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  Substance Info: (and synonyms)
Cashew Nut

Background Info:

Family: Anacardiaceae.

From the acaju tree of the Sumac or Cashew family. Native to Brazil. Also exported from southern India, Mozambique, Tanzania and Kenya. The family is a dermatitis-inducing group including poison ivy, poison oak, poison sumac and lacquer sumac. Kidney-shaped nut with smooth, creamy kernel which grows at the base of the fruit.

The cashew tree flowers once a year between January and March, but pollination is mostly entomophilous.

 

Adverse Reactions:

IMMUNE REACTIONS


[ 1 / 36 ]

This study wanted to derive threshold dose distributions for major allergenic foods and to elaborate the protein doses at which a proportion of the allergic population is likely to respond. Individual positive DBPCFCs were available for peanut (n = 135), cow's milk (n = 93), hen's egg (n = 53), hazelnut (n = 28), and cashew nut (n = 31). Fewer children were challenged with soy (n = 10) or walnut (n = 13). Threshold dose distributions showed a good statistical and visual fit. The protein dose at which 5% of the allergic population is likely to respond with objective reactions was 1.6 mg for peanut, 1.1 mg for cow's milk, 1.5 mg for hen's egg, 7.4 mg for cashew nut, and 0.29 mg for hazelnut. Thresholds for any symptom were on average 2 to 6 times lower than for objective symptoms. (Blom 2013 ref.28604 5)

Reference:
Blom WM, Vlieg-Boerstra BJ, Kruizinga AG, van der HS, Houben GF, Dubois AE. Threshold dose distributions for 5 major allergenic foods in children. J Allergy Clin Immunol 2013 Jan;131(1):172-179



[ 2 / 36 ]

A report of the evaluation of the clinical features of 4 Japanese cases of cashew nut (CN) allergy and the allergens involved: a 26 year old female with OAS, a 55 year old male with anaphylaxis, a 12 year old female with anaphylaxis and a 24 year old female with anaphylaxis.

The initial symptom was an oropharyngeal symptom in 3 of the 4 cases, of which 2 cases developed anaphylaxis within 10 minutes after eating only a few pieces of CN. (2 immediately, 1 at 10mins and one at 30mins). The 12 year old experienced anaphylaxis while on a plane. All 4 cases reacted positively to the skin prick test with CN, although 1 case of anaphylaxis tested negatively for CN by ImmunoCAP. Additionally, in 2 cases, IgE-binding to CN and pistachio were inhibited with both pistachios and CN, indicating cross-reactivity between CN and pistachios. IgE-immunoblotting of CN using sera from the 4 cases revealed 2 bands at molecular weights of approximately 33 kd and 42 kd, whereas that of pistachios showed a single band at 36 kd. However, IgE in all 4 sera did not bind to rAna o 2. (Hasegawa 2009 ref.23019 5)

Reference:
Hasegawa M, Inomata N, Yamazaki H, Morita A, Kirino M, Ikezawa Z. Clinical features of four cases with cashew nut allergy and cross-reactivity between cashew nut and pistachio. Allergol Int 2009 Jun;58(2):209-15.



[ 3 / 36 ]

The diagnosis of fixed 'drug' eruption is not difficult for dermatologists, but it is difficult to identify the causative agent when the patient denies ingestion of any drugs. This study reports on a 71-year-old woman experienced repeated erythema and tense bulla with a burning sensation and pruritus on the right ankle. The eruption remitted leaving pigmentation. Oral challenge and patch tests with cashew nut were positive. A fixed eruption without any antecedent drug ingestion should alert us to think of food as a causative agent. (Fukushima 2008 ref.22649 7)

Reference:
Fukushima S, Kidou M, Ihn H. Fixed food eruption caused by cashew nut. Allergol Int 2008 Sep;57(3):285-287



[ 4 / 36 ]

This Educational Clinical Case Series is on Food-dependent exercise-induced anaphylaxis in childhood, and reviews an approach to this this condition. A number of case reports are described.

