

Food allergy and anaphylaxis to walnut
https://doi.org/10.21508/1027-4065-2023-68-3-117-123
Abstract
Among the wide variety of tree nuts, walnut is an allergen that deserves special attention in the context of acute allergic reactions, due to their severity, low inducing trigger dose, and minimal likelihood of developing tolerance. The overall consumption of walnut has been steadily increasing, while the importance of this allergen as a trigger for anaphylaxis is underestimated due to its often “hidden” presence in foods and the difficulty of trigger verification. This article presents the epidemiological aspects of walnut food allergy, provides current data on the molecular characteristics and properties of various allergen proteins, and their clinical significance for the development of anaphylaxis. The article is supplemented with two clinical cases of food anaphylaxis to walnuts from own clinical practice.
About the Authors
A. A. IvanovRussian Federation
Moscow
N. V. Esakova
Russian Federation
Moscow
S. B. Zimin
Russian Federation
Moscow
V. V. Gorev
Russian Federation
Moscow
A. N. Pampura
Russian Federation
Moscow
References
1. McWilliam V., Koplin J., Lodge C., Tang M., Dharmage S., Allen K. The Prevalence of Tree Nut Allergy: A Systematic Review. Curr Allergy Asthma Rep 2015; 15(9): 54. DOI: 10.1007/s11882–015–0555–8
2. Poowuttikul P., Seth D. Anaphylaxis in Children and Adolescents. Pediatr Clin North Am 2019; 66(5): 995–1005. DOI: 10.1016/j.pcl.2019.06.005
3. Pampura A.N., Esakova N.V. Pediatric anaphylaxis: unresolved issues of diagnosis and patient management. Rossijskij allergologicheskij zhurnal 2021; 18(3): 131–136. (in Russ.) DOI: 10.36691/RJA1482
4. Esakova N.V., Treneva M.S., Okuneva T.S., Pampura A.N. Food Anaphylaxis: Reported Cases in Russian Federation Children. Am J Public Health Res 2015; 5: 187–191. DOI: 10.12691/ajphr-3–5–2
5. Blankestijn M.A., Remington B.C., Houben G.F., Baumert J.L., Knulst A.C., Blom W.M. et al. Threshold Dose Distribution in Walnut Allergy. J Allergy Clin Immunol Pract 2017; 5(2): 376–380. DOI: 10.1016/j.jaip.2016.12.005
6. Remington B.C., Westerhout J., Meima M.Y., Blom W.M., Kruizinga A.G., Wheeler M.W. et al. Updated population minimal eliciting dose distributions for use in risk assessment of 14 priority food allergens. Food Chem Toxicol 2020; 139: 111259. DOI: 10.1016/j.fct.2020.111259
7. FAOSTAT, The Statistics Division of the Food and Agriculture Organization of the United Nations. updated 2021 January 23; cited 2022 December 28. Available from: https:// www.fao.org/home/en / Ссылка активна на 20.04.2023.
