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A Growing Concern for Cashew and an Unexpected Risk From Almonds: Data From the Anaphylaxis Registry
Veronika Höfer1, Sabine Dölle-Bierke1, Dominique Sabouraud-Leclerc2,3
1Division of Allergy and Immunology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Cashew is now the leading cause of tree nut anaphylaxis in children, often triggered by small amounts. Improved prevention and treatment are crucial, especially given low adrenaline use.
Area of Science:
- Allergy and Immunology
- Clinical Medicine
- Public Health
Background:
- Food allergies, including tree nut-induced anaphylaxis (TIA), are a growing public health concern.
- Limited data exists on cashew-induced anaphylaxis, necessitating further investigation.
Purpose of the Study:
- To analyze trends and characteristics of TIA cases, with a focus on cashew and almond allergies.
- To identify key allergens, patient demographics, and management practices in TIA.
Main Methods:
- Retrospective analysis of TIA cases from the European Anaphylaxis Registry (2007-2024).
- Inclusion of 1083 cases with confirmed elicitors, stratified by age (children and adults).
Main Results:
- Cashew was the most frequent TIA trigger in children (334 cases), with increasing prevalence.
- Adults frequently reacted to hazelnut (105 cases), walnut (47 cases), and almond (35 cases).
- Anaphylaxis severity was age-independent; awareness and adrenaline use were low in both age groups.
Conclusions:
- Cashew is a significant and increasing allergen causing TIA in children.
- Almond is a notable allergen in adults; both require monitoring.
- Current acute management of TIA needs improvement to align with guidelines.
