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Scott H. Sicherer - One of the best experts on this subject based on the ideXlab platform.
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Current perspectives on Tree Nut allergy: a review.
Journal of asthma and allergy, 2018Co-Authors: Tamar Weinberger, Scott H. SichererAbstract:Tree Nut (TN) allergy is common and often severe. It has become an important health concern as availability and consumption have increased. Prevalence varies by age and geographic region and appears to have increased in children. Accidental ingestion of TNs is common. Unfortunately, there is a lower likelihood of resolution of TN allergy, roughly 10%. TN-specific skin tests and serum immunoglobulin E levels can help aid in the diagnosis of TN allergy, but a careful medical history is important because a positive test in isolation is not typically diagnostic. Component-resolved diagnostic tests are being increasingly utilized and may improve accuracy. Management consists of strict avoidance of the causal Nut(s) and prompt treatment of symptoms upon accidental exposure. A specific consideration with regard to the management of TN allergy is the decision to avoid all TNs or only the TNs to which a patient is clinically allergic. There are currently no data on the primary or secondary prevention of TN allergy. Treatment strategies are being evaluated.
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A voluntary registry for peaNut and Tree Nut allergy: characteristics of the first 5149 registrants.
Journal of Allergy and Clinical Immunology, 2001Co-Authors: Scott H. Sicherer, A. Wesley Burks, Terence J. Furlong, Anne Muñoz-furlong, Hugh A. SampsonAbstract:Abstract Background: A voluntary registry of individuals with peaNut and/or Tree Nut allergy was established in 1997 to learn more about these food allergies. Objective: The purpose of this study was to elucidate a variety of features of peaNut and Tree Nut allergy among the first 5149 registry participants. Methods: The registry was established through use of a structured questionnaire distributed to all members of the Food Allergy and Anaphylaxis Network and to patients by allergists. Parental surrogates completed the forms for children under the age of 18 years. Results: Registrants were primarily children (89% of registrants were younger than 18 years of age; the median age was 5 years), reflecting the membership of the Network. Isolated peaNut allergy was reported by 3482 registrants (68%), isolated Tree Nut allergy by 464 (9%), and allergy to both foods by 1203 (23%). Registrants were more likely to have been born in October, November, or December (odds ratio, 1.2; 95% CI, 1.18-1.23; P P Conclusions: Allergic reactions to peaNut and Tree Nut are frequently severe, often occur on the first known exposure, and can become more severe over time. (J Allergy Clin Immunol 2001;108:128-32.)
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PeaNut and Tree Nut allergic reactions in restaurants and other food establishments
Journal of Allergy and Clinical Immunology, 2001Co-Authors: Terence J. Furlong, Jennifer Desimone, Scott H. SichererAbstract:Abstract Background: The clinical features of food-allergic reactions in restaurants and other food establishments have not been studied. Of the registrants in the United States PeaNut and Tree Nut Allergy Registry (PAR), 13.7% have reported reactions associated with such establishments. Objective: The purpose of this study was to determine the features of allergic reactions to peaNut and Tree Nut in restaurant foods and foods purchased at other private establishments (eg, ice cream shops and bakeries). Methods: Telephone interviews were conducted through use of a structured questionnaire. Subjects/parental surrogates were randomly selected from among the 706 PAR registrants who reported a reaction in a restaurant or other food establishment. Results: Details were obtained for 156 episodes (29 first-time reactions) from 129 subjects/parental surrogates. Most reactions were caused by peaNut (67%) or Tree Nut (24%); for some reactions (9%), the cause was a combination of peaNut and another Nut or was unknown. Symptoms began at a median of 5 miNutes after exposure and were severe in 27% of reactions. Overall, 86% of reactions were treated (antihistamines, 86%; epinephrine, 40%). Establishments commonly cited were Asian food restaurants (19%), ice cream shops (14%), and bakeries/doughNut shops (13%). Among meal courses, desserts were a common cause (43%). Of 106 registrants with previously diagnosed allergy who ordered food specifically for ingestion by the allergic individual, only 45% gave prior notification about the allergy to the establishment. For 83 (78%) of these 106 reactions, someone in the establishment knew that the food contained peaNut or Tree Nut as an ingredient; in 50% of these incidents, the food item was "hidden" (in sauces, dressings, egg rolls, etc), visual identification being prevented. In 23 (22%) of the 106 cases, exposures were reported from contamination caused primarily by shared cooking/serving supplies. In the remaining 21 subjects with previously diagnosed allergy, reactions resulted from ingestion of food not intended for them, ingestion of food selected from buffet/food bars, or skin contact/inhalation (residual food on tables, 2; peaNut shells covering floors, 2; being within 2 feet of the cooking of the food, 1). Conclusions: Restaurants and other food establishments pose a number of dangers for peaNut- and Tree Nut–allergic individuals, particularly with respect to cross-contamination and unexpected ingredients in desserts and Asian food. Failure to establish a clear line of communication between patron and establishment is a frequent cause of errors. (J Allergy Clin Immunol 2001;108:867-70.)
