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

Publication

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

Journal Paper/Review - Sep 8, 2020

Lyons Sarah A, Pontoppidan Bo, Popov Todor A, Prado Nayade Del, Purohit Ashok, Reig Isabel, Seneviratne Suranjith L, Sinaniotis Athanasios, Vassilopoulou Emilia, Versteeg Serge A, Vieths Stefan, Zwinderman Aeilko H, Welsing Paco M J, Mills E N Clare, Ballmer-Weber Barbara, Knulst André C, Fernández-Rivas Montserrat, Papadopoulos Nikolaos G, Lidholm Jonas, Datema Mareen R, Le Thuy-My, Asero Riccardo, Barreales Laura, Belohlavkova Simona, de Blay Frédéric, Clausen Michael, Dubakiene Ruta, Fernández-Perez Cristina, Fritsche Philipp, Gislason David, Hoffmann-Sommergruber Karin, Jedrzejczak-Czechowicz Monika, Jongejan Laurian, Kowalski Marek L, Kralimarkova Tanya Z, Van Ree Ronald

Citation

Lyons S, Pontoppidan B, Popov T, Prado N, Purohit A, Reig I, Seneviratne S, Sinaniotis A, Vassilopoulou E, Versteeg S, Vieths S, Zwinderman A, Welsing P, Mills E, Ballmer-Weber B, Knulst A, Fernández-Rivas M, Papadopoulos N, Lidholm J, Datema M, Le T, Asero R, Barreales L, Belohlavkova S, de Blay F, Clausen M, Dubakiene R, Fernández-Perez C, Fritsche P, Gislason D, Hoffmann-Sommergruber K, Jedrzejczak-Czechowicz M, Jongejan L, Kowalski M, Kralimarkova T, Van Ree R. Walnut Allergy Across Europe: Distribution of Allergen Sensitization Patterns and Prediction of Severity. J Allergy Clin Immunol Pract 2020

Type

Journal Paper/Review (English)

Journal

J Allergy Clin Immunol Pract 2020

Publication Date

Sep 8, 2020

Issn Electronic

2213-2201

Brief description/objective

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.