Substance Info: (and synonyms)|
Brazil Nut Background Info:
Brazil nut is the seed of the Bertholletia excelsa tree (Family Lecythidaceae).
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A "nut box" was constructed containing samples of common nuts and pine nuts. Nut-allergic and nonallergic children were asked to identify the nuts, and their responses were compared and correlated by age. Nut-allergic children were asked to identify the nut(s) that they should not eat. In general, children, including those who are allergic to nuts, can identify few nuts. This lack of recognition could put them at increased risk for unintentional ingestion. As part of an overall educational plan, nut-allergic children should be taught not only to avoid but also to identify the nut to which they are allergic. (Ferdman 2006 ref.15441 7)
Ferdman RM, Church JA. Mixed-up nuts: identification of peanuts and tree nuts by children. Ann Allergy Asthma Immunol 2006 Jul;97(1):73-77
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Anaphylaxis due to skin testing for Brazil nut in an 18-year old male with clinically confirmed Walnut allergy. A few minutes after eating a cake the patient had generalized urticaria, angioedema of the face, wheezing dyspnoea and hypotension. The patient reported previous episodes of urticaria and oral itching after eating Walnuts, and the cake that had provoked anaphylaxis also contained Walnuts. During testing for Walnut and Brazil nut, immediately after pricking with fresh Brazil nut, a severe episode of anaphylaxis occurred, that required epinephrine and intravenous steroids. The subject had never eaten Brazil nut before. The authors hypothesize a cross reactivity effect, since this phenomenon is well known for tree nuts. (Senna 2005 ref.16695 0)
Senna G, Bonadonna P, Crivellaro M, Schiappoli M, Passalacqua G. Anaphylaxis due to Brazil nut skin testing in a walnut-allergic subject. J Investig Allergol Clin Immunol 2005;15(3):225-227
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A 42-year-old man developed generalised pruritus, itching of the throat, rhinitis, dyspnoea and dizziness 5 min after eating a few roasted Macadamia nuts. Skin prick tests were positive to Hazelnut and roasted Macadamia nut but negative for Peanut, Almond, Brazil nut and Walnut. A 34-year-old man repeatedly developed severe oral burning, itching and swelling after eating Hazelnut, Walnut, Brazil nut, Almond and Macadamia nut, but tolerating Peanut and Cashew nut. Skin prick test was positive to peanut, almond, hazelnut, Brazil nut and walnut but negative to cashew nut. A prick-to-prick was positive for Macadamia nut. Specific IgE to latex were 1.7 kU/l and negative to peanut, almond, hazelnut, Brazil nut, walnut, cashew nut and macadamia nut. (Lerch 2005 ref.10184 2)
Lerch M, Egger C, Bircher AJ. Allergic reactions to macadamia nut. Allergy 2005;60(1):130-1.
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Patients sensitized to minor Brazil nut allergens are reported to not have allergic symptoms (Pastorello 1998 ref.4333 5) but this is contradicted by a study of a 15 year old boy who experienced two distinct episodes of generalized urticaria about 30 minutes after eating Brazil nut. A SPT was very positive to Brazil nut. Serum IgE was positive to Brazil nut but negative to mustard, poppy seed, sesame seed or sunflower seed (no reactivity shown to 2S albumins) (Asero 2002 ref.7026 8)
Asero R, Mistrello G, Roncarolo D, Amato S. Allergy to minor allergens of Brazil nut. Allergy 2002 ;57(11):1080-1
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The seed storage 2S albumin, has been identified in the most diffused edible seeds and nuts, such as mustard, sesame, Brazil nut, walnut and peanut. In particular, a strong correlation between IgE-binding to these proteins and food-induced anaphylaxis has been demonstrated for Brazil nut and sesame seeds. (Pastorello 2001 ref.4135 7)
Pastorello EA, Pompei C, Pravettoni V, Brenna O, Farioli L, Trambaioli C, Conti A. Lipid transfer proteins and 2S albumins as allergens. Allergy 2001;56(S67):45-47
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The probability of a patient with nut allergy having specific IgE to a particular combination of peanut, hazelnut and brazil nut is similar, whatever their age or sex. The apparent increase in multiple nut reactivity with increasing age may therefore be due to exposure of previously unchallenged sensitivity. The frequency of multiple-nut specificity is sufficiently high that patients should always be tested for allergy to a range on nuts if they have a history of reacting to any nut. (Pumphrey 1999 ref.7807 4)
Pumphrey RS, Wilson PB, Faragher EB, Edwards SR. Specific immunoglobulin E to peanut, hazelnut and brazil nut in 731 patients: similar patterns found at all ages. Clin Exp Allergy 1999;29(9):1256-9
