![]() A HEP-index area of ≥0.4 corresponding with a wheal diameter of ≥3 mm was considered positive. We divided the area of the allergen-induced wheal by the mean area of two positive histamine-induced wheals. We used a precise scanning method to ascertain the SPT results. #Cashew allergy skinThe SPT was performed by applying a drop of the allergen extract on the skin of the volar aspect of the forearm subsequently the epidermis was punctured with a standardised 1 mm sharp tip sterile lancet. Mango juice was prepared from pieces of ripe mango fruit pulp, without skin or kernel. A 10% w/v extract in phosphate-buffered saline with the pre-treated material was made. Cashew nuts (roasted, unsalted) and pistachio nuts (fresh, not roasted, unsalted nuts) were homogenized mechanically, ground with a mortar and pestle, defatted by ether extraction, and subsequently air-dried. Skin prick testĪll children underwent a SPT in the IDEAL study with cashew nut and pistachio nut extract and mango juice, a positive control (histamine 10 mg/ml ALK-Abello, Nieuwegein, the Netherlands) in duplicate and a negative control. Parents of children (2–12 years old) and parents and children (≥12 years old) signed the informed consent. Prior to the pistachio and mango challenge a dietary history questionnaire was used on consumption of pistachio and mango Medical ethical approval was obtained in January 2015. The children underwent a DBPCFC with pistachio nut and an open food challenge with mango in this follow-up study. Medical history, sensitisation results (sIgE and SPT), and results from the DBPCFC with cashew nut were obtained from the IDEAL-study. For practical reasons only two of the three centres were invited to participate in this pistachio nut and mango follow-up study. Inclusion criterion for this IDEAL follow-up study was co-sensitization to pistachio nut, regardless the result of the double-blind placebo-controlled food challenge (DBPCFC) with cashew nut. Sensitized children who were tolerant to cashew nuts were excluded. 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. #Cashew allergy registrationTrial registration The study was registered in the Dutch trial register (registration number 3572) on 10 August 2012 (retrospectively registered)Ĭhildren were recruited from the multi-centre IDEAL-study and were included between January 2015 and June 2015. Therefore, a challenge test with pistachio nut is recommended in children with cashew nut and pistachio nut sensitisation. ConclusionĪlthough co-sensitisation between cashew nut and pistachio nut was observed in 98%, pistachio nut sensitisation was only clinically relevant in 34% of the children. None of the children was challenge positive to mango. Pistachio nut sensitisation was clinically relevant in only 34% of cashew-sensitised children and only 31% of cashew challenge positive children. Twenty-nine children (mean age of 11.6 years, 62% male) were included. In this follow-up study a double-blind placebo-controlled food challenge with pistachio nut and an open food challenge with mango were performed. Inclusion criterion for this IDEAL follow-up study was co-sensitization to pistachio nut, regardless the result of the DBPCFC with cashew nut. MethodsĬhildren were recruited from the study: ‘Improvement of Diagnostic mEthods for ALlergy assessment (IDEAL trial number NTR3572). 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. 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. Therefore, cashew nut sensitised children are frequently advised to eliminate cashew nuts and pistachio nuts from their diet. Cashew nut, pistachio nut and mango belong to the Anacardiaceae family and are botanically related. ![]()
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