1028 Comprehensive Clinical Study on Cashew Allergy: Preliminary Results

Sunday, 6 December 2015
Ivanka Trump Ballroom (Trump National Doral)

Nicolette De Jong, PhD , Allergology, Erasmusmc, Rotterdam, Netherlands

Hanna Van Der Valk, MD , Allergology, Internal Medicine, Rotterdam, Netherlands

Harry Wichers, PhD , Wur, Wageningen, Netherlands

Ewoud Dubois, MD, PhD , Umcg, Groningen, Netherlands

Hans De Groot , Rdgg, Delft, Netherlands

Roy Gerth Van Wijk, MD, PhD , Section of Allergology, Dept. of Internal Medicine, Erasmus Medical Center, Rotterdam, Netherlands


Cashew consumption can cause severe allergic reactions, with high risk of anaphylaxis and severe reactions may be elicited by minimal amounts of cashew allergen, suggesting high potency of the allergen comparable to other tree nuts and peanuts. The aim of the study is to measure prevalence -and clinical relevance of sensitization to cashew in children in the Netherlands.


A Dutch multicenter, prospective study has been started. The aim is to include 200 children (aged 2-17 year) with sensitization to cashew nut and a history of an allergic reaction to cashew nut or never ingested. Skin prick tests (SPT) and specific IgE will be measured with allergen extracts from cashew, pistachio, hazelnut, mango, peanut and birch pollen, and a DBPCFC with cashew will be performed.


So far, 185 patients have been included and 170 analyzed. The mean age of the children was 8.7 year (range 2-17 year). Of all the 170 DBPCFC’s, 75% (127) were assessed as positive and 39% of the reactions started at dose 1 (1 mg cashew nut protein). Severe reactions occurred in 15 percent of the children. Most children reacted with a combination of gastro-intestinal symptoms, skin symptoms, and upper airway symptoms. Mean SPT was 3.29 (HEP-index) and mean sIgE cashew was 19,79 (IE/l). AUC for SPT and sIgE was 0.793 and 0.740 respectively. Cashew sensitized patients were also sensitized to pistachio (99%), hazelnut (74%), peanut(72%), mango(39%) and birch pollen (81%)


Cashew allergens are highly potent and may cause severe allergic reactions on a low dose. SIgE and SPT results are predictive for the outcome of the DBPCFC. Almost every patient with cashew sensitization was sensitized to pistachio of which the clinical relevance is unknown.

Learning Objectives:
Learn how to diagnose a cashew allergy.

Be aware of the low dose of mg cashew that can cause an allergic reaction to cashew in children.