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The US PeaNut and Tree Nut Allergy Registry: characteristics of reactions in schools and day care.
The Journal of Pediatrics, 2001Co-Authors: Scott H. Sicherer, Jennifer Desimone, Terrence J. Furlong, Hugh A. SampsonAbstract:Abstract Objective: Severe food-allergic reactions occur in schools, but the features have not been described. Study design: Participants in the US PeaNut and Tree Nut Allergy Registry (PAR) who indicated that their child experienced an allergic reaction in school or day care were randomly selected for a telephone interview conducted with a structured questionnaire. Results: Of 4586 participants in the PAR, 750 (16%) indicated a reaction in school or day care, and 100 subjects or parental surrogates described 124 reactions to peaNut (115) or Tree Nuts (9); 64% of the reactions occurred in day care or preschool, and the remainder in elementary school or higher grades. Reactions were reported from ingestion (60%), skin contact/possible ingestion (24%), and inhalation/possible skin contact or ingestion (16%). In the majority of reactions caused by inhalation, concomitant ingestion/skin contact could not be ruled out. Various foods caused reactions by ingestion, but peaNut butter craft projects were commonly responsible for the skin contact (44%) or inhalation (41%) reactions. For 90% of reactions, medications were given (86% antihistamines, 28% epinephrine). Epinephrine was given in school by teachers in 4 cases, nurses in 7, and parents or others in the remainder. Treatment delays were attributed to delayed recognition of reactions, calling parents, not following emergency plans, and an unsuccessful attempt to administer epinephrine. Conclusions: School personnel must be educated to recognize and treat food-allergic reactions. Awareness must be increased to avoid accidental exposures, including exposure from peaNut butter craft projects. (J Pediatr 2001;138:560-5)
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A voluntary registry for peaNut and Tree Nut allergy: characteristics of the first 5149 registrants.
The Journal of allergy and clinical immunology, 2001Co-Authors: Scott H. Sicherer, A. Wesley Burks, Terence J. Furlong, Anne Muñoz-furlong, Hugh A. SampsonAbstract:A voluntary registry of individuals with peaNut and/or Tree Nut allergy was established in 1997 to learn more about these food allergies. The purpose of this study was to elucidate a variety of features of peaNut and Tree Nut allergy among the first 5149 registry participants. The registry was established through use of a structured questionnaire distributed to all members of the Food Allergy and Anaphylaxis Network and to patients by allergists. Parental surrogates completed the forms for children under the age of 18 years. Registrants were primarily children (89% of registrants were younger than 18 years of age; the median age was 5 years), reflecting the membership of the Network. Isolated peaNut allergy was reported by 3482 registrants (68%), isolated Tree Nut allergy by 464 (9%), and allergy to both foods by 1203 (23%). Registrants were more likely to have been born in October, November, or December (odds ratio, 1.2; 95% CI, 1.18-1.23; P <.0001). The median age of reaction to peaNut was 14 months, and the median age of reaction to Tree Nuts was 36 months; these represented the first known exposure for 74% and 68% of registrants, respectively. One half of the reactions involved more than 1 organ system, and more than 75% required treatment, frequently from medical personnel. Registrants with asthma were more likely than those without asthma to have severe reactions (33% vs 21%; P <.0001). In comparison with initial reactions, subsequent reactions due to accidental ingestion were more severe, more common outside the home, and more likely to be treated with epinephrine. Allergic reactions to peaNut and Tree Nut are frequently severe, often occur on the first known exposure, and can become more severe over time.
Theresa A. Nicklas - One of the best experts on this subject based on the ideXlab platform.
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Tree Nut consumption is associated with better adiposity measures and cardiovascular and metabolic syndrome health risk factors in u s adults nhanes 2005 2010
Nutrition Journal, 2015Co-Authors: Carol E Oneil, Victor L. Fulgoni, Theresa A. NicklasAbstract:Previous research has shown inconsistencies in the association of Tree Nut consumption with risk factors for cardiovascular disease (CVD) and metabolic syndrome (MetS). To determine the association of Tree Nut consumption with risk factors for CVD and for MetS in adults. NHANES 2005–2010 data were used to examine the associations of Tree Nut consumption with health risks in adults 19+ years (n = 14,386; 51 % males). Tree Nuts were: almonds, Brazil Nuts, cashews, filberts [hazelNuts], macadamias, pecans, pine Nuts, pistachios, and walNuts. Group definitions were non-consumers 25/<30 and ≥30, respectively) and having CVRF or MetS, were determined. Tree Nut consumption was associated with lower BMI (p = 0.004), waist circumference (WC) (p = 0.008), systolic blood pressure (BP) (p = 0.001), Homeostatic Model Assessment—Insulin Resistance (p = 0.043), and higher high density lipoprotein-cholesterol (p = 0.022), compared with no consumption, and a lower likelihood of OB (−25 %), OW/OB (−23 %), and elevated WC (−21 %). Tree Nut consumption was associated with better weight status and some CVRF and MetS components.
