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. 2021 Jan;9(1):225-235.e10.
doi: 10.1016/j.jaip.2020.08.051. Epub 2020 Sep 8.

Walnut Allergy Across Europe: Distribution of Allergen Sensitization Patterns and Prediction of Severity

Sarah A Lyons  1 , Mareen R Datema  2 , Thuy-My Le  3 , Riccardo Asero  4 , Laura Barreales  5 , Simona Belohlavkova  6 , Frédéric de Blay  7 , Michael Clausen  8 , Ruta Dubakiene  9 , Cristina Fernández-Perez  5 , Philipp Fritsche  10 , David Gislason  8 , Karin Hoffmann-Sommergruber  11 , Monika Jedrzejczak-Czechowicz  12 , Laurian Jongejan  13 , Marek L Kowalski  12 , Tanya Z Kralimarkova  14 , Jonas Lidholm  15 , Nikolaos G Papadopoulos  16 , Bo Pontoppidan  15 , Todor A Popov  17 , Nayade Del Prado  5 , Ashok Purohit  18 , Isabel Reig  19 , Suranjith L Seneviratne  20 , Athanasios Sinaniotis  21 , Emilia Vassilopoulou  22 , Serge A Versteeg  13 , Stefan Vieths  23 , Aeilko H Zwinderman  24 , Paco M J Welsing  25 , E N Clare Mills  21 , Barbara K Ballmer-Weber  26 , André C Knulst  3 , Montserrat Fernández-Rivas  27 , Ronald Van Ree  28
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Free article

Walnut Allergy Across Europe: Distribution of Allergen Sensitization Patterns and Prediction of Severity

Sarah A Lyons et al. J Allergy Clin Immunol Pract. 2021 Jan.
Free article

Abstract

Background: Walnut allergy is common across the globe, but data on the involvement of individual walnut components are scarce.

Objectives: To identify geographical differences in walnut component sensitization across Europe, explore cosensitization and cross-reactivity, and assess associations of clinical and serological determinants with severity of walnut allergy.

Methods: As part of the EuroPrevall outpatient surveys in 12 European cities, standardized clinical evaluation was conducted in 531 individuals reporting symptoms to walnut, with sensitization to all known walnut components assessed in 202 subjects. Multivariable Lasso regression was applied to investigate predictors for walnut allergy severity.

Results: Birch-pollen-related walnut sensitization (Jug r 5) dominated in Northern and Central Europe and lipid transfer protein sensitization (Jug r 3) in Southern Europe. Profilin sensitization (Jug r 7) was prominent throughout Europe. Sensitization to storage proteins (Jug r 1, 2, 4, and 6) was detected in up to 10% of subjects. The walnut components that showed strong correlations with pollen and other foods differed between centers. The combination of determinants best predicting walnut allergy severity were symptoms upon skin contact with walnut, atopic dermatitis (ever), family history of atopic disease, mugwort pollen allergy, sensitization to cat or dog, positive skin prick test result to walnut, and IgE to Jug r 1, 5, 7, or carbohydrate determinants (area under the curve = 0.81; 95% CI, 0.73-0.89).

Conclusions: Walnut-allergic subjects across Europe show clear geographical differences in walnut component sensitization and cosensitization patterns. A predictive model combining results from component-based serology testing with results from extract-based testing and information on clinical background allows for good discrimination between mild to moderate and severe walnut allergy.

Keywords: Allergen components; EuroPrevall; Europe; IgE sensitization; Prediction; Severity; Walnut allergy; iFAAM.

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