A 7-yr-old boy presented with generalized urticaria, bilateral wheezing, rhinorrhea and itchy red eyes. After touring an animal farm, a lunch of pasta with pesto sauce was had and followed by a game of football played on a newly mown lawn. His symptoms had developed some 15 min into a game of football. SPT was 4 mm to cashew nut and 6 mm for grass pollen. The pesto sauce had included both cashew and pine nuts. A DBPCFC to cashew nut was positive (induced urticaria and angioedema of his lips).

A 9-yr-old female arrived from a local school gymnasium having presented with urticaria, hypotension, delayed capillary refill time, and hoarseness. Some 45 min prior to exercising, she had eaten a wheat sandwich which was covered with peanut butter and honey. Her coach recalls that she had not been able to complete her training sessions on at least two previous occasions due to a complaint of ‘dizziness’. Baseline serum tryptase was elevated; serial tryptase
samples returned to normal over the next 48 h. Specific IgE results returned negative to an extended panel of food and aero-allergens. Latex-specific IgE and SPT were negative. A contact and inhalation challenge to gymnast hand powder was negative. A modified exercise challenge (performed after fasting for 4 h) was positive (as evidenced by the onset of generalized urticaria and complaint of dizziness).

A 14-yr-old male, presented to the emergency department having been retrieved from a public swimming pool. Paramedics documented hypo- tension, generalized urticaria, angioedema and wheezing. He recalled a sensation of ‘warmth, ?ushing, and generalized itching’ which preceded his collapse due to ‘weakness.’ He had consumed a wheat pasta meal some 20 min prior to his swimming class. He has a long history of tolerance to exercise and wheat, but could not recall if he had previously ever eaten wheat shortly before taking exercise. An SPT to wheat returned a wheal diameter of 4 mm and a wheat-specific IgE was 6.7 kU/L. An incremental open-wheat challenge was negative as was an exercise challenge which was per- formed after fasting for 4 h. An exercise challenge, performed after the ingestion of two thick slices of whole-wheat bread was positive, as evidenced by urticaria and hypotension. A double-blind placebo-controlled food exercise challenge (DBPCFEC) to wheat was repeated and also returned positive. (du 2007 ref.20277 8)

Reference:
du Toit GD. Food-dependent exercise-induced anaphylaxis in childhood. Pediatr Allergy Immunol 2007 Aug;18(5):455-463



[ 5 / 36 ]

Cashew nut causes more severe reactions than peanut. Children whose worst ever reaction was to cashew nut were matched with two children each whose worst ever reaction was to peanut. A total of 47 children in the cashew group were matched to 94 in the peanut group. There were no differences in clinical features between groups for matching criteria, except asthma (more prevalent in the peanut group). Wheezing and cardiovascular symptoms were reported more frequently during reactions in the cashew compared with the peanut group. The cashew group received intramuscular adrenaline more frequently. This is the first study to show by case-matching that severe clinical reactions occur more frequently in cashew compared with peanut allergy. (Clark 2007 ref.20239 7)

Reference:
Clark AT, Anagnostou K, Ewan PW. Cashew nut causes more severe reactions than peanut: case-matched comparison in 141 children. Allergy 2007 Aug;62(8):913-916



[ 6 / 36 ]

Anaphylaxis to cashew and peanut. An increasing number of patients with an anaphylactic reaction after eating small amounts of cashew nuts have been reported. In this study from Holland, three children, a boy aged 7 and two girls aged 9 and 10 years, respectively, with heterogeneous case histories involving allergic upper airway and conjunctival symptoms and constitutional eczema, allergy for cashew nuts was diagnosed in the first two and allergy for peanuts in the third. (de Groot 2007 ref.20174 2)

Reference:
de Groot H. Allergy to cashew nuts and peanuts. [Dutch] Ned Tijdschr Geneeskd 2007 May 5;151(18):997-1001



[ 7 / 36 ]

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)

Reference:
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



[ 8 / 36 ]

A 26-year-old woman felt tingling on her tongue and itching both in the throat and on the face immediately after she put a cashew nut on her tongue. CAP-FEIA and skin prick test were positive for cashew nuts and negative for peanuts and other tree nuts. Diagnosis of oral allergy syndrome was made. Skin prick test with cashew nuts normalized one year after she began avoiding cashew nuts. (Inomata 2006 ref.14098 7)