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Tree Nut consumption is associated with better adiposity measures and cardiovascular and metabolic syndrome health risk factors in U.S. Adults: NHANES 2005-2010
Nutrition Journal, 2015Co-Authors: Carol E. O'neil, Victor L. Fulgoni, Theresa A. NicklasAbstract:Previous research has shown inconsistencies in the association of Tree Nut consumption with risk factors for cardiovascular disease (CVD) and metabolic syndrome (MetS). To determine the association of Tree Nut consumption with risk factors for CVD and for MetS in adults. NHANES 2005–2010 data were used to examine the associations of Tree Nut consumption with health risks in adults 19+ years (n = 14,386; 51 % males). Tree Nuts were: almonds, Brazil Nuts, cashews, filberts [hazelNuts], macadamias, pecans, pine Nuts, pistachios, and walNuts. Group definitions were non-consumers 25/
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Tree Nut consumption is associated with better Nutrient adequacy and diet quality in adults: National Health and Nutrition Examination Survey 2005-2010.
Nutrients, 2015Co-Authors: Carol E. O'neil, Theresa A. Nicklas, Victor L. FulgoniAbstract:Nutrient adequacy of Tree Nut consumers has not been examined. The National Health and Nutrition Examination Survey 2005-2010 data were used to assess the association of Tree Nut consumption by adults 19+ years (n = 14,386) with Nutrient adequacy and diet quality. Covariate adjusted usual intake was determined using two 24-h dietary recalls and the National Cancer Institute method. Percentages of the consumption groups below the Estimated Average Requirement (EAR) or above the Adequate Intake (AI) were determined. Diet quality was determined using the Healthy Eating Index-2005 (HEI) score. Usual intake data showed consumers of Tree Nuts had a lower percentage (p < 0.0001) of the population below the EAR for vitamins A (22 ± 5 vs. 49 ± 1), E (38 ± 4 vs. 94 ± 0.4) and C (17 ± 4 vs. 44 ± 1); folate (2.5 ± 1.5 vs. 12 ± 0.6); calcium (26 ± 3 vs. 44 ± 1); iron (3 ± 0.6 vs. 9 ± 0.4); magnesium (8 ± 1 vs. 60 ± 1); and zinc (1.5 ± 1 vs. 13 ± 1). Tree Nut consumers had a higher percentage (p < 0.0001) of the population above the AI for fiber (33 ± 3 vs. 4 ± 0.3) and potassium (12 ± 3 mg vs. 2 ± 0.2 mg). HEI-2005 total score was higher (p < 0.0001) in Tree Nut consumers (61 ± 0.7 vs. 52 ± 0.3) than non-consumers. Health professionals should encourage the use of Tree Nuts as part of a dietary approach to healthy eating.
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Tree Nut consumption improves Nutrient intake and diet quality in US adults: an analysis of National Health and Nutrition Examination Survey (NHANES) 1999-2004.
Asia Pacific Journal of Clinical Nutrition, 2010Co-Authors: Carol E. O'neil, Debra R. Keast, Victor L. Fulgoni, Theresa A. NicklasAbstract:Recent epidemiologic studies assessing Tree Nut (almonds, Brazil Nuts, cashews, hazelNuts, macadamia Nuts, pecans, pine Nuts, pistachios, and walNuts) consumption and the association with Nutrient intake and diet quality are lacking. This study determined the association of Tree Nut consumption and Nutrient intake and diet quality using a nationally representative sample of adults. Adults 19+ years (y) (n=13,292) participating in the 1999-2004 National Health and Nutrition Examination Survey were used. Intake was determined from 24-hour diet recalls; Tree Nut consumers were defined as those consuming > or =(1/4) ounce/day (7.09 g). Means, standard errors, and ANOVA (adjusted for covariates) were determined using appropriate sample weights. Diet quality was measured using the Healthy Eating Index-2005. Among consumers, mean intake of Tree Nuts/Tree Nut butters was 1.19 +/- 0.04 oz/d versus 0.01 +/- 0.00 oz/d for non-consumers. In this study, 5.5 +/- 0.3 % of individuals 19-50 y (n=7,049) and 8.4 +/- 0.6 % of individuals 51+ y (n=6,243) consumed Tree Nuts/Tree Nut butters. Mean differences (p
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Tree Nut consumption improves Nutrient intake and diet quality in us adults an analysis of national health and Nutrition examination survey nhanes 1999 2004
