Abstract

Allergies to peanuts, tree nuts, and sesame seeds are among the most important food related causes of anaphylaxis. Important clinical questions include: why is there a variable occurrence of co-allergy among these foods and is this immunologically mediated? Clinical and immunological data summarized here suggest an immunologic basis for these co-allergies based on similarities among the 2S-albumins. Data from component resolved diagnostics have highlighted the relationship between IgE binding to these allergens and the presence of IgE-mediated food allergy. Furthermore, in vitro and in vivo experiments provide strong evidence that the 2S albumins are the most important allergens in peanuts for inducing an allergic effector response. Although the 2S albumins are diverse, they have a common disulfide linked core with similar physicochemical properties that make them prime candidates to explain much of the observed co-allergy among peanuts, tree nuts and sesame seeds. The well-established frequency of cashew and pistachio nut co-allergy (64-100%) highlights how the structural similarities among their 2S albumins may account for observed clinical cross-reactivity. A complete understanding of the physicochemical properties of the 2S albumins in peanuts, tree nuts and sesame seeds will enhance our ability to diagnose, treat and ultimately prevent these allergies.

View details for DOI 10.1016/j.jaci.2020.11.004

View details for PubMedID 33217410