8. Gubanov I.A., Krylova I.L., Tihonova V.L. Useful wild plants of the USSR. M.: Mysl’, 1976; 81–85. (in Russ.)
9. Lyons S.A., Datema M.R., Le T.M., Asero R., Barreales L., Belohlavkova S. et al. Walnut Allergy Across Europe: Distribution of Allergen Sensitization Patterns and Prediction of Severity. J Allergy Clin Immunol Pract 2021; 9(1): 225–235. e10. DOI: 10.1016/j.jaip.2020.08.051
10. Fernández-Rivas M., Barreales L., Mackie A.R., Fritsche P., Vázquez-Cortés S., Jedrzejczak-Czechowicz M. et al. The EuroPrevall outpatient clinic study on food allergy: background and methodology. Allergy 2015; 70(5): 576–84. DOI: 10.1111/all.12585
11. Burney P.G., Potts J., Kummeling I., Mills E.N., Clausen M., Dubakiene R. et al. The prevalence and distribution of food sensitization in European adults. Allergy 2014; 69(3): 365–371. DOI: 10.1111/all.12341
12. Hoyos-Bachiloglu R., Ivanovic-Zuvic D., Álvarez J., Linn K., Thöne N., de los Ángeles Paul M. et al. Prevalence of parent-reported immediate hypersensitivity food allergy in Chilean school-aged children. Allergol Immunopathol (Madr) 2014; 42(6): 527–32. DOI: 10.1016/j.aller.2013.09.006
13. Lee S.Y., Ahn K., Kim J., Jang G.C., Min T.K., Yang H.J. et al. A multicenter retrospective case study of anaphylaxis triggers by age in Korean children. Allergy Asthma Immunol Res 2016; 8(6): 535–540. DOI: 10.4168/aair.2016.8.6.535
14. Grabenhenrich L.B., Dölle S., Moneret-Vautrin A., Köhli A., Lange L., Spindler T. et al. Anaphylaxis in children and adolescents: The European Anaphylaxis Registry. J Allergy Clin Immunol 2016; 137(4): 1128–1137.e1. DOI: 10.1016/j.jaci.2015.11.015
15. Costa J., Carrapatoso I., Oliveira M.B., Mafra I. Walnut allergens: molecular characterization, detection and clinical relevance. Clin Exp Allergy 2014; 44(3): 319–341. DOI: 10.1111/cea.12267
16. ALLERGEN NOMENCLATURE WHO/IUIS Allergen Nomenclature Sub-Committee. updated 2022 April 29; cited 2022 December 28. Available from: http://www.allergen.org/search.php?allergenname=&allergensource=Juglans&Tax-Source=&TaxOrder=&foodallerg=all&bioname= / Ссылка активна на 03.04.2023.
17. NCBI, National Center for Biotechnology Information, Bethesda, USA. updated 2013 September 30; cited 2022 December 28. Available from: http://www.ncbi.nlm.nih.gov / Ссылка активна на 03.04.2023
18. Teuber S.S., Dandekar A.M., Peterson W.R., Sellers C.L. Cloning and sequencing of a gene encoding a 2S albumin seed storage protein precursor from English walnut (Juglans regia), a major food allergen. J Allergy Clin Immunol 1998; 101 (6 Pt 1): 807–814. DOI: 10.1016/S0091–6749(98)70308–2
19. Sato S., Yamamoto M., Yanagida N., Ito K., Ohya Y., Imai T. et al. Jug r 1 sensitization is important in walnut-allergic children and youth. J Allergy Clin Immunol Pract 2017; 5(6): 1784–1786.e1. DOI: 10.1016/j.jaip.2017.04.025
20. Lee J., Jeong K., Jeon S.A., Lee S. Component resolved diagnosis of walnut allergy in young children: Jug r 1 as a major walnut allergen. Asian Pac J Allergy Immunol 2019; 39(3): 190–196. DOI: 10.12932/AP-161118–0443
21. Teuber S.S., Jarvis K.C., Dandekar A.M., Peterson W.R., Ansari A.A. Identification and cloning of a complementary DNA encoding a vicilin-like proprotein, jug r 2, from english walnut kernel (Juglans regia), a major food allergen. J Allergy Clin Immunol 1999; 104(6): 1311–1320. DOI: 10.1016/s0091–6749(99)70029–1
22. Ballmer-Weber B.K., Lidholm J., Lange L., Pascal M., Lang C., Gernert S. et al. Allergen Recognition Patterns in Walnut Allergy Are Age Dependent and Correlate with the Severity of Allergic Reactions. J Allergy Clin Immunol Pract 2019; 7(5): 1560–1567.e6. DOI: 10.1016/j.jaip.2019.01.029
23. Fernández-Rivas M., Cuevas M. Peels of Rosaceae fruits have a higher allergenicity than pulps. Clin Exp Allergy 1999; 29(9): 1239–1247. DOI: 10.1046/j.1365–2222.1999.00628.x
24. Pastorello E.A., Farioli L., Pravettoni V., Robino A.M., Scibilia J., Fortunato D. et al. Lipid transfer protein and vicilin are important walnut allergens in patients not allergic to pollen. J Allergy Clin Immunol 2004; 114(4): 908–914. DOI: 10.1016/j.jaci.2004.06.020.