Asia Pacific Journal of Clinical Nutrition, 2010Co-Authors: Carol E Oneil, Debra R. Keast, Victor L. Fulgoni, Theresa A. NicklasAbstract:Recent epidemiologic studies assessing Tree Nut (almonds, Brazil Nuts, cashews, hazelNuts, macadamia Nuts, pecans, pine Nuts, pistachios, and walNuts) consumption and the association with Nutrient intake and diet quality are lacking. This study determined the association of Tree Nut consumption and Nutrient intake and diet quality using a nationally representative sample of adults. Adults 19+ years (y) (n=13,292) participating in the 1999-2004 National Health and Nutrition Examination Survey were used. Intake was determined from 24-hour diet recalls; Tree Nut consumers were defined as those consuming > or =(1/4) ounce/day (7.09 g). Means, standard errors, and ANOVA (adjusted for covariates) were determined using appropriate sample weights. Diet quality was measured using the Healthy Eating Index-2005. Among consumers, mean intake of Tree Nuts/Tree Nut butters was 1.19 +/- 0.04 oz/d versus 0.01 +/- 0.00 oz/d for non-consumers. In this study, 5.5 +/- 0.3 % of individuals 19-50 y (n=7,049) and 8.4 +/- 0.6 % of individuals 51+ y (n=6,243) consumed Tree Nuts/Tree Nut butters. Mean differences (p<0.01) between Tree Nut consumers and non-consumers of adult shortfall Nutrients were: fiber (+5.0 g/d), vitamin E (+3.7 mg AT/d), calcium (+73 mg/d), magnesium (+95 mg/d), and potassium (+260 mg/d). Tree Nut consumers had lower sodium intake (-157 mg/d, p<0.01). Diet quality was significantly higher in Tree Nut consumers (58.0+/-0.4 vs. 48.5+/-0.3, p<0.01). Tree Nut consumption was associated with a higher overall diet quality score and improved Nutrient intakes. Specific dietary recommendations for Nut consumption should be provided for consumers.
Hugh A. Sampson - One of the best experts on this subject based on the ideXlab platform.
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The use of serum-specific IgE measurements for the diagnosis of peaNut, Tree Nut, and seed allergy.
Journal of Allergy and Clinical Immunology, 2008Co-Authors: Jennifer M. Maloney, Magnus Rudengren, Staffan Ahlstedt, S. A. Bock, Hugh A. SampsonAbstract:Background The gold standard for diagnosing food allergy is the double-blind, placebo-controlled food challenge. Diagnostic food-specific IgE levels might assist in diagnosing food allergies and circumventing the need for food challenges. Objectives The purpose of this study was to determine the utility of food-specific IgE measurements for identifying symptomatic peaNut, Tree Nut, and seed allergies and to augment what is known about the relationships among these foods. Methods Patients referred for suspected peaNut or Tree Nut allergies answered a questionnaire about their perceived food allergies. Allergen-specific diagnoses were based on questionnaire, medical history, and, when relevant, skin prick tests and serum specific IgE levels. Sera from the patients were analyzed for specific IgE antibodies to peaNuts, Tree Nuts, and seeds by using ImmunoCAP Specific IgE (Phadia, Inc, Uppsala, Sweden). Results Three hundred twenty-four patients (61% male; median age, 6.1 years; range, 0.2-40.2 years) were evaluated. The patients were highly atopic (57% with atopic dermatitis and 58% with asthma). The majority of patients with peaNut allergy were sensitized to Tree Nuts (86%), and 34% had documented clinical allergy. The relationship between diagnosis and allergen-specific IgE levels were estimated by using logistic regression. Diagnostic decision points are suggested for peaNut and walNut. Probability curves were drawn for peaNut, sesame, and several Tree Nuts. High correlations were found between cashew and pistachio and between pecan and walNut. Conclusions Quantification of food-specific IgE is a valuable tool that will aid in the diagnosis of symptomatic food allergy and might decrease the need for double-blind, placebo-controlled food challenges.
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A voluntary registry for peaNut and Tree Nut allergy: characteristics of the first 5149 registrants.
Journal of Allergy and Clinical Immunology, 2001Co-Authors: Scott H. Sicherer, A. Wesley Burks, Terence J. Furlong, Anne Muñoz-furlong, Hugh A. SampsonAbstract:Abstract Background: A voluntary registry of individuals with peaNut and/or Tree Nut allergy was established in 1997 to learn more about these food allergies. Objective: The purpose of this study was to elucidate a variety of features of peaNut and Tree Nut allergy among the first 5149 registry participants. Methods: The registry was established through use of a structured questionnaire distributed to all members of the Food Allergy and Anaphylaxis Network and to patients by allergists. Parental surrogates completed the forms for children under the age of 18 years. Results: Registrants were primarily children (89% of registrants were younger than 18 years of age; the median age was 5 years), reflecting the membership of the Network. Isolated peaNut allergy was reported by 3482 registrants (68%), isolated Tree Nut allergy by 464 (9%), and allergy to both foods by 1203 (23%). Registrants were more likely to have been born in October, November, or December (odds ratio, 1.2; 95% CI, 1.18-1.23; P P Conclusions: Allergic reactions to peaNut and Tree Nut are frequently severe, often occur on the first known exposure, and can become more severe over time. (J Allergy Clin Immunol 2001;108:128-32.)