Reference:
Inomata N, Osuna H, Ikezawa Z. Oral allergy syndrome due to cashew nuts in the patient without pollinosis. [Japanese] Arerugi 2006 Jan;55(1):38-42



[ 9 / 36 ]

Inhalation of pectin has been identified as a cause of occupational asthma. This study describes the first case of allergy to ingested pectin. A 3 1/2-year-old boy developed anaphylaxis once after eating cashews and later after eating a pectin-containing fruit 'smoothie.' He also has a history of generalized pruritus after eating grapefruit. The child had a positive skin prick test reaction to pectin and a high RAST reaction to cashew and pistachio. He had a low-level positive RAST reaction to grapefruit. The pectin in the smoothie was confirmed to be of citrus origin. Review of previous case reports of pectin-induced occupational asthma revealed several patients with allergies to and cross-reactivity with cashew. (Ferdman 2006 ref.16309 7)

Reference:
Ferdman RM, Ong PY, Church JA. Pectin anaphylaxis and possible association with cashew allergy. Ann Allergy Asthma Immunol 2006 Dec;97(6):759-760



[ 10 / 36 ]

A 65-year-old female (patient 1) and a 25-year-old male (patient 2) reported anaphylactic episodes, in the first 30’ after ingestion of pesto genovese sauce (containing raw basil, pine nuts, garlic, olive oil, with/without parmesan cheese). Patient 1 experienced generalized urticaria, angioedema and dyspnoea that resolved rapidly after treatment. Patient 2, experienced itchy mouth, rhinitis (rhinorrea and congestion), conjunctivitis and emesis, that remitted 60 min after the administration of antihistamine. Both patients complained of OAS (itching and burning mouth sensation) every time they used to eat oregano-seasoned Greek salad. Patient 2 also reported allergy to tree nuts (OAS to walnut and almond and alaphylaxis to pistachio and cashew nut) and seasonal rhinitis. SPT to all Labiatae tested (basil, oregano, marjoram, sage, mint, thyme, lavender) were positive in Patient 1, while in Patient 2 only basil, oregano and lavender resulted positive. Patient 1 was also found positive to Mugwort. Patient 2 had positive SPT to Grasses, hazelnut, almond, walnut, pistachio, cashew nut and celery. sIgE resulted negative to basil, marjoram and thyme in both patients. The study concludes that allergy to Labiatae is observed in pollen-allergic patients. Allergy to a member of this plant family is not always followed by allergy to the other members, although basil allergy seems to be connected to oregano OAS. (Vartholomaios 2006 ref.22976 5)

Reference:
Vartholomaios S, Pitsios C, Lefousis C, Mikos N, Kompoti E, Kouridakis S. Coexisting allergy to basil and oregano presentation of two case reports. EAACI Congress, Vienna-Austria. 2006 Jun; Oral Abstract 529.



[ 11 / 36 ]

Cashew nut allergy is the second most commonly reported tree nut allergy in the United States. (Robotham 2005 ref.11871 7)

Reference:
Robotham JM, Wang F, Seamon V, Teuber SS, Sathe SK, Sampson HA, Beyer K, Seavy M, Roux KH. Ana o 3, an important cashew nut (Anacardium occidentale L.) allergen of the 2S albumin family. J Allergy Clin Immunol 2005 Jun;115(6):1284-90.



[ 12 / 36 ]

A retrospective review of 213 Australian children with peanut or tree nut allergy was undertaken over a 42 month period. Anaphylaxis to cashew nut was more common than to peanut (74.1% v 30.5%). Of 213 patients seen with peanut and/or tree nut allergy, 177 patients (83.1%) had peanut allergy, 27 (12.6%) had cashew allergy, and 9 (4.2%; 2 each to almond and pecan, 1 each to hazelnut and walnut, and 3 were a mixture of nuts) had allergy to other tree nuts. A number of patients had anaphylaxis without cutaneous involvement. (Davoren 2005 ref.15757 0)

Reference:
Davoren M, Peake J. Cashew nut allergy is associated with a high risk of anaphylaxis. Arch Dis Child 2005 Oct;90(10):1084-5.



