Clinical and laboratory characteristics of cashew nut allergy in Korean children: Findings from a tertiary hospital
Main Article Content
Keywords
anaphylaxis, cashew nut allergy, children, immediate type allergy, tree nut allergy
Abstract
Objective: Cashew nut (CN) allergy is becoming increasingly prevalent and represents a major cause of tree nut-induced anaphylaxis in Korean children. This study investigated the clinical characteristics and laboratory findings of CN allergy in Korean children.
Patients and methods: Sixty-four children with a history of CN ingestion, who underwent serum CN-specific immunoglobulin E (CN-sIgE) measurements from January 2013 to February 2023, were enrolled through a retrospective medical record review. The demographic characteristics, clinical profiles, and laboratory findings were evaluated.
Result: Thirty-five patients had immediate-type reactions after exposure to CN (CN-allergic group), whereas 29 showed no symptoms after ingesting CN (CN-tolerant group). Over 60% of patients in the CN-allergic group were allergic to ≥ 1 other tree nuts and 17.1% had peanut allergies. In the CN-allergic group, cutaneous symptoms were most common (94.1%), followed by respiratory (35.3%), gastrointestinal (32.4%), and cardiovascular (2.9%) symptoms. Anaphylaxis due to CN exposure was observed in 51.4% of patients in the CN-allergic group. The median CN-sIgE level of the CN-allergic group was significantly higher than that of the CN-tolerant group (5.5 kUA/L vs. 0.06 kUA/L, P < 0.001). The optimal cutoff level for distinguishing the CN-allergic group from the CN-tolerant group was 0.55 kUA/L (sensitivity 94.29%, specificity 93.10%).
Conclusion: Co-allergies to other tree nuts were common in children with CN allergy and more than 50% of patients with CN allergy experienced anaphylaxis. The optimal cutoff level for distinguishing between the CN-allergic and CN-tolerant groups was 0.55 kUA/L.
References
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12 Sasaki M, Koplin JJ, Dharmage SC, Field MJ, Sawyer SM, McWilliam V, et al. Prevalence of clinic-defined food allergy in early adolescence: The schoolnuts study. J Allergy Clin Immunol. 2018;141:391–8 e4. 10.1016/j.jaci.2017.05.041
13 Ducharme L, Gabrielli S, Clarke AE, Morris J, Gravel J, Lim R, et al. Tree nut-induced anaphylaxis in Canadian emergency departments: Rate, clinical characteristics, and management. Ann Allergy Asthma Immunol. 2022;129:335–41. 10.1016/j.anai.2022.06.008
14 Lee SY, Ahn K, Kim J, Jang GC, Min TK, Yang HJ, et al. A multicenter retrospective case study of anaphylaxis triggers by age in Korean children. Allergy Asthma Immunol Res. 2016;8:535–40. 10.4168/aair.2016.8.6.535
15 Jeong K, Lee SY, Ahn K, Kim J, Lee HR, Suh DI, et al. A multicenter study on anaphylaxis caused by peanut, tree nuts, and seeds in children and adolescents. Allergy. 2017;72:507–10. 10.1111/all.13096
16 Dolle-Bierke S, Hofer V, Francuzik W, Naher AF, Bilo MB, Cichocka-Jarosz E, et al. Food-induced anaphylaxis: Data from the European Anaphylaxis Registry. J Allergy Clin Immunol Pract. 2023;11:2069–79 e7. 10.1016/j.jaip.2023.03.026
17 Robotham JM, Wang F, Seamon V, Teuber SS, Sathe SK, Sampson HA, et al. Ana o 3, an important cashew nut (Anacardium occidentale L.) allergen of the 2S albumin family. J Allergy Clin Immunol. 2005;115:1284–90. 10.1016/j.jaci.2005.02.028
18 Blazowski L, Majak P, Kurzawa R, Kuna P, Jerzynska J. Food allergy endotype with high risk of severe anaphylaxis in children—Monosensitization to cashew 2S albumin Ana o 3. Allergy. 2019;74:1945–55. 10.1111/all.13810
