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J Allergy Clin Immunol. 2015 Aug;136(2):382-91. doi: 10.1016/j.jaci.2014.12.1949. Epub 2015 Mar 13.

Hazelnut allergy across Europe dissected molecularly: A EuroPrevall outpatient clinic survey.

Datema MR1, Zuidmeer-Jongejan L1, Asero R2, Barreales L3, Belohlavkova S4, de Blay F5, Bures P6, Clausen M7, Dubakiene R8, Gislason D7, Jedrzejczak-Czechowicz M9, Kowalski ML9, Knulst AC10, Kralimarkova T11, Le TM10, Lovegrove A12, Marsh J13, Papadopoulos NG14, Popov T15, Del Prado N3, Purohit A5, Reese G15, Reig I16, Seneviratne SL17, Sinaniotis A18, Versteeg SA1, Vieths S15, Zwinderman AH19, Mills C13, Lidholm J20, Hoffmann-Sommergruber K21, Fernández-Rivas M16, Ballmer-Weber B6, van Ree R22.

ABSTRACT

BACKGROUND:

Hazelnut allergy is birch pollen-driven in Northern/Western Europe and lipid transfer protein-driven in Spain and Italy. Little is known about other regions and other allergens.

OBJECTIVE:

Establishing a molecular map of hazelnut allergy across Europe.

METHODS:

In 12 European cities, subjects reporting reactions to hazelnut (n = 731) were evaluated and sensitization to 24 foods, 12 respiratory allergen sources, and latex was tested by using skin prick test and ImmunoCAP. A subset (124 of 731) underwent a double-blind placebo-controlled food challenge to hazelnut. Sera of 423 of 731 subjects were analyzed for IgE against 7 hazelnut allergens and cross-reactive carbohydrate determinants by ImmunoCAP.

RESULTS:

Hazelnut allergy was confirmed in 70% of those undergoing double-blind placebo-controlled food challenges. Birch pollen-driven hazelnut sensitization (Cor a 1) dominated in most cities, except in Reykjavik, Sofia, Athens, and Madrid, where reporting of hazelnut allergy was less frequent anyhow. In Athens, IgE against Cor a 8 dominated and strongly correlated with IgE against walnut, peach, and apple and against Chenopodium, plane tree, and mugwort pollen. Sensitization to seed storage proteins was observed in less than 10%, mainly in children, and correlated with IgE to nuts, seeds, and legumes. IgE to Cor a 12, observed in all cities (10% to 25%), correlated with IgE to nuts, seeds, and pollen.

CONCLUSIONS:

In adulthood, the importance of hazelnut sensitization to storage proteins, oleosin (Cor a 12), and Cor a 8 is diluted by the increased role of birch pollen cross-reactivity with Cor a 1. Cor a 8 sensitization in the Mediterranean is probably driven by diet in combination with pollen exposure. Hazelnut oleosin sensitization is prevalent across Europe; however, the clinical relevance remains to be established.