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The US PeaNut and Tree Nut Allergy Registry: characteristics of reactions in schools and day care.
The Journal of Pediatrics, 2001Co-Authors: Scott H. Sicherer, Jennifer Desimone, Terrence J. Furlong, Hugh A. SampsonAbstract:Abstract Objective: Severe food-allergic reactions occur in schools, but the features have not been described. Study design: Participants in the US PeaNut and Tree Nut Allergy Registry (PAR) who indicated that their child experienced an allergic reaction in school or day care were randomly selected for a telephone interview conducted with a structured questionnaire. Results: Of 4586 participants in the PAR, 750 (16%) indicated a reaction in school or day care, and 100 subjects or parental surrogates described 124 reactions to peaNut (115) or Tree Nuts (9); 64% of the reactions occurred in day care or preschool, and the remainder in elementary school or higher grades. Reactions were reported from ingestion (60%), skin contact/possible ingestion (24%), and inhalation/possible skin contact or ingestion (16%). In the majority of reactions caused by inhalation, concomitant ingestion/skin contact could not be ruled out. Various foods caused reactions by ingestion, but peaNut butter craft projects were commonly responsible for the skin contact (44%) or inhalation (41%) reactions. For 90% of reactions, medications were given (86% antihistamines, 28% epinephrine). Epinephrine was given in school by teachers in 4 cases, nurses in 7, and parents or others in the remainder. Treatment delays were attributed to delayed recognition of reactions, calling parents, not following emergency plans, and an unsuccessful attempt to administer epinephrine. Conclusions: School personnel must be educated to recognize and treat food-allergic reactions. Awareness must be increased to avoid accidental exposures, including exposure from peaNut butter craft projects. (J Pediatr 2001;138:560-5)
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A voluntary registry for peaNut and Tree Nut allergy: characteristics of the first 5149 registrants.
The Journal of allergy and clinical immunology, 2001Co-Authors: Scott H. Sicherer, A. Wesley Burks, Terence J. Furlong, Anne Muñoz-furlong, Hugh A. SampsonAbstract:A voluntary registry of individuals with peaNut and/or Tree Nut allergy was established in 1997 to learn more about these food allergies. The purpose of this study was to elucidate a variety of features of peaNut and Tree Nut allergy among the first 5149 registry participants. The registry was established through use of a structured questionnaire distributed to all members of the Food Allergy and Anaphylaxis Network and to patients by allergists. Parental surrogates completed the forms for children under the age of 18 years. Registrants were primarily children (89% of registrants were younger than 18 years of age; the median age was 5 years), reflecting the membership of the Network. Isolated peaNut allergy was reported by 3482 registrants (68%), isolated Tree Nut allergy by 464 (9%), and allergy to both foods by 1203 (23%). Registrants were more likely to have been born in October, November, or December (odds ratio, 1.2; 95% CI, 1.18-1.23; P <.0001). The median age of reaction to peaNut was 14 months, and the median age of reaction to Tree Nuts was 36 months; these represented the first known exposure for 74% and 68% of registrants, respectively. One half of the reactions involved more than 1 organ system, and more than 75% required treatment, frequently from medical personnel. Registrants with asthma were more likely than those without asthma to have severe reactions (33% vs 21%; P <.0001). In comparison with initial reactions, subsequent reactions due to accidental ingestion were more severe, more common outside the home, and more likely to be treated with epinephrine. Allergic reactions to peaNut and Tree Nut are frequently severe, often occur on the first known exposure, and can become more severe over time.
A. Wesley Burks - One of the best experts on this subject based on the ideXlab platform.
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Irradiated Tree Nut Flours for Use in Oral Immunotherapy.