[ 13 / 36 ]

A case of cashew nut allergy followed by almond allergy. (Kakemizu 2003 ref.8821 8)

Reference:
Kakemizu N, Yamakawa Y, Aihara M, Ikezawa Z. A case of cashew nut allergy followed by almond allergy. [Japanese] Arerugi 2003;52(10):1022-6



[ 14 / 36 ]

In a study to characterize Ana o 2, from cashew nut, 21 cashew-nut allergic subjects ranging from 25 to 62 years in age were evaluated. Age of onset of cashew allergy varied between 1 year and 15 years, with 15 less than 3 years of age. (Wang 2003 ref.8557 7)

Reference:
Wang F, Robotham JM, Teuber SS, Sathe SK, Roux KH. Ana o 2, a major cashew (Anacardium occidentale L.) nut allergen of the legumin family. Int Arch Allergy Immunol 2003;132(1):27-39



[ 15 / 36 ]

This study reports on an allergic reaction (upper airway obstruction) to cashew that was initially misdiagnosed as foreign body aspiration. (Nguyen 2003 ref.7396 3)

Reference:
Nguyen AD, Gern JE. Food allergy masquerading as foreign body obstruction. Ann Allergy Asthma Immunol 2003;90(2):271-2



[ 16 / 36 ]

An anaphylactic reaction to cashew nut developed in a nonatopic 60-year-old man 25 days after receiving a liver allograft from a 15-year-old atopic boy who died of anaphylaxis after peanut ingestion. The liver recipient had no history of nut allergy. Posttransplantation skin prick test results were positive for peanut, cashew nut, and sesame seed, and the donor had allergen-specific IgE antibodies to the same 3 allergens. This illustrates that transfer of IgE-mediated hypersensitivity can occur after liver transplantation and have potentially serious consequences. (Phan 2003 ref.7439 1)

Reference:
Phan TG, Strasser SI, Koorey D, McCaughan GW, Rimmer J, Dunckley H, Goddard L, Adelstein S. Passive transfer of nut allergy after liver transplantation. Arch Intern Med 2003;163(2):237-9



[ 17 / 36 ]

Of 42 children with cashew allergy, the mean age at first allergic reaction was 2 years and the mean age at diagnosis of cashew allergy was 2.7 years. One in five children (12%) had a prior history of exposure to cashew nuts. Fifty-six per cent had skin symptoms, 25% had respiratory signs and 17% had digestive signs. Eighteen children had proven, associated food allergies (pistachio, seven; egg, five; mustard, three; shrimp, two; cow milk, one). The mean wheal diameter of the skin prick tests was 7 mm (3-16 mm) and the mean specific IgE level was 3.1 kUA/L (<0.35->100 kUA/L). Eight children had positive food challenges. The study concludes that the increase in cashew allergy is worrying because it affects young children who may have a reaction without ever having been exposed to cashews. Almost one-third of children are allergic to pistachios, which belong to the same botanical family as cashews. Clinical history is generally and sufficiently suggestive to diagnose cashew allergy without recourse to food challenges. (Rance 2003 ref.8663 0)

Reference:
Rance F, Bidat E, Bourrier T, Sabouraud D. Cashew allergy: observations of 42 children without associated peanut allergy. Allergy 2003;58(12):1311-1314



[ 18 / 36 ]

Nonoccupational allergic contact dermatitis to cashew nut simulating photosensitivity eczema in a 56-year-old white man. A widesread rash developed after roasting cashew nuts. When opening the kitchen stove, he noticed dispersion of dense vapor over his body. Thow hours later itching of the exposed sites occurred followed by a rash. (Criado 2002 ref.10079 3)

Reference:
Criado RF, Criado PR, Malaman F, Ensina LF, Vasconcellos C, Aun WT, Mello JF, Pires MC. Nonoccupational allergic contact dermatitis to cashew nut simulating photosensitivity eczema. Am J Contact Dermat 2002;13(2):85-6



