birch pollen-driven in Northern/Western Europe and lipid transfer protein-driven in Spain and Italy. Little is known about other regions and other allergens.
  
  
  OBJECTIVE
  Establishing a molecular map of hazelnut allergy across Europe.
  
  
  METHODS
  In 12 European cities, subjects reporting reactions to hazelnut (n = 731) were evaluated and sensitization to 24 foods, 12 respiratory allergen sources, and latex was tested by using skin prick test and ImmunoCAP. A subset (124 of 731) underwent a double-blind placebo-controlled food challenge to hazelnut. Sera of 423 of 731 subjects were analyzed for IgE against 7 hazelnut allergens and cross-reactive carbohydrate determinants by ImmunoCAP.
  
  
  RESULTS
  Hazelnut allergy was confirmed in 70% of those undergoing double-blind placebo-controlled food challenges. Birch pollen-driven hazelnut sensitization (Cor a 1) dominated in most cities, except in Reykjavik, Sofia, Athens, and Madrid, where reporting of hazelnut allergy was less frequent anyhow. In Athens, IgE against Cor a 8 dominated and strongly correlated with IgE against walnut, peach, and apple and against Chenopodium, plane tree, and mugwort pollen. Sensitization to seed storage proteins was observed in less than 10%, mainly in children, and correlated with IgE to nuts, seeds, and legumes. IgE to Cor a 12, observed in all cities (10% to 25%), correlated with IgE to nuts, seeds, and pollen.
  
  
  CONCLUSIONS
  In adulthood, the importance of hazelnut sensitization to storage proteins, oleosin (Cor a 12), and Cor a 8 is diluted by the increased role of birch pollen cross-reactivity with Cor a 1. Cor a 8 sensitization in the Mediterranean is probably driven by diet in combination with pollen exposure. Hazelnut oleosin sensitization is prevalent across Europe; however, the clinical relevance remains to be established.
authors.affiliation: Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Mareen R
authors.initials: MR
authors.lastname: Datema
authors.affiliation: Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Laurian
authors.initials: L
authors.lastname: Zuidmeer-Jongejan
authors.affiliation: Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Asero
authors.affiliation: Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Barreales
authors.affiliation: Pediatric Department, Faculty Hospital Bulovka, Prague, Czech Republic.
authors.forename: Simona
authors.initials: S
authors.lastname: Belohlavkova
authors.affiliation: Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: de Blay
authors.affiliation: Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Bures
authors.affiliation: Faculty of Medicine, University of Iceland, Landspitali University Hospital, Reykjavik, Iceland.
authors.forename: Michael
authors.initials: M
authors.lastname: Clausen
authors.affiliation: Medical Faculty, Vilnius University, Vilnius, Lithuania.
authors.forename: Ruta
authors.initials: R
authors.lastname: Dubakiene
authors.affiliation: Faculty of Medicine, University of Iceland, Landspitali University Hospital, Reykjavik, Iceland.
authors.forename: David
authors.initials: D
authors.lastname: Gislason
authors.affiliation: Department of Immunology, Rheumatology and Allergy, Faculty of Medicine, Medical University of Lodz, Lodz, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Jedrzejczak-Czechowicz
authors.affiliation: Department of Immunology, Rheumatology and Allergy, Faculty of Medicine, Medical University of Lodz, Lodz, Poland.
authors.forename: Marek L
authors.initials: ML
authors.lastname: Kowalski
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: André C
authors.initials: AC
authors.lastname: Knulst
authors.affiliation: Clinic of Allergy and Asthma, Medical University of Sofia, Sofia, Bulgaria.
authors.forename: Tanya
authors.initials: T
authors.lastname: Kralimarkova
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Thuy-My
authors.initials: TM
authors.lastname: Le
authors.affiliation: Department of Plant Biology and Crop Science, Rothamsted Research, Harpenden, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Lovegrove
authors.affiliation: Institute of Inflammation and Repair, Manchester Institute of Biotechnology, University of Manchester, Manchester, United Kingdom.
authors.forename: Justin
authors.initials: J
authors.lastname: Marsh
authors.affiliation: Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece; Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, United Kingdom.
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Papadopoulos
authors.affiliation: Division of Allergology, Paul-Ehrlich-Insitut, Federal Institute for Vaccines and Biomedicines, Langen, Germany.
authors.forename: Todor
authors.initials: T
authors.lastname: Popov
authors.affiliation: Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.
authors.forename: Náyade
authors.initials: N
authors.lastname: Del Prado
authors.affiliation: Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Ashok
authors.initials: A
authors.lastname: Purohit
authors.affiliation: Division of Allergology, Paul-Ehrlich-Insitut, Federal Institute for Vaccines and Biomedicines, Langen, Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Reese
authors.affiliation: Allergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Reig
authors.affiliation: Department of Clinical Immunology, St Mary's Hospital, and Imperial College London, London, United Kingdom.
authors.forename: Suranjith L
authors.initials: SL
authors.lastname: Seneviratne
authors.affiliation: Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Sinaniotis
authors.affiliation: Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Serge A
authors.initials: SA
authors.lastname: Versteeg
authors.affiliation: Division of Allergology, Paul-Ehrlich-Insitut, Federal Institute for Vaccines and Biomedicines, Langen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Vieths
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.affiliation: Institute of Inflammation and Repair, Manchester Institute of Biotechnology, University of Manchester, Manchester, United Kingdom.
authors.forename: Clare
authors.initials: C
authors.lastname: Mills
authors.affiliation: Phadia AB, Uppsala, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Lidholm
authors.affiliation: Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria.
authors.forename: Karin
authors.initials: K
authors.lastname: Hoffmann-Sommergruber
authors.affiliation: Allergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Fernández-Rivas
authors.affiliation: Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Ballmer-Weber
authors.affiliation: Department of Experimental Immunology, Academic Medical Center, Amsterdam, The Netherlands; Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: r.vanree@amc.uva.nl.
authors.forename: Ronald
authors.initials: R
authors.lastname: van Ree
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000276:immunology*; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D052179:Antigens, Plant / Q000276:immunology*; D029662:Betula / Q000737:chemistry / Q000276:immunology; D002352:Carrier Proteins / Q000276:immunology; D031211:Corylus / Q000737:chemistry / Q000276:immunology*; D003429:Cross Reactions; D004311:Double-Blind Method; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D021184:Nut Hypersensitivity / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology / Q000503:physiopathology; D011058:Pollen / Q000276:immunology; D012882:Skin Tests
chemical_list: D000485:Allergens; D052179:Antigens, Plant; D002352:Carrier Proteins; C527352:Cor a 8 allergen, Corylus avellana; C030363:lipid transfer protein; C510904:oleosin, Corylus avellana; D007073:Immunoglobulin E
keywords: EuroPrevall; component-resolved diagnosis; hazelnut allergy; outpatient clinic