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Anaphylaxis. A 31-year-old woman who had had seasonal rhinoconjunctivitis and asthma for the last 10 years developed pharyngeal itching, lip swelling, dysphonia, dyspnea, wheezing, and generalized macular exanthema 10 minutes after eating a Brazil nut. She had previously developed oral allergy syndrome after eating almond, walnut, sunflower seed, and hazelnut. She had suffered from abdominal pain after eating chestnut. She tolerated peanut and pistachio. Prick-by-prick with Brazil nut and prick tests with a Brazil nut extract were positive. Prick tests and prick-by-prick with almond, peanut, chestnut, sunflower seed, and pistachio were positive. Prick-by-prick with hazelnut, walnut, and cashew nut were positive. Serum specific IgE was: Class 2 for almond, peanut, chestnut, and pistachio; Class 3 for hazelnut and sunflower seed; Class 2 for Brazil nut (2.37 kU/l). (Borja 1999 ref.7806 4)
Borja JM, Bartolome B, Gomez E, Galindo PA, Feo F. Anaphylaxis from Brazil nut. Allergy 1999;54(9):1007-8
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This study reports on 11 patients with anaphylaxis after eating Brazil nuts and 10 subjects with no symptoms to this food item although both groups had specific IgE to Brazil nut. (Pastorello 1998 ref.4333 5)
Pastorello EA, Farioli L, Pravettoni V, Ispano M, Conti A, Ansaloni R, Rotondo F, et al. Sensitization to the major allergen of Brazil nut is correlated with the clinical expression of allergy. J Allergy Clin Immunol 1998;102:1021-1027
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Vomiting, diarrhoea and loss of consciousness. (Bartolome 1997 ref.625 94)
Bartolome B, Mendez JD, Armentia A, Vallverdu A, Palacios R. Allergens from Brazil nut: immunochemical characterization. Allergol Immunopathol (Madr) 1997;25(3):135-44
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In a study of 62 patients with nut allergy (adults and children), peanuts were the commonest cause of allergy (47) followed by Brazil nut (18), almond (14), and hazelnut (13). The commonest symptom was facial angioedema, and the major life threatening reaction was laryngeal oedema. Hypotension was uncommon. (Ewan 1996 ref.1625 8)
Ewan PW. Clinical study of peanut and nut allergy in 62 consecutive patients: new features and associations. BMJ 1996;312(7038):1074-8
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On the Isle of Wight (population 125,000), 12 patients were seen in 8 years who had adverse reactions immediately following exposure to Brazil nut. Eleven developed angioedema, 7 generalized urticaria, 5 bronchospasm, 2 stridor, 2 throat tightness, 2 itchy mouth and 1 syncope. Onset of symptoms was less than 3 mins in all. Eight patients were strongly positive on skin test to Brazil nut. In six out of eight patients, RAST was also positive, class 2 or more. In three patients there was no definite evidence of IgE-mediated hypersensitivity. Total IgE was normal in five patients with severe reactions. Ten out of 12 patients had other atopic diseases such as asthma, eczema or allergic rhinitis usually from infancy or early childhood. Seven out of eight patients were positive to several food and/or inhalant allergens on skin test. (Arshad 1991 ref.284 21)
Arshad, SH, Malmberg, E, Krapf, K, Hide, DW. Clinical and immunological characteristics of Brazil nut allergy. Clin Exp Allergy 1991;21:373-376
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In this study, 102 patients with the initial diagnosis of idiopathic anaphylaxis were evaluated with a battery of 79 food-antigen skin prick tests selected to include foods reported or suspected of provoking anaphylaxis. Thirty-two patients (31%) had positive tests to one or more food antigens. In five of these patients, subsequently eating a food that elicited a positive test provoked an anaphylactic reaction. Two patients eliminated the foods completely, stopped having reactions, and refused challenge. In these seven patients, 10 different antigens provoked anaphylaxis: aniseed, cashew nut, celery, flaxseed, hops, mustard, mushroom, shrimp, sunflower, and walnut. We conclude that a battery of selected food-antigen skin prick tests provided a useful method for identifying an offending antigen in these patients and that some (7% in our series) cases of "idiopathic" anaphylaxis by history are not truly idiopathic.
The 10 antigens with positive clinical correlation
Antigens A B C
Aniseed 1 5 20
Cashew nut 1 2 50
Celery 2 4 50
Flaxseed 1 1 100
Hops 1 2 50
Mushroom 1 3 33
Mustard 2 3 66
Shrimp 1 3 33
Sunflower seed 1 3 33
Walnut 1 1 100
A = Total No. of positive skin tests with positive correlation
B = Total No. of positive skin tests
C = Percent of positive skin tests with positive correlation
Total number of positive skin prick tests.
