Elizur Arnon, Appel Michael Y, Nachshon Liat, Levy Michael B, Epstein-Rigbi Naama, Pontoppidan Bo, Lidholm Jonas, Goldberg Michael R
Institute of Allergy, Immunology and Pediatric Pulmonology and Department of Pediatrics, Yitzhak Shamir Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Institute of Allergy, Immunology and Pediatric Pulmonology and Department of Pediatrics, Yitzhak Shamir Medical Center, Zerifin, Israel.
J Allergy Clin Immunol Pract. 2020 Jan;8(1):157-165.e2. doi: 10.1016/j.jaip.2019.08.038. Epub 2019 Sep 9.
Diagnostic methods for distinguishing walnut-allergic patients from walnut-sensitized but walnut-tolerant individuals are limited. Furthermore, characteristics of single walnut versus dual walnut-pecan allergy are lacking.
To provide clinical and molecular characteristics of walnut- and pecan-allergic patients.
A prospective cohort study of 76 walnut-sensitized patients was performed. Walnut skin prick test and serum measurements of specific IgE to walnut and its components were performed. Patients were challenged to walnut and pecan unless they regularly consumed walnut and pecan.
Of the 76 patients studied, 61 were diagnosed as walnut-allergic and 15 as walnut-tolerant. IgE levels greater than or equal to 0.35 kU/L to Jug r 1 or 4 provided the best diagnostic method for identifying walnut-allergic patients (accuracy, 0.93). Of the 61 walnut-allergic patients, 49 were pecan-allergic whereas 12 were pecan-tolerant. None of the walnut-tolerant patients was allergic to pecan. Dual allergic patients had significantly lower walnut reaction dose (median, 100 mg vs 1230 mg; P < .001). IgE levels greater than or equal to 0.35 kU/L to Jug r 4, low-molecular-weight vicilins, or high-molecular-weight vicilins best segregated dual walnut-pecan-allergic patients from single walnut-allergic patients. Inhibition studies demonstrated that walnut pretreatment completely blocked IgE binding to pecan, whereas in some patients, pecan incubation only partially blocked IgE binding to walnut.
Walnut components are helpful in diagnosing walnut allergy and in identifying patients with pecan coallergy. Competitive ELISA indicates that pecan comprises a subset of the allergenic determinants of walnut.
区分核桃过敏患者与对核桃致敏但耐受的个体的诊断方法有限。此外，缺乏单一核桃过敏与核桃 - 山核桃双重过敏的特征。
提供核桃和山核桃过敏患者的临床和分子特征。
对76名核桃致敏患者进行了一项前瞻性队列研究。进行了核桃皮肤点刺试验以及血清中核桃及其成分特异性IgE的检测。除非患者经常食用核桃和山核桃，否则对其进行核桃和山核桃激发试验。
在研究的76名患者中，61名被诊断为核桃过敏，15名对核桃耐受。对胡桃球蛋白1或4的IgE水平大于或等于0.35 kU/L为识别核桃过敏患者提供了最佳诊断方法（准确率为0.93）。在61名核桃过敏患者中，49名对山核桃过敏，而12名对山核桃耐受。所有对核桃耐受的患者均不对山核桃过敏。双重过敏患者的核桃反应剂量显著更低（中位数分别为100 mg和1230 mg；P <.001）。对胡桃球蛋白4、低分子量豌豆球蛋白或高分子量豌豆球蛋白的IgE水平大于或等于0.35 kU/L能最好地将核桃 - 山核桃双重过敏患者与单一核桃过敏患者区分开来。抑制研究表明，核桃预处理可完全阻断IgE与山核桃的结合，而在一些患者中，山核桃孵育仅部分阻断IgE与核桃的结合。
核桃成分有助于诊断核桃过敏并识别山核桃共过敏患者。竞争性ELISA表明，山核桃包含核桃变应原决定簇的一个子集。