19 Brettig T, Dang T, McWilliam V, Peters RL, Koplin JJ, Perrett KP. The accuracy of diagnostic testing in determining tree nut allergy: A systematic review. J Allergy Clin Immunol Pract. 2021;9:2028–49 e2. 10.1016/j.jaip.2020.12.048
20 McWilliam V, Peters RL, Allen KJ, Dharmage SC, Ponsonby AL, Tang MLK, et al. Skin prick test predictive values for the outcome of cashew challenges in children. J Allergy Clin Immunol Pract. 2020;8:141–8 e2. 10.1016/j.jaip.2019.05.057
21 Elizur A, Appel MY, Nachshon L, Levy MB, Epstein-Rigbi N, Golobov K, et al. NUT co-reactivity–Acquiring knowledge for elimination recommendations (NUT CRACKER) study. Allergy. 2018;73:593–601. 10.1111/all.13353
22 Riggioni C, Ricci C, Moya B, Wong D, van Goor E, Bartha I, et al. Systematic review and meta-analyses on the accuracy of diagnostic tests for IgE-mediated food allergy. Allergy. 2024;79:324–52. 10.1111/all.15939
23 Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF, Jr., Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med. 2006;47:373–80. 10.1016/j.annemergmed.2006.01.018
24 van der Valk JP, Dubois AE, Gerth van Wijk R, Wichers HJ, de Jong NW. Systematic review on cashew nut allergy. Allergy. 2014;69:692–8. 10.1111/all.12401
25 Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372:803–13. 10.1056/NEJMoa1414850
26 Peters RL, Barret DY, Soriano VX, McWilliam V, Lowe AJ, Ponsonby AL, et al. No cashew allergy in infants introduced to cashew by age 1 year. J Allergy Clin Immunol. 2021;147:383–4. 10.1016/j.jaci.2020.07.003
27 McWilliam VL, Koplin JJ, Allen K, Robinson M, Smart J, Loke P, et al. TreEAT trial: Protocol for a randomized controlled trial investigating the efficacy and safety of early introduction of tree nuts for the prevention of tree nut allergy in infants with peanut allergy. Pediatr Allergy Immunol. 2023;34:e13930. 10.1111/pai.13930
28 Maloney JM, Rudengren M, Ahlstedt S, Bock SA, Sampson HA. The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy. J Allergy Clin Immunol. 2008;122:145–51. 10.1016/j.jaci.2008.04.014
29 Couch C, Franxman T, Greenhawt M. Characteristics of tree nut challenges in tree nut allergic and tree nut sensitized individuals. Ann Allergy Asthma Immunol. 2017;118:591–6 e3. 10.1016/j.anai.2017.02.010
30 Brough HA, Caubet JC, Mazon A, Haddad D, Bergmann MM, Wassenberg J, et al. Defining challenge-proven coexistent nut and sesame seed allergy: A prospective multicenter European study. J Allergy Clin Immunol. 2020;145:1231–9. 10.1016/j.jaci.2019.09.036
31 Abrams EM, Becker AB. Oral food challenge outcomes in a pediatric tertiary care center. Allergy Asthma Clin Immunol. 2017;13:43. 10.1186/s13223-017-0215-8
32 Dobbertin-Welsch J, Staudacher O, Yurek S, Trendelenburg V, Tschirner S, Ziegert M, et al. Organ-specific symptom patterns during oral food challenge in children with peanut and tree nut allergy. Pediatr Allergy Immunol. 2022;33:e13778. 10.1111/pai.13778
33 Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: Summary of the NIAID-sponsored expert panel report. J Allergy Clin Immunol. 2010;126:1105–18. 10.1016/j.jaci.2010.10.007
34 Venkatachalam M, Monaghan EK, Kshirsagar HH, Robotham JM, O’Donnell SE, Gerber MS, et al. Effects of processing on immunoreactivity of cashew nut (Anacardium occidentale L.) seed flour proteins. J Agric Food Chem. 2008;56:8998–9005. 10.1021/jf801199q
35 Santos AF, Riggioni C, Agache I, Akdis CA, Akdis M, Alvarez-Perea A, et al. EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy. 2023;78:3057–76. 10.1111/all.15906
36 Fleischer DM, Conover-Walker MK, Matsui EC, Wood RA. The natural history of tree nut allergy. J Allergy Clin Immunol 2005 Nov;116(5):1087–93. 10.1016/j.jaci.2005.09.002
2 Jackson KD, Howie LD, Akinbami LJ. Trends in allergic conditions among children: United States, 1997–2011. NCHS Data Brief. 2013:1–8.