[ 19 / 36 ]

15 subjects with life-threatening reactions to cashews. (Teuber 2002 ref.10078 3)

Reference:
Teuber SS, Sathe SK, Peterson WR, Roux KH. Characterization of the soluble allergenic proteins of cashew nut (Anacardium occidentale L.). J Agric Food Chem 2002;50(22):6543-9



[ 20 / 36 ]

This study reports that 48% of their patients reacted to minimal contact with cashew, i.e., smelling, touching, or tasting, but not eating cashew. The authors point out that severe reactions are as severe as those from peanut allergy. (Hourihane 2001 ref.4093 8)

Reference:
Hourihane JO, Harris H, Langton-Hewer S, Kilburn SA, Warner Clinical features of cashew allergy. Allergy 2001;56(3):252-3



[ 21 / 36 ]

Accidental exposures to cashew are less frequent than exposures of peanut allergic subjects to peanut, but the reactions caused are equally severe, and occur with similar speed. (Harris 2000 ref.3569 3)

Reference:
Harris H, Kilburn S, Langton-Hewer S, et al. Clinical Features of Cashew Allergy AAAAI 56th Annual Meeting 2000;March 3–8



[ 22 / 36 ]

With the increasing use and consumption of eastern and Asian cuisine, with foodstuffs such as sesame, paranuts or cashew nuts, these allergies are more frequent than they were formerly. Peanut allergy has become an epidemic problem in the United States. In this article allergic reactions to nuts, seeds and grains are discussed. Illustrative cases are presented. and a 1-year-old boy, who had suffered from erythema and periorbital angioedema after inadvertently putting a macadamia nut into his mouth, is described. SPT with fresh macadamia nut was positive. (Senti 2000 ref.7443 5)

Reference:
Senti G, Ballmer-Weber BK, Wuthrich B. Nuts, seeds and grains from an allergist's point of view. [German] / Nusse, Samen und Kerne aus allergologischer Sicht. Schweiz Med Wochenschr 2000;130(47):1795-804



[ 23 / 36 ]

Three cases of anaphylaxis to cashew nuts: a 20 month old girl suffered facial angioedema and generalized urticaria immediately after eating a cashew nut, a 12 year old girl experienced oral itching, generalized urticuria, wheezing, dyspnoea, and dizziness 15 minutes after eating one cashew nut, a 36 year old woman developed generalized erythema, rhinorrhoea, dyspnoe, dysphagia, nausea, vomiting and diarrhoea immediately after eating ice cream containing cashew nuts. Skin tests and specific IgE to cashew and pistachio nuts were positive in all three patients. (Garcia 2000 ref.8729 1)

Reference:
Garcia F, Moneo I, Fernandez B, Garcia-Menaya JM, Blanco J, Juste S, Gonzalo. Allergy to Anacardiaceae: description of cashew and pistachio nut allergens. J Investig Allergol Clin Immunol 2000;10(3):173-7.



[ 24 / 36 ]

Anaphylaxis to cashew nuts. Skin tests and specific IgE to cashew and pistachio nuts were positive in all three patients. Both nuts showed several protein bands in SDS-PAGE. The strongest IgE-binding bands had similar molecular weights (15, 30 and 60 kDa) in cashew and pistachio nuts. (Garcia 2000 ref.8729 1)

Reference:
Garcia F, Moneo I, Fernandez B, Garcia-Menaya JM, Blanco J, Juste S, Gonzalo. Allergy to Anacardiaceae: description of cashew and pistachio nut allergens. J Investig Allergol Clin Immunol 2000;10(3):173-7.



