Evaluation of patients with suspected cashew allergy
The determination of the relative amount of IgE antibody to total cashew, and IgE antibodies to the specific cashew component, may aid in assessment of the potential strength and type of allergenic response to cashew.
IgE antibody to total cashew will be initially tested.
If detectable total cashew IgE antibody is present, an additional specific component to the cashew allergen antibody testing will be performed. This is comprised of testing for IgE antibodies to the potential allergen Ana o 3.
| Test Id | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| CASHX | Cashew Component, IgE, S | No | No |
Testing begins with analysis of cashew-specific total IgE. If the cashew-specific total IgE result is negative (<0.10 kU/L), testing is complete.
If the cashew-specific total IgE result is 0.10 kU/L or more, then the cashew component (Ana o 3) test will be performed at an additional charge.
Fluorescent Enzyme Immunoassay (FEIA)
Cashew component
Ana o 3
Testing begins with analysis of cashew-specific total IgE. If the cashew-specific total IgE result is negative (<0.10 kU/L), testing is complete.
If the cashew-specific total IgE result is 0.10 kU/L or more, then the cashew component (Ana o 3) test will be performed at an additional charge.
Serum
For a listing of allergens available for testing, see Allergens - Immunoglobulin E (IgE) Antibodies
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.6 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
If not ordering electronically, complete, print, and send an Allergen Test Request (T236) with the specimen.
0.4 mL
| Gross hemolysis | OK |
| Gross lipemia | OK |
| Gross icterus | OK |
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 14 days | |
| Frozen | 90 days |
Evaluation of patients with suspected cashew allergy
Testing begins with analysis of cashew-specific total IgE. If the cashew-specific total IgE result is negative (<0.10 kU/L), testing is complete.
If the cashew-specific total IgE result is 0.10 kU/L or more, then the cashew component (Ana o 3) test will be performed at an additional charge.
Allergies to tree nuts are relatively prevalent and can result in severe reactions. The main culprits in tree nut allergies include walnut, almond, pistachio, cashew, pecan, hazelnut, macadamia, Brazil nut, and pine nuts. Tree nut allergy often appears in young children and estimates of prevalence range from 0.1% to greater than 5% of the population, dependent on geographical region.
In the case of nut-induced allergic reactions, as with many other foods, symptoms usually present within minutes of ingestion. Over 80% of reactions to tree nuts involve allergy related respiratory symptoms. Tree nut allergies are one of the most dangerous types of allergic reaction with 20% to 40% of cases of related anaphylaxis and 70% to 90% of fatalities attributable to nut exposure, including peanut exposure.
Ana o 3 is a heat and digestion stable storage protein found in high abundance in cashew nuts. Approximately 80% of those with cashew allergy exhibit reactivity to the Ana o 3 component. Cashew nut allergy is often associated with severe reactions. Sensitization with Ana o 3 is associated with anaphylaxis in system reactions.
Severe reactions in those with cashew nut allergy occur at a higher frequency than in those with peanut allergy. Cashews can be found in Asian cuisines, pesto, and nut butter. Cooking will not destroy the allergenic potential of Ana o 3 f. In addition to being severe, cashew nut allergy is persistent and can manifest early in life. Co-sensitization has been repeated between pistachio, walnuts, and, to a lesser extent, hazelnut.
| Class | IgE kU/L | Interpretation |
| 0 | <0.10 | Negative |
| 0/1 | 0.10-0.34 | Borderline/Equivocal |
| 1 | 0.35-0.69 | Equivocal |
| 2 | 0.70-3.49 | Positive |
| 3 | 3.50-17.4 | Positive |
| 4 | 17.5-49.9 | Strongly positive |
| 5 | 50.0-99.9 | Strongly positive |
| 6 | > or =100 | Strongly positive |
Concentrations of 0.70 kU/L or more (class 2 and above) will flag as abnormally high.
Reference values apply to all ages.
When detectable total cashew IgE antibody is present (> or =0.10 IgE kUa/L), additional specific component IgE antibody testing will be performed. If a potential specific allergenic cashew component IgE is detectable (> or =0.10 IgE kUa/L), an interpretive report will be provided.
When the sample is negative for total cashew IgE antibody (<0.10 IgE kUa/L), further testing for specific cashew component IgE antibodies will not be performed. A negative IgE result for total cashew antibody may indicate a lack of sensitization to the potential cashew allergenic component.