3 Ahn K, Kim J, Hahm MI, Lee SY, Kim WK, Chae Y, et al. Prevalence of immediate-type food allergy in Korean schoolchildren: A population-based study. Allergy Asthma Proc. 2012;33:481–7. 10.2500/aap.2012.33.3598
4 Kim M, Lee JY, Jeon HY, Yang HK, Lee KJ, Han Y, et al. Prevalence of immediate-type food allergy in Korean schoolchildren in 2015: A nationwide, population-based study. Allergy Asthma Immunol Res. 2017;9:410–6. 10.4168/aair.2017.9.5.410
5 McWilliam V, Koplin J, Lodge C, Tang M, Dharmage S, Allen K. The prevalence of tree nut allergy: A systematic Review. Curr Allergy Asthma Rep. 2015;15:54. 10.1007/s11882-015-0555-8
6 Sicherer SH, Munoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol. 2010;125:1322–6. 10.1016/j.jaci.2010.03.029
7 Motosue MS, Bellolio MF, Van Houten HK, Shah ND, Campbell RL. National trends in emergency department visits and hospitalizations for food-induced anaphylaxis in US children. Pediatr Allergy Immunol. 2018;29:538–44. 10.1111/pai.12908
8 Jeong K, Kim J, Ahn K, Lee SY, Min TK, Pyun BY, et al. Age-based causes and clinical characteristics of immediate-type food allergy in Korean children. Allergy Asthma Immunol Res. 2017;9:423–30. 10.4168/aair.2017.9.5.423
9 Jeong K, Ye YM, Kim SH, Kim KW, Kim JH, Kwon JW, et al. A multicenter anaphylaxis registry in Korea: Clinical characteristics and acute treatment details from infants to older adults. World Allergy Organ J. 2020;13:100449. 10.1016/j.waojou.2020.100449
10 McWilliam V, Peters R, Tang MLK, Dharmage S, Ponsonby AL, Gurrin L, et al. Patterns of tree nut sensitization and allergy in the first 6 years of life in a population-based cohort. J Allergy Clin Immunol. 2019;143:644–50 e5. 10.1016/j.jaci.2018.07.038
11 Sun X, Zhao J, Wang Q, Shi G, Yang J, Ming L. Prevalence of allergen sensitization among 15,534 patients with suspected allergic diseases in Henan province, China. Asian Pac J Allergy Immunol. 2019;37:57–64.
12 Sasaki M, Koplin JJ, Dharmage SC, Field MJ, Sawyer SM, McWilliam V, et al. Prevalence of clinic-defined food allergy in early adolescence: The schoolnuts study. J Allergy Clin Immunol. 2018;141:391–8 e4. 10.1016/j.jaci.2017.05.041
13 Ducharme L, Gabrielli S, Clarke AE, Morris J, Gravel J, Lim R, et al. Tree nut-induced anaphylaxis in Canadian emergency departments: Rate, clinical characteristics, and management. Ann Allergy Asthma Immunol. 2022;129:335–41. 10.1016/j.anai.2022.06.008
14 Lee SY, Ahn K, Kim J, Jang GC, Min TK, Yang HJ, et al. A multicenter retrospective case study of anaphylaxis triggers by age in Korean children. Allergy Asthma Immunol Res. 2016;8:535–40. 10.4168/aair.2016.8.6.535
15 Jeong K, Lee SY, Ahn K, Kim J, Lee HR, Suh DI, et al. A multicenter study on anaphylaxis caused by peanut, tree nuts, and seeds in children and adolescents. Allergy. 2017;72:507–10. 10.1111/all.13096
16 Dolle-Bierke S, Hofer V, Francuzik W, Naher AF, Bilo MB, Cichocka-Jarosz E, et al. Food-induced anaphylaxis: Data from the European Anaphylaxis Registry. J Allergy Clin Immunol Pract. 2023;11:2069–79 e7. 10.1016/j.jaip.2023.03.026
17 Robotham JM, Wang F, Seamon V, Teuber SS, Sathe SK, Sampson HA, et al. Ana o 3, an important cashew nut (Anacardium occidentale L.) allergen of the 2S albumin family. J Allergy Clin Immunol. 2005;115:1284–90. 10.1016/j.jaci.2005.02.028
18 Blazowski L, Majak P, Kurzawa R, Kuna P, Jerzynska J. Food allergy endotype with high risk of severe anaphylaxis in children—Monosensitization to cashew 2S albumin Ana o 3. Allergy. 2019;74:1945–55. 10.1111/all.13810
19 Brettig T, Dang T, McWilliam V, Peters RL, Koplin JJ, Perrett KP. The accuracy of diagnostic testing in determining tree nut allergy: A systematic review. J Allergy Clin Immunol Pract. 2021;9:2028–49 e2. 10.1016/j.jaip.2020.12.048
20 McWilliam V, Peters RL, Allen KJ, Dharmage SC, Ponsonby AL, Tang MLK, et al. Skin prick test predictive values for the outcome of cashew challenges in children. J Allergy Clin Immunol Pract. 2020;8:141–8 e2. 10.1016/j.jaip.2019.05.057
