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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.
Background:
Food allergies are a major health concern with rising prevalence. Dietary habits are changing, and information about cashew-induced anaphylaxis is limited.
Methods:
Cases of tree nut-induced anaphylaxis (TIA) registered from 2007 until April 2024 were extracted from the European Anaphylaxis Registry and analyzed.
Results:
1389 cases of TIA out of 5945 registered food-induced reactions (23%) were identified. 1,083 cases with confirmed elicitor status, including 845 children (median age 4 years, 61% male) and 238 adults (38 years, 40% male), were selected for further analysis. The most frequent elicitors among children were cashew (n = 334), hazelnut (n = 211) and walnut (n = 146). The proportion of cashew-induced anaphylaxis increased from 2007 to 2024, and reactions were frequently caused by small amounts (< 1 teaspoon). Adults reacted frequently to hazelnut (n = 105), walnut (n = 47) but also almond (n = 35) and to higher amounts. Potential cofactors were present in 50% of the adult patients and 17% of children. The reaction severity was age-independent, and only a minority of patients was previously aware of their allergy (children 23%, adults 21%). The use of adrenaline was low in lay treatment (children 13%, adults 3%) and reached approximately 40% upon professional treatment.
Conclusion:
Cashew is an increasing, relevant allergen leading to anaphylaxis and is now the most frequent cause of TIA among children. These findings highlight the need for effective prevention and treatment measures. Almond was a frequent elicitor among adults and should be further monitored. The acute management requires improvement to comply with current guidelines.
