Oral allergy syndrome (OAS) in pollinosis patients after eating pistachio nuts: Two cases with two different patterns of onset

Abstract

We describe two uncommon cases of oral allergy syndrome (OAS) after eating pistachio nuts (p.n.) in subjects (a 54-year-old man and a 3-year-old girl) with exclusive skin prick test (SPT) positivity to Parietaria (P.) and pistachio nut (p.n.) allergens. Serologic P.- and p.n.-specific IgE determinations were also carried out. A double-blind, placebo-controlled food challenge (DBPCFC) was performed, for ethical reasons, only in the adult patient, but we observed a positive intraoral reaction only after slight scratching of the oral mucosa. Since this patient had put three whole p.n. with their shells into his mouth, breaking them with his teeth, before the onset of symptoms, we suggest that slight injury of the oral mucosa may enhance the local response. Preliminary results with SDS-PAGE and immunoblotting demonstrate the occurrence of a slight degree of cross-reactivity between these allergens, but further studies are necessary to obtain a definite conclusion.

Identification of two pistachio allergens, Pis v 1 and Pis v 2, belonging to the 2S albumin and 11S globulin family

“…Pistachio (Pistacia vera) is one of the tree nuts increasingly attributable to IgE-mediated allergic reactions [7][8][9].…”

“…Pistachios are a member of the Anacardiaceae family and show in vitro cross-reactivity with cashew and mango, which belong to the same botanical family [7,11]. Cross-reactivity with nan-gai nut was also reported [12], and an association between Parietaria pollinosis [9] and Artemisia pollinosis [13] has been suggested. Pistachio might also pose a potential hazard to some lipid transfer protein-allergic patients [14].…”

Scientific criteria and the selection of allergenic foods for product labelling

“…Oral allergy syndrome is common in pollinosis patients after ingestion of nuts. Pistachio nut allergy was demonstrated with DBPCFC in one patient (127).…”

Criteria to Determine Priority Allergens: Tree Nut Allergy Review

“…Using specifi c IgE determination by CAP -inhibition and leukocyte histamine release, Parra et al [75] demonstrated the cross -reactivity of pistachio with cashew and other dried fruits belonging to taxonomically unrelated botanical families. Liccardi et al [76] described two uncommon cases of OAS in a 54 -year -old man and a 3 -year -old girl, both after eating pistachio nuts. The man had put three whole pistachios with shells in his mouth and cracked them with his teeth before the onset of symptoms.…”