21 Elizur A, Appel MY, Nachshon L, Levy MB, Epstein-Rigbi N, Golobov K, et al. NUT co-reactivity–Acquiring knowledge for elimination recommendations (NUT CRACKER) study. Allergy. 2018;73:593–601. 10.1111/all.13353
22 Riggioni C, Ricci C, Moya B, Wong D, van Goor E, Bartha I, et al. Systematic review and meta-analyses on the accuracy of diagnostic tests for IgE-mediated food allergy. Allergy. 2024;79:324–52. 10.1111/all.15939
23 Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF, Jr., Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med. 2006;47:373–80. 10.1016/j.annemergmed.2006.01.018
24 van der Valk JP, Dubois AE, Gerth van Wijk R, Wichers HJ, de Jong NW. Systematic review on cashew nut allergy. Allergy. 2014;69:692–8. 10.1111/all.12401
25 Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372:803–13. 10.1056/NEJMoa1414850
26 Peters RL, Barret DY, Soriano VX, McWilliam V, Lowe AJ, Ponsonby AL, et al. No cashew allergy in infants introduced to cashew by age 1 year. J Allergy Clin Immunol. 2021;147:383–4. 10.1016/j.jaci.2020.07.003
27 McWilliam VL, Koplin JJ, Allen K, Robinson M, Smart J, Loke P, et al. TreEAT trial: Protocol for a randomized controlled trial investigating the efficacy and safety of early introduction of tree nuts for the prevention of tree nut allergy in infants with peanut allergy. Pediatr Allergy Immunol. 2023;34:e13930. 10.1111/pai.13930
28 Maloney JM, Rudengren M, Ahlstedt S, Bock SA, Sampson HA. The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy. J Allergy Clin Immunol. 2008;122:145–51. 10.1016/j.jaci.2008.04.014
29 Couch C, Franxman T, Greenhawt M. Characteristics of tree nut challenges in tree nut allergic and tree nut sensitized individuals. Ann Allergy Asthma Immunol. 2017;118:591–6 e3. 10.1016/j.anai.2017.02.010
30 Brough HA, Caubet JC, Mazon A, Haddad D, Bergmann MM, Wassenberg J, et al. Defining challenge-proven coexistent nut and sesame seed allergy: A prospective multicenter European study. J Allergy Clin Immunol. 2020;145:1231–9. 10.1016/j.jaci.2019.09.036
31 Abrams EM, Becker AB. Oral food challenge outcomes in a pediatric tertiary care center. Allergy Asthma Clin Immunol. 2017;13:43. 10.1186/s13223-017-0215-8
32 Dobbertin-Welsch J, Staudacher O, Yurek S, Trendelenburg V, Tschirner S, Ziegert M, et al. Organ-specific symptom patterns during oral food challenge in children with peanut and tree nut allergy. Pediatr Allergy Immunol. 2022;33:e13778. 10.1111/pai.13778
33 Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: Summary of the NIAID-sponsored expert panel report. J Allergy Clin Immunol. 2010;126:1105–18. 10.1016/j.jaci.2010.10.007
34 Venkatachalam M, Monaghan EK, Kshirsagar HH, Robotham JM, O’Donnell SE, Gerber MS, et al. Effects of processing on immunoreactivity of cashew nut (Anacardium occidentale L.) seed flour proteins. J Agric Food Chem. 2008;56:8998–9005. 10.1021/jf801199q
35 Santos AF, Riggioni C, Agache I, Akdis CA, Akdis M, Alvarez-Perea A, et al. EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy. 2023;78:3057–76. 10.1111/all.15906
36 Fleischer DM, Conover-Walker MK, Matsui EC, Wood RA. The natural history of tree nut allergy. J Allergy Clin Immunol 2005 Nov;116(5):1087–93. 10.1016/j.jaci.2005.09.002
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May 1, 2025
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Kim, J., Youm, S., Lee, . S., & Jeong, K. (2025). Clinical and laboratory characteristics of cashew nut allergy in Korean children: Findings from a tertiary hospital. Allergologia Et Immunopathologia, 53(3), 51-59. https://doi.org/10.15586/aei.v53i3.1289
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How to Cite
Kim, J., Youm, S., Lee, . S., & Jeong, K. (2025). Clinical and laboratory characteristics of cashew nut allergy in Korean children: Findings from a tertiary hospital. Allergologia Et Immunopathologia, 53(3), 51-59. https://doi.org/10.15586/aei.v53i3.1289