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Hazelnut allergy: a double-blind, placebo-controlled food challenge multicenter study.
J Allergy Clin Immunol 2000; 105(3):577-81JA

Abstract

BACKGROUND

Tree nuts are a common cause of food allergy in Europe. However, few studies deal with real food allergy to hazelnuts in subjects believed to be allergic to this food.

OBJECTIVE

We sought to select subjects with a history of allergic reactions on ingestion of hazelnut and determine how many of these have true allergy by means of the double-blind, placebo-controlled food challenge (DBPCFC).

METHODS

Eighty-six subjects with a history of symptoms after hazelnut ingestion were recruited from 3 allergy centers (Milan, Zurich, and Copenhagen). All subjects underwent skin prick tests (SPTs) with aeroallergens and hazelnut, as well as having their specific hazelnut IgE levels determined. Diagnosis of clinical relevant food allergy was made on the basis of the DBPCFC.

RESULTS

Sixty-seven (77.9%) of 86 subjects had a positive DBPCFC result; 8 were placebo responders, and 11 were nonresponders. Of the 11 nonresponders, 4 had positive open-challenge test results. Of the DBPCFC-positive subjects, 87% also had positive skin test responses to birch pollen extract. Specific IgE determination for hazelnut (positive CAP response >/=0.7 kU/L [ie, class 2]) showed a sensitivity of 0.75, a positive predictive value (PPV) of 0.92, a specificity of 0.16, and a negative predictive value (NPV) of 0.05. Skin tests with commercial hazelnut extract produced a sensitivity of 0.89, a PPV of 0.92, a specificity of 0.05, and an NPV of 0.05. Skin tests with natural food produced a sensitivity of 0.88, a PPV of 0.94, a specificity of 0.27, and an NPV of 0.15.

CONCLUSION

This study shows that hazelnut is an allergenic source that can cause real food allergy, as confirmed by DBPCFC. Skin and IgE tests demonstrated reasonable sensitivity and PPV but a very low specificity and NPV, thus implying that these should not be used to validate the diagnosis of food allergy to hazelnut.

Authors+Show Affiliations

U.O. Medicina Generale 1, A.O Niguarda Hospital, Milan, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10719310

Citation

Ortolani, C, et al. "Hazelnut Allergy: a Double-blind, Placebo-controlled Food Challenge Multicenter Study." The Journal of Allergy and Clinical Immunology, vol. 105, no. 3, 2000, pp. 577-81.
Ortolani C, Ballmer-Weber BK, Hansen KS, et al. Hazelnut allergy: a double-blind, placebo-controlled food challenge multicenter study. J Allergy Clin Immunol. 2000;105(3):577-81.
Ortolani, C., Ballmer-Weber, B. K., Hansen, K. S., Ispano, M., Wüthrich, B., Bindslev-Jensen, C., ... Pastorello, E. A. (2000). Hazelnut allergy: a double-blind, placebo-controlled food challenge multicenter study. The Journal of Allergy and Clinical Immunology, 105(3), pp. 577-81.
Ortolani C, et al. Hazelnut Allergy: a Double-blind, Placebo-controlled Food Challenge Multicenter Study. J Allergy Clin Immunol. 2000;105(3):577-81. PubMed PMID: 10719310.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hazelnut allergy: a double-blind, placebo-controlled food challenge multicenter study. AU - Ortolani,C, AU - Ballmer-Weber,B K, AU - Hansen,K S, AU - Ispano,M, AU - Wüthrich,B, AU - Bindslev-Jensen,C, AU - Ansaloni,R, AU - Vannucci,L, AU - Pravettoni,V, AU - Scibilia,J, AU - Poulsen,L K, AU - Pastorello,E A, PY - 2000/3/17/pubmed PY - 2000/4/15/medline PY - 2000/3/17/entrez SP - 577 EP - 81 JF - The Journal of allergy and clinical immunology JO - J. Allergy Clin. Immunol. VL - 105 IS - 3 N2 - BACKGROUND: Tree nuts are a common cause of food allergy in Europe. However, few studies deal with real food allergy to hazelnuts in subjects believed to be allergic to this food. OBJECTIVE: We sought to select subjects with a history of allergic reactions on ingestion of hazelnut and determine how many of these have true allergy by means of the double-blind, placebo-controlled food challenge (DBPCFC). METHODS: Eighty-six subjects with a history of symptoms after hazelnut ingestion were recruited from 3 allergy centers (Milan, Zurich, and Copenhagen). All subjects underwent skin prick tests (SPTs) with aeroallergens and hazelnut, as well as having their specific hazelnut IgE levels determined. Diagnosis of clinical relevant food allergy was made on the basis of the DBPCFC. RESULTS: Sixty-seven (77.9%) of 86 subjects had a positive DBPCFC result; 8 were placebo responders, and 11 were nonresponders. Of the 11 nonresponders, 4 had positive open-challenge test results. Of the DBPCFC-positive subjects, 87% also had positive skin test responses to birch pollen extract. Specific IgE determination for hazelnut (positive CAP response >/=0.7 kU/L [ie, class 2]) showed a sensitivity of 0.75, a positive predictive value (PPV) of 0.92, a specificity of 0.16, and a negative predictive value (NPV) of 0.05. Skin tests with commercial hazelnut extract produced a sensitivity of 0.89, a PPV of 0.92, a specificity of 0.05, and an NPV of 0.05. Skin tests with natural food produced a sensitivity of 0.88, a PPV of 0.94, a specificity of 0.27, and an NPV of 0.15. CONCLUSION: This study shows that hazelnut is an allergenic source that can cause real food allergy, as confirmed by DBPCFC. Skin and IgE tests demonstrated reasonable sensitivity and PPV but a very low specificity and NPV, thus implying that these should not be used to validate the diagnosis of food allergy to hazelnut. SN - 0091-6749 UR - https://www.unboundmedicine.com/medline/citation/10719310/Hazelnut_allergy:_a_double_blind_placebo_controlled_food_challenge_multicenter_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(00)81542-0 DB - PRIME DP - Unbound Medicine ER -