2 - Almond
5 - Aniseed
1 - Artichoke
1 - Baker's yeast
1 - Beet
1 - Brazil nut
2 - Brewer's yeast
1 - Caraway seed
2 - Cashew nut
5 - Castor bean
4 - Celery
8 - Chamomile
2 - Chestnut
1 - Chicory
1 - Clam
2 - Coconut
1 - Cottonseed
2 - Crab
1 - Fennel
4 - Filbert (hazelnut)
I - Flaxseed
1 - Garbanzo bean
2 - Ginger
1 - Halibut
1 - Honey
2 - Hops
3 - Horseradish
1 - Lentil
1 - Lima beans
2 - Lobster
2 - Mango
1 - Milk
5 - Millet
3 - Mushroom
3 - Mustard
1 - Nutmeg
2 - Pea
1 - Pistachio
3 - Poppy seed
2 - Sesame seed
3 - Shrimp
3 - Sunflower
1 - Thyme
1 - Tumeric
1 - Walnut
None for Allspice, Apple, Banana, Bay leaf, Black pepper, Buckwheat, Cantaloupe, Chicken, Chili pepper, Chocolate, Cinnamon, Clove, Cod, Corn, Cumin seed, Dill seed, Egg, Garlic, Juniper berry, Orange, Oyster, Peach, Peanut, Potato, Psyllium seed, Raspberry, Sage, Salmon, Soybean, Strawberry, Sweet potato, Tangerine, Tapioca, Vanilla.
7 patients with positive clinical correlation to a SPT
1 : Aniseed
2 : Shrimp
3 : Mustard, flaxseed
4 : Celery, hops
5 : Celery, mustard, sunflower
6 : Walnut, cashew nut
7 : Mushroom
(Stricker 1986 ref.9 3606)
Stricker WE, Anorve Lopez E, Reed CE. Food skin testing in patients with "idiopathic anaphylaxis". J Allergy Clin Immunol 1986;77:516-519
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A report from the Isle of Wight on 4 individuals with Brazil nut allergy. (Hide 1983 ref.588 73)
Hide DW. Clinical curio: allergy to brazil nut. (letter) BMJ Clin Research 1983;287:900
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Fifteen cases of systemic allergic reactions to ingcslant antigens arc reported. penicillin, pinto bean, halibut, rice, potato, Brazil nut, shrimp, milk, a cereal mix, garbanzo bean, tangerine, salicylsalicylic acid, and demethylchlortetracycline.
A 37-year-old woman with dyspnea, generalized urticaria and angioedema, and syncope. She was unconscious with laryngeal stridor, pulmonary wheezing, cyanosis, angioedema of the face and oropharynx, and generalized urticaria. Subsequently, 4 reactions of varying severity occurred. Pinto bean became apparent from a diet diary. A prick test with extract prepared from fresh, raw pinto bean caused a large local cutaneous reaction and was followed by mild generalized symptoms of dyspnea, wheezing, pruritus, and flushing.
A 27-year-old man, while ingesting halibut and toast, abruptly developed dyspnea, generalized urticaria, facial angioedema, dizziness, "faintness," diarrhea, nausea, and emesis. He was hypotensive. Wheezing, generalized urticaria, and facial angioedema were present. A similar reaction occurred several months earlier while ingesting halibut. A cutaneous prick test was strongly positive to halibut extract.
A 21-year-old woman experienced dyspnea, dizziness, pruritus, swelling of the face, weakness, headache, and abdominal cramps. These symptoms developed while ingesting rice. Similar reactions, including syncope, had previously occurred during ingestion of rice. She had facial angioedema, generalized urticaria, cyanosis, and wheezing. A cutaneous prick test was strongly positive with a dilute solution of rice extract.
A 17-year-old boy with wheezing, dyspnea, angioedema, dizziness, weakness, and chest pain described as "tightness" which occurred repeatedly after ingestion of potato. Cutaneous scratch tests were positive to potato extract.
A 28-year-old man who experienced immediate systemic allergic reactions numerous times after ingestion of Brazil nut, pistachio nut, and cashew. Reactions were characterized by rhinorrhea, dyspnea; cyanosis; angioedema of face, tongue, and pharynx; abdominal cramps; weakness; and dizziness. A cutaneous scratch test with Brazil nut extract was performed elsewhere and caused a large local reaction and wheezing.