The journal of allergy and clinical immunology. In practice, 2020Co-Authors: Anusha Penumarti, A. Wesley Burks, Nicole Szczepanski, Janelle Kesselring, Elizabeth Gabel, Rohini Sheth, Jelena P Berglund, Edwin H Kim, Michael D KulisAbstract:Tree Nut allergies affect an estimated 1% of the US population and is lifelong in 90% of allergic individuals. Oral immunotherapy (OIT) for food allergies is an effective method to induce desensitization in a majority of participants in trials of peaNut, egg, and milk OIT. Limited trials using Tree Nut OIT have been reported, possibly due to the lack of standardized drug products. Food products used in OIT are considered drugs by the Food and Drug Administration (FDA) because they are intended to modulate the individuals' immune responses to the food allergens. As such, OIT drug products must meet FDA standards for acceptable levels of microbes and undergo testing for allergenic proteins. We aimed to determine the suitability of walNut, cashew, hazelNut, and almond flours for use in OIT trials. We employed gamma irradiation on commercially available walNut, cashew, hazelNut, and almond flours and tested their levels of microbial contamination, total protein, and allergen content, along with stability of these parameters over time. Our results demonstrate that irradiation of Tree Nut flours greatly diminishes the levels of total aerobic bacteria, mold, yeast, Escherichia coli, and Salmonella, whereas there are no substantial changes in total protein or allergen content. Importantly, the microbial levels, protein, and allergen content remained stable over a 24-month period. Irradiation of Tree Nut flours is a safe and effective method of processing to allow Tree Nut products to meet the FDA standards for OIT drug products. Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
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Tree Nut allergy: risk factors for development, mitigation of reaction risk and current efforts in desensitization
Expert Review of Clinical Immunology, 2015Co-Authors: Mona Liu, A. Wesley Burks, Todd D. GreenAbstract:Allergy to Tree Nuts has grown widespread among patients, specifically in the pediatric population, in recent years. In this review, we evaluate and summarize the literature specific to development and treatment of Tree Nut allergy. The cause of Tree Nut allergy, such as most food allergies, is unknown; there are theories regarding maternal dietary factors as well as sensitization related to cross-reactivity to peaNut allergens. The gold standard for the diagnosis of Tree Nut allergy is the double-blind, placebo-controlled, oral food challenge; however, simpler and more cost-effective diagnostic methods, such as the skin prick test and serum-specific IgE are often used as a supplement for diagnosis. Management of Tree Nut allergy consists of dietary avoidance and using epinephrine to manage serious allergic reactions. Alternative therapeutic methods, such as oral and sublingual immunotherapy and modification of allergenic proteins are being explored to develop safer, more effective and long-lasting manage...
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Tree Nut allergy: risk factors for development, mitigation of reaction risk and current efforts in desensitization
Expert review of clinical immunology, 2015Co-Authors: Mona Liu, A. Wesley Burks, Todd D. GreenAbstract:Allergy to Tree Nuts has grown widespread among patients, specifically in the pediatric population, in recent years. In this review, we evaluate and summarize the literature specific to development and treatment of Tree Nut allergy. The cause of Tree Nut allergy, such as most food allergies, is unknown; there are theories regarding maternal dietary factors as well as sensitization related to cross-reactivity to peaNut allergens. The gold standard for the diagnosis of Tree Nut allergy is the double-blind, placebo-controlled, oral food challenge; however, simpler and more cost-effective diagnostic methods, such as the skin prick test and serum-specific IgE are often used as a supplement for diagnosis. Management of Tree Nut allergy consists of dietary avoidance and using epinephrine to manage serious allergic reactions. Alternative therapeutic methods, such as oral and sublingual immunotherapy and modification of allergenic proteins are being explored to develop safer, more effective and long-lasting management of Tree Nut allergy. We comment on the current studies involving risk factors for sensitization, diagnosis and management of Tree Nut allergy.
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A voluntary registry for peaNut and Tree Nut allergy: characteristics of the first 5149 registrants.
Journal of Allergy and Clinical Immunology, 2001Co-Authors: Scott H. Sicherer, A. Wesley Burks, Terence J. Furlong, Anne Muñoz-furlong, Hugh A. SampsonAbstract:Abstract Background: A voluntary registry of individuals with peaNut and/or Tree Nut allergy was established in 1997 to learn more about these food allergies. Objective: The purpose of this study was to elucidate a variety of features of peaNut and Tree Nut allergy among the first 5149 registry participants. Methods: The registry was established through use of a structured questionnaire distributed to all members of the Food Allergy and Anaphylaxis Network and to patients by allergists. Parental surrogates completed the forms for children under the age of 18 years. Results: Registrants were primarily children (89% of registrants were younger than 18 years of age; the median age was 5 years), reflecting the membership of the Network. Isolated peaNut allergy was reported by 3482 registrants (68%), isolated Tree Nut allergy by 464 (9%), and allergy to both foods by 1203 (23%). Registrants were more likely to have been born in October, November, or December (odds ratio, 1.2; 95% CI, 1.18-1.23; P P Conclusions: Allergic reactions to peaNut and Tree Nut are frequently severe, often occur on the first known exposure, and can become more severe over time. (J Allergy Clin Immunol 2001;108:128-32.)
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A voluntary registry for peaNut and Tree Nut allergy: characteristics of the first 5149 registrants.