[ 25 / 36 ]

A 42-year-old patient allergic to pistachio who had anaphylaxis due to cashew nuts is described. He was admitted complaining of mouth and lip itching, slurred voice, dyspnea, and vomiting a few minutes after eating some cashew nuts. History disclosed three previous episodes of adverse reactions to pistachio. At the age of 30 years, when eating chocolate and hazelnut candy, the patient reported suffering strong mouth itching followed by vomiting. Three years later, the patient complained of the same symptoms while eating pasta with a sauce based on garlic, basil, and pine nuts and attributed the symptoms to pine nuts and basil. After a few months, mouth itching and vomiting occurred again when the patient ate pistachio nuts. Inquiry into the ingredients found that the candy contained pistachio extract and that pistachio nuts had been used for the pasta sauce. Skin prick test was positive for pistachio and cashew nut. Serum specific IgE was normal for both. (Quercia 1999 ref.15763 5)

Reference:
Quercia O, Rafanelli S, Marsigli L, Foschi FG, Stefanini GF. Unexpected anaphylaxis to cashew nut. Allergy 1999 Aug;54(8):895-7.



[ 26 / 36 ]

Shortness of breath, widespread urticaria, angioedem. (Rasanen 1998 ref.2172 4)

Reference:
Rasanen L, Makinen-Kiljunen S, Harvima RJ. Pectin and cashew nut allergy: cross-reacting allergens? Allergy 1998;53:626-628



[ 27 / 36 ]

Cashew nut hypersensitivity are being reported at an increasing prevalence in China. This study reports on the evaluation of 30 patients over 2 years with cashew nut allergy. All 30 were skin prick test and serum specific IgE positive.

Three patients who were challenged developed itching of the mouth and ears, throat tightness, abdominal pain, tachycarida and urticaria within two hours. Oral symptoms had been reported by all thirty (oral contact urticaria, mouth and ear itching, numbness, tongue swelling or throat tightness), 26 experienced generalized urticaria, skin flush, itching or angiodema, 21 experienced nausea, vomiting, abdominal pain or diarrhoea, 14 experienced dysphasia, laryngeal oedema, 13 experienced stridor, rhinoconjunctivitis, dyspnea or cough, 6 developed syncope, hypotension, 1 experienced chill and 1 headache. (Li 1997 ref.15762 5)

Reference:
Li H, Zhang H. Hypersensitivity of cashew nut. Chin Med Sci J 1997 Sep;12(3):189-92.



[ 28 / 36 ]

Explore allergic reactions to this food in older individuals. Perianal contact dermatitis due to cashew ingestion. The urushiol (see) dermatitis caused by plants of the Anacardiaceae family is the most common cause of acute allergic contact dermatitis, but with the precautions taken today to avoid contamination of food products with cashew urushiols, it is rare to find a case of cashew nut dermatitis in the United States. "Perianal eruptions may be due to materials deliberately applied to the anogenital region or to ingested antigens that remain sufficiently intact within the feces to affect perianal skin." (Rosen 1994 ref.2181 6)

Reference:
Rosen T, Fordice DB Cashew nut dermatitis. South Med J 1994;87(4):543-546



[ 29 / 36 ]

Asthma. (Kraut 1992 ref.2174 2)

Reference:
Kraut A, Peng Z, Becker AB, Warren CPW. Christmas candy maker's asthma. IgG4-mediated pectin allergy. Chest 1992;102:1605-1607



[ 30 / 36 ]

Two cases of death in a series of 13 patients with fatal or near fatal food-related anaphylactic reactions. Lupin flour in food may produce urticaria and anaphylaxis. (Sampson 1992 ref.287 83)

Reference:
Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med 1992;347:380-384



[ 31 / 36 ]

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)

Reference:
Stricker WE, Anorve Lopez E, Reed CE. Food skin testing in patients with "idiopathic anaphylaxis". J Allergy Clin Immunol 1986;77:516-519



[ 32 / 36 ]

"Idiopathic" anaphylaxis. An evaluation of 102 patients with the initial diagnosis of idiopathic anaphylaxis with a battery of 79 food-antigen skin prick tests selected to include foods reported or suspected of provoking anaphylaxis. Only those patients whose episodes consisted of at least two of the following were included in the study: angioedema with or without hives, laryngeal edema leading to severe dyspnea, hypotension, or loss of consciousness. 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. In seven patients, 10 different antigens provoked anaphylaxis: aniseed, cashew nut, celery, flaxseed, hops, mustard, mushroom (species not specified), shrimp, sunflower, and walnut. The authors 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. (Stricker 1986 ref.9257 4)

