title: Association of tree nut and coconut sensitizations.
abstract: Coconut (Cocos nucifera), despite being a drupe, was added to the US Food and Drug Administration list of tree nuts in 2006, causing potential confusion regarding the prevalence of coconut allergy among tree nut allergic patients.
  
  
  
  To determine whether sensitization to tree nuts is associated with increased odds of coconut sensitization.
  
  
  
  A single-center retrospective analysis of serum specific IgE levels to coconut, tree nuts (almond, Brazil nut, cashew, chestnut, hazelnut, macadamia, pecan, pistachio, and walnut), and controls (milk and peanut) was performed using deidentified data from January 2000 to August 2012. Spearman correlation (ρ) between coconut and each tree nut was determined, followed by hierarchical clustering. Sensitization was defined as a nut specific IgE level of 0.35 kU/L or higher. Unadjusted and adjusted associations between coconut and tree nut sensitization were tested by logistic regression.
  
  
  
  Of 298 coconut IgE values, 90 (30%) were considered positive results, with a mean (SD) of 1.70 (8.28) kU/L. Macadamia had the strongest correlation (ρ = 0.77), whereas most other tree nuts had significant (P < .05) but low correlation (ρ < 0.5) with coconut. The adjusted odds ratio between coconut and macadamia was 7.39 (95% confidence interval, 2.60-21.02; P < .001) and 5.32 (95% confidence interval, 2.18-12.95; P < .001) between coconut and almond, with other nuts not being statistically significant.
  
  
  
  Our findings suggest that although sensitization to most tree nuts appears to correlate with coconut, this is largely explained by sensitization to almond and macadamia. This finding has not previously been reported in the literature. Further study correlating these results with clinical symptoms is planned.
authors: Section of Allergy/Immunology, Children's Mercy Kansas City, Kansas City, Missouri. Electronic address: bpolk@cmh.edu.
authors: Brooke I
authors: BI
authors: Polk
authors: Division of Computer Science and Electrical Engineering, University of Missouri-Kansas City, Kansas City, MO.
authors: Deendayal
authors: D
authors: Dinakarpandian
authors: Section of Allergy/Immunology, Children's Mercy Kansas City, Kansas City, Missouri.
authors: Maya
authors: M
authors: Nanda
authors: Section of Allergy/Immunology, Children's Mercy Kansas City, Kansas City, Missouri.
authors: Charles
authors: C
authors: Barnes
authors: Section of Allergy/Immunology, Children's Mercy Kansas City, Kansas City, Missouri.
authors: Chitra
authors: C
authors: Dinakar
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003059:Cocos / Q000276:immunology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D039106:Macadamia / Q000276:immunology; D008297:Male; D021184:Nut Hypersensitivity / Q000097:blood / Q000453:epidemiology* / Q000276:immunology; D009754:Nuts / Q000276:immunology*; D016017:Odds Ratio; D000068181:Prunus dulcis / Q000276:immunology; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000485:Allergens; D007073:Immunoglobulin E