The Journal of allergy and clinical immunology, 2001Co-Authors: Scott H. Sicherer, A. Wesley Burks, Terence J. Furlong, Anne Muñoz-furlong, Hugh A. SampsonAbstract:A voluntary registry of individuals with peaNut and/or Tree Nut allergy was established in 1997 to learn more about these food allergies. The purpose of this study was to elucidate a variety of features of peaNut and Tree Nut allergy among the first 5149 registry participants. The registry was established through use of a structured questionnaire distributed to all members of the Food Allergy and Anaphylaxis Network and to patients by allergists. Parental surrogates completed the forms for children under the age of 18 years. Registrants were primarily children (89% of registrants were younger than 18 years of age; the median age was 5 years), reflecting the membership of the Network. Isolated peaNut allergy was reported by 3482 registrants (68%), isolated Tree Nut allergy by 464 (9%), and allergy to both foods by 1203 (23%). Registrants were more likely to have been born in October, November, or December (odds ratio, 1.2; 95% CI, 1.18-1.23; P <.0001). The median age of reaction to peaNut was 14 months, and the median age of reaction to Tree Nuts was 36 months; these represented the first known exposure for 74% and 68% of registrants, respectively. One half of the reactions involved more than 1 organ system, and more than 75% required treatment, frequently from medical personnel. Registrants with asthma were more likely than those without asthma to have severe reactions (33% vs 21%; P <.0001). In comparison with initial reactions, subsequent reactions due to accidental ingestion were more severe, more common outside the home, and more likely to be treated with epinephrine. Allergic reactions to peaNut and Tree Nut are frequently severe, often occur on the first known exposure, and can become more severe over time.
Suzanne S. Teuber - One of the best experts on this subject based on the ideXlab platform.
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Tree Nut allergens.
International Archives of Allergy and Immunology, 2003Co-Authors: Kenneth H. Roux, Suzanne S. Teuber, Shridhar K. SatheAbstract:Allergic reactions to Tree Nuts can be serious and life threatening. Considerable research has been conducted in recent years in an attempt to characterize those allergens that are most responsible for allergy sensitization and triggering. Both native and recombinant Nut allergens have been identified and characterized and, for some, the IgE-reactive epitopes described. Some allergens, such as lipid transfer proteins, profilins, and members of the Bet v 1-related family, represent minor constituents in Tree Nuts. These allergens are frequently cross-reactive with other food and pollen homologues, and are considered panallergens. Others, such as legumins, vicilins, and 2S albumins, represent major seed storage protein constituents of the Nuts. The allergenic Tree Nuts discussed in this review include those most commonly responsible for allergic reactions such as hazelNut, walNut, cashew, and almond as well as those less frequently associated with allergies including pecan, chestNut, Brazil Nut, pine Nut, macadamia Nut, pistachio, cocoNut, Nangai Nut, and acorn.
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Tree Nut allergy
Current Allergy and Asthma Reports, 2003Co-Authors: Suzanne S. Teuber, Shridhar K. Sathe, Sarah S. Comstock, Kenneth H. RouxAbstract:Tree Nuts are clinically associated with severe immunoglobulin E-mediated systemic allergic reactions independent of pollen allergy and with reactions that are usually confined to the oral mucosa in patients with immunoglobulin E directed toward cross-reacting pollen allergens. The latter reactions can progress to severe and life-threatening episodes in some patients. Many patients with severe Tree Nut allergy are co-sensitized to peaNut. Clinical studies on cross-reactivity between the Tree Nuts are few in number, but based on reports to date, avoidance of the other Tree Nuts once sensitivity is diagnosed appears prudent unless specific challenges are performed to ensure clinical tolerance. Even then, great care must be taken to avoid crosscontamination. As with other severe food allergies, a recurrent problem in clinical management is the failure of physicians to prescribe self-injectable epinephrine to patients who are at risk of anaphylaxis.
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The atopic dog as a model of peaNut and Tree Nut food allergy
Journal of Allergy and Clinical Immunology, 2002Co-Authors: Suzanne S. Teuber, Gregorio Del Val, Susumu Morigasaki, Hye Rim Jung, Pamela H. Eisele, Oscar L. Frick, Bob B. BuchananAbstract:Abstract Background: Animal models are needed that mimic human IgE-mediated peaNut and Tree Nut allergy. Atopic dogs have been previously used in a model of food allergy to cow's milk, beef, wheat, and soy, with the demonstration of specific IgE production and positive oral challenges similar to those seen in human subjects. Objective: We sought to sensitize dogs to peaNut, walNut, and Brazil Nut and to assess whether sensitization is accompanied by clinical reactions and whether there is cross-reactivity among the different preparations. Methods: Eleven dogs were sensitized subcutaneously by using an established protocol with 1 μg each of peaNut, English walNut, or Brazil Nut protein extracts in alum first at birth and then after modified live virus vaccinations at 3, 7, and 11 weeks of age. The dogs were sensitized to other allergens, including soy and either wheat or barley. Intradermal skin tests, IgE immunoblotting to Nut proteins, and oral challenges were performed with ground Nut preparations. Results: At 6 months of age, the dogs' intradermal skin test responses were positive to the Nut extracts. IgE immunoblotting to peaNut, walNut, and Brazil Nut showed strong recognition of proteins in the aqueous preparations. Each of the 4 peaNut- and the 3 Brazil Nut–sensitized dogs and 3 of the 4 walNut-sensitized dogs reacted on oral challenge with the corresponding primary immunogen at age 2 years. None of the peaNut-sensitized dogs reacted clinically with walNut or Brazil Nut challenges. One of the walNut-sensitized dogs had delayed (overnight) vomiting to Brazil Nut. Conclusions: On the basis of measurements of the mean amount of allergen eliciting a skin test response in dogs, the hierarchy of reactivity by skin testing is similar to the clinical experience in human subjects (peaNut > Tree Nuts > wheat > soy > barley). Cross-reactivity, which was not apparent between soy and peaNut or Tree Nuts or between peaNut and Tree Nuts, was slight between walNut and Brazil Nut. The results give further support to the dog as a model of human food allergy. (J Allergy Clin Immunol 2002;110:921-7.)