Reference:
Stricker WE, Anorve-Lopez E, Reed CE. Food skin testing in patients with idiopathic anaphylaxis. J Allergy Clin Immunol 1986;77(3):516-9



[ 33 / 36 ]

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)

Reference:
Stricker WE, Anorve Lopez E, Reed CE. Food skin testing in patients with "idiopathic anaphylaxis". J Allergy Clin Immunol 1986;77:516-519



[ 34 / 36 ]

Allergic contact dermatitis. (Bedello 1985 ref.2860 5)

Reference:
Bedello PG, Goitre M, Cane D, Roncarolo G, Alovisi V Allergic contact dermatitis to cashew nut. Contact Dermatitis 1985;12(4):235



[ 35 / 36 ]

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.

Case
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.

Case
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.

Case
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.

Case
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.

Case
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.
Case
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.
Case
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.
Case
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.
Case 10
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.

Case 11
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.

Case
A 37-year-old man with adverse effects to salicylsalicylic acid and acetylsalicylic acid.

Case
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.

Case
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)

Reference:
Golbert, T, Patterson, R, Pruzansky, JJ. Systemic allergic reactions to ingested antigens. J Allergy 1969;44:96-107



[ 36 / 36 ]

See: Cashew nut (for adverse effects to cashew nut, the food)
Cashew nut tree (for adverse effects to the pollen from the tree)

Reference:
Editor Comment Editorial comment, common knowledge, or still to add - -




Non-Immune reactions


[ 1 ]

Cashew nut dermatitis in a returned traveler. (Maje 2001 ref.15761 7)

Reference:
Maje HA, Freedman DO. Cashew nut dermatitis in a returned traveler. J Travel Med 2001 Jul-Aug;8(4):213-5.



[ 2 ]

Systemic contact dermatitis to raw cashew nuts in a pesto sauce. Systemic contact dermatitis from the cashew nut shell oil resorcinol allergens cardol and anacardic acid is recognized clinically as a dermatitis with flexural accentuation, typically distributed on the extremities, groin, and buttocks, and occurring generally 1 to 3 days after ingestion of raw cashew nuts contaminated with allergenic oil. This study reports on a 55-year-old man with a 4 day history of systemic contact dermatitis to raw cashew nuts, an atypical and unexpected ingredient flavoring an imported pesto sauce. (Hamilton 1998 ref.2176 8)

Reference:
Hamilton TK, Zug KA Systemic contact dermatitis to raw cashew nuts in a pesto sauce. Am J Contact Dermat 1998;9(1):51-54



[ 3 ]

Explore allergic reactions to this food in older individuals. Perianal contact dermatitis due to cashew ingestion. The urushiol (see) dermatitis caused by plants of the Anacardiaceae family is the most common cause of acute allergic contact dermatitis, but with the precautions taken today to avoid contamination of food products with cashew urushiols, it is rare to find a case of cashew nut dermatitis in the United States. "Perianal eruptions may be due to materials deliberately applied to the anogenital region or to ingested antigens that remain sufficiently intact within the feces to affect perianal skin." (Rosen 1994 ref.2181 6)

Reference:
Rosen T, Fordice DB Cashew nut dermatitis. South Med J 1994;87(4):543-546



[ 4 ]

Dermatitis. (Behl 1985 ref.2861 5)

Reference:
Behl PN Dermatitis from cashew nuts . J Am Acad Dermatol 1985;12(1 Pt 1):117



[ 5 ]

Contact or systemic dermatitis to cardol and ancardic acid found in the cashew nut shell oil. Between April 4 and May 10, 1982, 54 individuals developed a poison ivy-like dermatitis 1 to 8 days after eating imported cashew nuts (contaminated by urushiol from the cashew shell oil). The patients had a very pruritic, erythematous, maculopapular eruption that was accentuated in the flexural areas of the body. Three had blistering of the mouth and four had rectal itching. Nine tested who reacted to the cashew extract also reacted to poison ivy urushiol. (Marks 1984 ref.2185 4)