Clinical correlation of results from in vitro IgE testing with patient history of allergic or anaphylactic responses to cashew nuts is recommended.
Negative results for IgE antibodies against cashew nut extract or allergenic components do not completely exclude the possibility of clinically relevant allergic responses upon exposure.
Positive results for IgE to cashew nuts or any potential cashew allergenic components are not diagnostic for allergy and only indicate patient may be sensitized to cashew nuts or a cross-reactive allergen.
Testing for IgE antibodies may not be useful in patients previously treated with immunotherapy to determine if residual clinical sensitivity exists or in patients whose medical management does not depend upon the identification of allergen specificity.
False-positive results for IgE antibodies may occur in patients with markedly elevated serum IgE (>2500 kU/L) due to nonspecific binding to allergen solid phases.
Cross-reacting carbohydrate determinants may also result in positive total cashew specific IgE testing.
1. Salo PM, Arbes SJ Jr, Jaramillo R, et al. Prevalence of allergic sensitization in the United States: results from the National Health and Nutrition Examination Survey (NHANES) 2005-2006. J Allergy Clin Immunol. 2014;134(2):350-359
2. Waserman S, Watson W. Food allergy. Allergy Asthma Clin Immunol. 2011;7 Suppl 1(Suppl 1):S7
3. Abrams EM, Sicherer SH. Diagnosis and management of food allergy. CMAJ. 2016;188(15):1087-1093
4. Weinberger T, Sicherer S. Current perspectives on tree nut allergy: a review. J Asthma Allergy. 2018;11:41-51
5. Lomas JM, Jarvinen KM. Managing nut-induced anaphylaxis: challenges and solutions. J Asthma Allergy. 2015;8:115-123
6. Maloney JM, Rudengren M, Ahlstedt S, Bock SA, Sampson HA. The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy. J Allergy Clin Immunol. 2008;122(1):145-151
7. Sicherer SH, Burks AW, Sampson HA. Clinical features of acute allergic reactions to peanut and tree nuts in children. Pediatrics. 1998;102(1):e6
8. Crespo JF, James JM, Fernandez-Rodriguez C, Rodriguez J. Food allergy: nuts and tree nuts. Br J Nutr. 2006;96 Suppl 2:S95-S102
9. Yang L, Clements S, Joks R. A retrospective study of peanut and tree nut allergy: Sensitization and correlations with clinical manifestations [published online ahead of print, 2015 Feb 27]. Allergy Rhinol (Providence). 2015;doi:10.2500/ar.20105.6.0108
10. Masthoff LJ, Hoff R, Verhoeckx KC, et al. A systematic review of the effect of thermal processing on the allergenicity of tree nuts. Allergy. 2013;68(8):983-993
11. Davoren M, Peake J. Cashew nut allergy is associated with a high risk of anaphylaxis. Arch Dis Child. 2005;90(10):1084-1085
12. Robotham JM, Wang F, Seamon V, et al. Ana o 3, an important cashew nut (Anacardium occidentale L.) allergen of the 2S albumin family. J Allergy Clin Immunol. 2005;115(6):1284-1290
13. Clark AT, Anagnostou K, Ewan PW. Cashew nut causes more severe reactions than peanut: case-matched comparison in 141 children. Allergy. 2007;62(8):913-916
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16. Bastiaan-Net S, Batstra MR, Aazamy N, et al. IgE cross-reactivity measurement of cashew nut, hazelnut and peanut using a novel IMMULITE inhibition method. Clin Chem Lab Med. 2020;58(11):1875-1883
Specific IgE from the patient's serum reacts with the allergen of interest, which is covalently coupled to an ImmunoCAP. After washing away nonspecific IgE, enzyme-labeled anti-IgE antibody is added to form a complex. After incubation, unbound anti-IgE is washed away, and the bound complex is then incubated with a developing agent. After stopping the reaction, the fluorescence of the eluate is measured. Fluorescence is proportional to the amount of specific IgE present in the patient's sample (ie, the higher the fluorescence value, the more IgE antibody is present).(Package insert: ImmunoCAP System Specific IgE FEIA. Phadia; Rev 06/2020)
Monday through Friday
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.
86003
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| CASHR | Cashew Component Reflex, S | 6718-1 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| CASH1 | Cashew, IgE, S | 6718-1 |