Pistachio (Pistachio vera) and cashew nut (Anacardium occidentale), members of the Anacardiaceae family, account for a significant percentage of food allergies worldwide. 1 Nuts are one of the main causes of food anaphylaxis, eliciting a significant number of life-threatening reactions, which are aggravated by the fact that these allergens are often hidden in processed foods. Variability of allergic phenotypes to nut allergens with complex cross-reactivity profiles complicates clinical management of the patient. 2 In this sense, several allergenic patterns have been defined according to different factors such as geographical area, age, eating habits, pollinosis, and so on.Most nut allergens belong to a small number of protein families, which homologous members share three-dimensional structure, biologic function and sequence identity, exhibiting inter and intraspecies cross-reactivity. In a clinic context, it is important to establish correlations within each food allergen family based on their crossreactivity and their ability to trigger systemic reactions or anaphylaxis.Nowadays, the availability of few purified and well-characterized allergens makes difficult to predict which of them are included in these particular associations. Different nuts clusters, grouped around one allergen, make it possible to optimize the management of nut allergy.Previous studies have shown that pistachio and cashew nut presented a high degree of cross-reactivity at the specific IgE (sIgE) level, owing to their botanic proximity. 3 Furthermore, at least 86% of patients allergic to nuts are also allergic to multiple species 4 and for cashew or pistachio allergic subjects a significant proportion are poly-sensitized to different nuts. Several major allergens have been identified in cashew -Ana o 1 (7S vicilin), Ana o 2 (11S globulin), Ana o 3 (2S albumin), 5 and in pistachio -Pis v 1 (2S albumin), Pis v 2 and 5 (11S globulin), Pis v 3 (7S globulin) and Pis v 4. 6 Except Pis v 4, a manganese superoxide dismutase, all others are seed storage proteins. Prior studies showed that 7S vicilins and 11S globulins from different tree nuts exhibit moderate cross-reactivity at IgE level. 7 However, cross-reactivity mediated by 2S albumins has not been well explored and appears to be infrequent and, as in Brassicaceae seeds, nearly restricted to members of phylogenetically related families. 8The aim of the present study was to evaluate a selected group of six patients with allergy to pistachio and/or cashew nut exclusively sensitized to 2S albumins. Results of this study proved that there is IgE cross-reactivity between these two Anacardiaceae 2S albumins but they were not cross-reactive to 2S albumins from other sources, which will provide significant data on the clinical management of this subgroup of patients. These patients displayed clinical features described in Table 1. All the patients reported systemic symptoms when eating pistachio and/or cashew nut and showed positive skin test to these nut extracts and sIgE to their 2S albumins, Pis v ...