Reference:
Marks JG Jr, DeMelfi T, McCarthy MA, Witte EJ, et al. Dermatitis from cashew nuts. J Am Acad Dermatol 1984;10(4):627-631



[ 6 ]

In a case series of patients with cashew nut dermatitis, positive patch tests to moistened, crushed raw cashews, but not to roasted cashews in patients with an internal-external contact type of hypersensitivity to raw cashews purchased from organic food stores was demonstrated. Control patients without a history of poison ivy sensitivity did not react to raw cashew patch test and did not develop the rash on ingestion of large amounts of raw cashews. Affected patients had eaten between 150 and 450 g of cashews, prompting the authors to conclude that large quantities of allergen in raw cashews would provoke the syndrome in highly sensitive people. (Ratner 1974 ref.2863 2) (Other studies have demonstrated very low levels or allergen are required, suggesting that low levels may be due to a protein allergen whereas high levels required may be as a result of a substance such as cardol)

Reference:
Ratner JH, Spencer SK, Grainge JM Cashew nut dermatitis. An example of internal-external contact-type hypersensitivity. Arch Dermatol 1974;110(6):921-3



[ 7 ]

Contact dermatitis. (Cueva 1965 ref.15769 3)

Reference:
Cueva J. A case of contact dermatitis caused by cashew nuts. [Spanish] Alergia 1965 May;12(4):133-5.



[ 8 ]

Contact dermatitis from cashew nut shell. (McNairy 1959 ref.15770 2)

Reference:
McNairy DJ. Contact dermatitis from cashew nut shell novelties. Ariz Med 1959 May;16(5):361-2.



[ 9 ]

See: Cashew nut (for adverse effects to cashew nut, the food)
Cashew nut tree (for adverse effects to the pollen from the tree)

Reference:
Editor Comment Editorial comment, common knowledge, or still to add - -




Occupational reactions


[ 1 ]

Paronychia in cashew nut industry workers. Impairment of the epidermal barrier of the proximal nail fold, through mechanical or chemical trauma, is a forerunner of chronic paronychia, because it encourages irritants, allergens and microorganisms. Cashew nut industry workers are subject to dermatological lesions due to occasional contact with the main cashew nut shell liquid (CNSL), some of its components acting as both irritants (anacardic acid and other phenolic substances) and sensitizers (cardol). In 20 female workers, paronychia was observed in 9 workers; a further 16 presented with cutaneous lesions associated with CNSL contact. The only patient found to be sensitized to cardol showed no paronychia. (Nogueira Diogenes 2002 ref.9853 8)

Reference:
Nogueira Diogenes MJ, Oliveira Ramos FD, Alencar Oliveira AD, Coelho Nogueira Diogenes P. Paronychia in cashew nut industry workers. Contact Dermatitis 2002;47(2):121



[ 2 ]

Contact dermatitis among cashew nut workers. (Diogenes 1996 ref.2178 8)

Reference:
Diogenes MJ, de Morais SM, Carvalho FF Contact dermatitis among cashew nut workers. Contact Dermatitis 1996;35(2):114-115



[ 3 ]

Contact dermatitis among cashew nut workers. (Srinivas 1990 ref.2858 7)

Reference:
Srinivas CR, Pasricha JS Dermatological problems of workers employed in cashew nut factories. Contact Dermatitis 1990;22(3):192



[ 4 ]

Decreased sensitivity or no sensitivity to poison ivy/oak developed in 9 of the 13 cashew nut shell oil factory employees previously affected. (Reginella 1989 ref.2183 6)

Reference:
Reginella RF, Fairfield JC, Marks JG Jr Hyposensitization to poison ivy after working in a cashew nut shell oil processing factory. Contact Dermatitis 1989;20(4):274-279



[ 5 ]

Oral submucous fibrosis among cashew workers (Varghese 1986 ref.2859 8)

Reference:
Varghese I, Rajendran R, Sugathan CK, Vijayakumar T Prevalence of oral submucous fibrosis among the cashew workers of Kerala-south India. Indian J Cancer 1986;23(2):101-4




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Allergy Advisor  - Food Additive and Preservative Allergy and Intolerance Database


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