A 24-year-old with a history of ingestion of shrimp and lobster which had repeatedly caused rhinorrhea, angioedema of face and oropharynx, urticaria, dyspnea, wheezing, dizziness, and syncope. A cutaneous prick test with shrimp extract was markedly positive. He later ingested shrimp casserole to avoid insulting a girl friend despite knowledge of his sensitivity to this food. Pruritus, generalized urticaria, swelling of the face and neck, dyspnea, dysphagia, laryngeal stridor, weakness, and dizziness developed immediately.
A 5-month-old with reactions which invariably followed ingestion of pasteurized but otherwise uncooked milk. Reactions were characterized by pallor, cyanosis, muscle flaccidity, and generalized urticaria.. On one occasion, milk was accidentally spilled on him; urticaria developed at all sites of contact. Further cutaneous testing was deferred. He tolerated milk in baked foods.
A 49-year-old man with dyspnea, swelling of the face and oropharynx, pruritus, urticaria, and dyspnea which developed while he was ingesting a cereal mix. Angioedema of the face, generalized urticaria, cyanosis, and wheezing were present. Cutaneous prick tests were positive with the specific lot of cereal mix which the patient was ingesting. Cutaneous tests with individual ingredients of the cereal mix were negative. The reaction is attributed to the specific lot of cereal mix and may have been caused by a contaminant.
A 39-year-old with dizziness, dyspnea, wheezing, generalized pruritus, and swelling of the face and oropharynx. Positive findings included rhinorrhea, lacrimation, generalized urticaria, and angioedema of the face and oropharynx. Partially cooked garbanzo bean (chick-pea) was ingested immediately prior to his reaction. A cutaneous prick test with this food was positive. He tolerated well-cooked beans.
A 33-year-old woman suddenly developed generalized pruritus, dyspnea, abdominal "cramps," nausea, and dizziness while eating a meal. Physical findings included generalized urticaria, angioedema of face and oropharynx, and wheezing. Tangerine was among the foods ingested before the reaction. A cutaneous prick test with fresh tangerine juice was positive. She subsequently ingested lemonade and fresh orange without adverse effect. Cutaneous tests with fresh orange juice were negative.
A 37-year-old man with adverse effects to salicylsalicylic acid and acetylsalicylic acid.
A 34-year-old male physician experienced within 20 minutes of ingestion of demethylchlortetracycline, headache, transient syncope, dyspnea, "tightness in the chest," angioedema of the face and hands, and generalized urticaria developed. Findings were generalized urticaria, periorbital edema, and edema of the hands and feet.
A 22-year-old man with chest pain dyspnea, swelling of the face, generalized pruritus, and syncope developed while lie was ingesting a meal. Similar reactions had occurred 5 times previously. The causative antigen was undetermined, but all reactions followed ingestion of various foods containing a large mold content. (Golbert, 1969 ref.286 73)
Golbert, T, Patterson, R, Pruzansky, JJ. Systemic allergic reactions to ingested antigens. J Allergy 1969;44:96-107
[ 1 ]
Brazil nut aspiration. (Ripley 2007 ref.21040 8)
Ripley DP, Henderson AK. A case of bronchial aspiration: the importance of early diagnosis and clinical suspicion. Prim Care Respir J 2007 Jun;16(3):191-3.
[ 2 ]
The effects on iron absorption of nuts were measured in 137 Indian women. When the absorption from bread and nut meals (walnuts, almonds, peanuts, and hazelnuts) was compared with that from bread meals, the overall geometric mean absorption from the nut meals (1.8%) was significantly less than from the bread meals alone (6.6%). In contrast, coconut did not reduce absorption significantly. All the nuts tested contained significant amounts of two known inhibitors of iron absorption (phytates and polyphenols) but the amounts in coconut were significantly less than in the other nuts. Fifty milligrams ascorbic acid overcame the inhibitory effects of two nuts that were tested (Brazil nuts and peanuts). This is different from that found previously for soy protein, another potent inhibitor of iron absorption. (Macfarlane 1988 ref.7810 1)
Macfarlane BJ, Bezwoda WR, Bothwell TH, Baynes RD, Bothwell JE, MacPhail AP, Lamparelli RD, Mayet F. Inhibitory effect of nuts on iron absorption. Am J Clin Nutr 1988;47(2):270-4
[ 3 ]
Intestinal obstruction and perforation due to an ingested Brazil nut. (Durdey 1985 ref.7812 2)
Durdey P. Intestinal obstruction and perforation due to an ingested Brazil nut. J R Coll Surg Edinb 1985;30(6):395