Low percentage of clinically relevant pistachio nut and mango co-sensitisation in cashew nut sensitised children.
BACKGROUND
Cashew nut, pistachio nut and mango belong to theAnacardiaceaefamily and are botanically related. Therefore, cashew nut sensitised children are frequently advised to eliminate cashew nuts and pistachio nuts from their diet. The 'Improvement of Diagnostic mEthods for ALlergy assessment (IDEAL trial number NTR3572) study showed that cashew nut sensitised children were co-sensitised to pistachio nut in 98% of cases and to mango in 21% of cases. The aim of this follow-up study to IDEAL is to assess the clinical relevance of co-sensitisation to pistachio nut and mango in cashew nut sensitised children.


METHODS
Children were recruited from the study: 'Improvement of Diagnostic mEthods for ALlergy assessment (IDEAL trial number NTR3572). Inclusion criterion for the IDEAL study was sensitization to cashew nut as demonstrated by either SPT or sIgE, and a clinical history of reactions to cashew nuts or no previous (known) exposure. Sensitized children who were tolerant to cashew nuts were excluded. Inclusion criterion for this IDEAL follow-up study was co-sensitization to pistachio nut, regardless the result of the DBPCFC with cashew nut. In this follow-up study a double-blind placebo-controlled food challenge with pistachio nut and an open food challenge with mango were performed.


RESULTS
Twenty-nine children (mean age of 11.6 years, 62% male) were included. Pistachio nut sensitisation was clinically relevant in only 34% of cashew-sensitised children and only 31% of cashew challenge positive children. None of the children was challenge positive to mango.


CONCLUSIONS
Although co-sensitisation between cashew nut and pistachio nut was observed in 98%, pistachio nut sensitisation was only clinically relevant in 34% of the children. Therefore, a challenge test with pistachio nut is recommended in children with cashew nut and pistachio nut sensitisation.Trial registrationThe study was registered in the Dutch trial register (registration number 3572) on 10 August 2012 (retrospectively registered).
Department of Internal Medicine, Section of Allergology, Erasmus MC, Office Gk 323, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
J P M
JPM
van der Valk
Department of Internal Medicine, Section of Allergology, Erasmus MC, Office Gk 323, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
R El
RE
Bouche
Department of Internal Medicine, Section of Allergology, Erasmus MC, Office Gk 323, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
R
R
Gerth van Wijk
Department of Paediatric Allergology, Diaconessenhuis Voorburg, RdGG, Delft, The Netherlands.
H
H
de Groot
Food and Biobased Research, Wageningen University and Research Centre, Wageningen, The Netherlands.
H J
HJ
Wichers
Department of Paediatric Pulmonology and Paediatric Allergology, University Medical Centre Groningen, GRIAC Research Institute, University of Groningen, Groningen, The Netherlands.
A E J
AEJ
Dubois
Department of Internal Medicine, Section of Allergology, Erasmus MC, Office Gk 323, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
N W
NW
de Jong
Cashew nut allergy; Children; Co-sensitisation; Food challenge test; Mango allergy; Pistachio nut allergy