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Systemic allergic reaction to cocoNut (Cocos nucifera) in 2 subjects with hypersensitivity to Tree Nut and demonstration of cross-reactivity to legumin-like seed storage proteins: new cocoNut and walNut food allergens.
Journal of Allergy and Clinical Immunology, 1999Co-Authors: Suzanne S. Teuber, W. Rich PetersonAbstract:Abstract Background: Two patients with Tree Nut allergy manifested by life-threatening systemic reactions reported the subsequent onset of systemic reactions after the consumption of cocoNut. Objective: Herein, the IgE-binding proteins from cocoNut are described, and in vitro cross-reactivity with other Nuts is investigated. Methods: The IgE-binding profile of cocoNut endosperm tissue extract was analyzed by SDS-PAGE followed by immunoblotting. Immunoblot inhibition studies with walNut, almond, peaNut, and cocoNut were performed. Results: Sera IgE from both patients recognized reduced cocoNut allergens with molecular weights of 35 and 36.5 kd. IgE from 1 patient also bound a 55-kd antigen. Preabsorption of sera with Nut extracts suppressed IgE binding to cocoNut proteins. Preabsorption of sera with cocoNut caused the disappearance of IgE binding to protein bands at 35 and 36 kd on a reduced immunoblot of walNut protein extract in 1 patient and suppression of IgE binding to a protein at 36 kd in the other patient. Conclusion: The reduced cocoNut protein at 35 kd was previously shown to be immunologically similar to soy glycinin (legumin group of seed storage proteins). The clinical reactivity in these 2 patients is likely due to cross-reacting IgE antibodies primarily directed against walNut, the original clinical allergy reported, and most likely to a walNut legumin-like protein. CocoNut allergy in patients with Tree Nut allergy is rare; these are the first 2 patients ever reported, and therefore there is no general indication to advise patients with Tree Nut allergy to avoid cocoNut. (J Allergy Clin Immunol 1999;103:1180-5.)
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Systemic allergic reaction to cocoNut (Cocos nucifera) in 2 subjects with hypersensitivity to Tree Nut and demonstration of cross-reactivity to legumin-like seed storage proteins: new cocoNut and walNut food allergens.
The Journal of allergy and clinical immunology, 1999Co-Authors: Suzanne S. Teuber, W. Rich PetersonAbstract:Two patients with Tree Nut allergy manifested by life-threatening systemic reactions reported the subsequent onset of systemic reactions after the consumption of cocoNut. Herein, the IgE-binding proteins from cocoNut are described, and in vitro cross-reactivity with other Nuts is investigated. The IgE-binding profile of cocoNut endosperm tissue extract was analyzed by SDS-PAGE followed by immunoblotting. Immunoblot inhibition studies with walNut, almond, peaNut, and cocoNut were performed. Sera IgE from both patients recognized reduced cocoNut allergens with molecular weights of 35 and 36.5 kd. IgE from 1 patient also bound a 55-kd antigen. Preabsorption of sera with Nut extracts suppressed IgE binding to cocoNut proteins. Preabsorption of sera with cocoNut caused the disappearance of IgE binding to protein bands at 35 and 36 kd on a reduced immunoblot of walNut protein extract in 1 patient and suppression of IgE binding to a protein at 36 kd in the other patient. The reduced cocoNut protein at 35 kd was previously shown to be immunologically similar to soy glycinin (legumin group of seed storage proteins). The clinical reactivity in these 2 patients is likely due to cross-reacting IgE antibodies primarily directed against walNut, the original clinical allergy reported, and most likely to a walNut legumin-like protein. CocoNut allergy in patients with Tree Nut allergy is rare; these are the first 2 patients ever reported, and therefore there is no general indication to advise patients with Tree Nut allergy to avoid cocoNut.
