Cashew Allergy Compared to Peanut Allergy in a US Tertiary Care Center

Abstract

Background:

International literature has shown an increased incidence of cashew allergy with a higher propensity toward severe reactions such as anaphylaxis. The clinical characteristics of cashew allergy compared to peanut allergy in a US center have not been reported.

Objective:

To describe the clinical characteristics of cashew allergic patients compared to peanut in a US tertiary care center.

Methods:

A retrospective chart review and a phone survey were conducted to identify the clinical characteristics of cashew allergic patients in comparison to peanut allergic patients in a US tertiary care center. Cashew and peanut allergic patients were selected based on documentation or history of clinical allergy by questionnaire and chart review and positive specific immunoglobulin E (IgE;>0.35 kU/L). Age at exposure, quantitative serum IgE, clinical presentation characteristics, and atopic history were recorded.

Results:

In our center, patients with cashew allergy were more likely to experience anaphylaxis (P < 0.05) and less likely to have atopic dermatitis (P < 0.04) than peanut allergic patients. Anaphylaxis was present in 50% of cashew and 25% of peanut allergic patients. The most common symptom at presentation was cutaneous involvement (69%). Respiratory symptoms were experienced among 50% of cashew allergic subjects. Asthma, allergic rhinitis, and concomitant food allergy were similar in both groups.

Conclusions:

This study includes the first direct comparison of anaphylaxis in a cohort of cashew allergic patients compared to peanut allergy in a US tertiary care center. Cashew allergy resulted in more severe allergic reactions compared to peanut in this US center. Since cashew allergic reactions are more likely to result in anaphylaxis, patients and their parents should be educated on the correct use of the epinephrine auto-injector and practice strict tree nut exposure avoidance.