title: Association of Clinical Reactivity with Sensitization to Allergen Components in Multifood-Allergic Children.
abstract: BACKGROUND
  Thirty percent of children with food allergies have multiple simultaneous allergies; however, the features of these multiple allergies are not well characterized serologically or clinically.
  
  
  OBJECTIVE
  We comprehensively evaluated 60 multifood-allergic patients by measuring serum IgE to key allergen components, evaluating clinical histories and medication use, performing skin tests, and conducting double-blind, placebo-controlled food challenges (DBPCFCs).
  
  
  METHODS
  Sixty participants with multiple food allergies were characterized by clinical history, DBPCFCs, total IgE, specific IgE, and component-resolved diagnostics (IgE and IgG4) data. The food allergens tested were almond, egg, milk, sesame, peanut, pecan, walnut, hazelnut, cashew, pistachio, soy, and wheat.
  
  
  RESULTS
  Our data demonstrate that of the reactions observed during a graded DBPCFC, gastrointestinal reactions occurred more often in boys than in girls, as well as in individuals with high levels of IgE to 2S albumins from cashew, walnut, and hazelnut. Certain food allergies often occurred concomitantly in individuals (ie, cashew/pistachio and walnut/pecan/hazelnut). IgE testing to components further corroborated serological relationships between and among these clustered food allergies.
  
  
  CONCLUSIONS
  Associations of certain food allergies were shown by DBPCFC outcomes as well as by correlations in IgE reactivity to structurally related food allergen components. Each of these criteria independently demonstrated a significant association between allergies to cashew and pistachio, as well as among allergies to walnut, pecan, and hazelnut.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif.
authors.forename: Sandra
authors.initials: S
authors.lastname: Andorf
authors.affiliation: Thermo Fisher Scientific, Immunodiagnostics, Uppsala, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Magnus P
authors.initials: MP
authors.lastname: Borres
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif.
authors.forename: Whitney
authors.initials: W
authors.lastname: Block
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif.
authors.forename: Dana
authors.initials: D
authors.lastname: Tupa
authors.affiliation: Division of General Medicine, Department of Medicine, Stanford University, Stanford, Calif.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Bollyky
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif.
authors.forename: Vanitha
authors.initials: V
authors.lastname: Sampath
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif.
authors.forename: Arnon
authors.initials: A
authors.lastname: Elizur
authors.affiliation: Thermo Fisher Scientific, Immunodiagnostics, Uppsala, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Lidholm
authors.affiliation: Thermo Fisher Scientific, Immunodiagnostics, Kalamazoo, Mich.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Jones
authors.affiliation: Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif; Departments of Pathology and of Microbiology and Immunology, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Galli
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Chinthrajah
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif. Electronic address: knadeau@stanford.edu.
authors.forename: Kari C
authors.initials: KC
authors.lastname: Nadeau
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003429:Cross Reactions; D004527:Egg Proteins / Q000276:immunology; D005260:Female; D005512:Food Hypersensitivity / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008894:Milk Proteins / Q000276:immunology; D018716:Molecular Mimicry; D000068181:Prunus dulcis / Q000276:immunology; D012882:Skin Tests
chemical_list: D000485:Allergens; D004527:Egg Proteins; D008894:Milk Proteins; D007073:Immunoglobulin E
keywords: Component-resolved testing; Double-blind, placebo-controlled food challenge; IgE; Multifood allergy