25. Su M., Venkatachalam M., Teuber S.S., Roux K.H., Sathe S.K. Impact of c-irradiation and thermal processing on the antigenicity of almond, cashew nut and walnut proteins. J Sci Food Agric 2004; 84: 1119–1125. DOI: 10.1002/jsfa.1748
26. Masthoff L.J., Hoff R., Verhoeckx K.C., van Os-Medendorp H., Michelsen-Huisman A., Baumert J.L. et al. A systematic review of the effect of thermal processing on the allergenicity of tree nuts. Allergy 2013; 68(8): 983–993. DOI: 10.1111/all.12185
27. Wallowitz M., Peterson W.R., Uratsu S., Comstock S.S., Dandekar A.M., Teuber S.S. Jug r 4, a legumin group food allergen from walnut (Juglans regia Cv. Chandler). J Agric Food Chem 2006; 54(21): 8369–8375. DOI: 10.1021/jf061329s
28. Borres M.P., Sato S., Ebisawa M. Recent advances in diagnosing and managing nut allergies with focus on hazelnuts, walnuts, and cashew nuts. World Allergy Organ J 2022; 15(4): 100641. DOI: 10.1016/j.waojou.2022.100641
29. Cardona V., Ansotegui I.J., Ebisawa M., El-Gamal Y., Fernandez Rivas M., Fineman S. et al. World allergy rganization anaphylaxis guidance, 2020. World Allergy Organ J 2020; 13(10): 100472. DOI: 10.1016/j.waojou.2020.100472
30. Sampson H.A., Munoz-Furlong A., Campbell R.L., Adkinson N.F. Jr., Bock S.A., Branum A. et al. Second symposium on the definition and management of anaphylaxis: summary report — Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 2006; 117: 391–397. DOI: 10.1016/j.jaci.2005.12.1303
31. Anaphylactic shock. THE RUSSIAN ASSOCIATION OF ALLERGOLOGY AND CLINICAL IMMUNOLOGY and The All-Russia Public Organization «Federation of Anaesthesiologists and Reanimatologists» (in Russ.) https://raaci.ru/dat/pdf/allergic_shock_2020.pdf / Ссылка активна на 03.04.2023.
32. Esakova N.V., Zaharova I.N., Osmanov I.M., Kolushkin D.S., Pampura A.N. Anaphylaxis among children hospitalized with severe allergic reactions: a 5-year retrospective analysis. Vopr det dietol 2022; 20(4): 21–30. (in Russ.) DOI: 10.20953/1727–5784–2022–4–21–30
33. Feldweg A.M. Food-Dependent, Exercise-Induced Anaphylaxis: Diagnosis and Management in the Outpatient Setting. J Allergy Clin Immunol Pract 2017; 5(2): 283–288. DOI: 10.1016/j.jaip.2016.11.022
34. Elizur A., Appel M.Y., Nachshon L., Levy M.B., Epstein-Rigbi N., Pontoppidan B. et al. Clinical and Molecular Characterization of Walnut and Pecan Allergy (NUT CRACKER Study). J Allergy Clin Immunol Pract 2020; 8(1): 157–165. e2. DOI: 10.1016/j.jaip.2019.08.038
35. Maloney J.M., Rudengren M., Ahlstedt S., Bock S.A., Sampson H.A. The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy. J Allergy Clin Immunol 2008; 122(1): 145–151. DOI: 10.1016/j.jaci.2008.04.014
36. Steering Committee Authors; Review Panel Members. A WAO — ARIA — GA2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020. World Allergy Organ J 2020; 13(2): 100091. DOI: 10.1016/j.waojou.2019.100091
37. Sasamoto K., Nagakura K.I., Sato S., Yanagida N., Ebisawa M. Low-dose oral immunotherapy for walnut allergy with anaphylaxis: Three case reports. Allergol Int 2021; 70(3): 392–394. DOI: 10.1016/j.alit.2021.01.007
Review
For citations:
Ivanov A.A., Esakova N.V., Zimin S.B., Gorev V.V., Pampura A.N. Food allergy and anaphylaxis to walnut. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2023;68(3):117-123. (In Russ.) https://doi.org/10.21508/1027-4065-2023-68-3-117-123