Almond
Summary
Almonds are one of the most important nut species belonging to Rosaceae family. Sweet almonds (Prunus amygdalus dulcis) and bitter almonds (Prunus amygdalus amara) are the two main varieties of almonds. Various studies reported almonds as one of the most common allergens in the United States, Korea and the United Kingdom. Almond allergy may lead to oral allergy syndrome, allergic rhinitis, asthma, and atopic dermatitis. Pollen-food syndrome rarely causes anaphylaxis and mainly mild symptoms. Almond sensitized individuals should avoid direct or indirect consumption of almond. Cross-reactivity generally occurs with peach allergens, tree nut allergens as well as birch pollen allergens. Also, almond allergic patients are highly prone to cross-reactivity with mahleb. Almond sensitized people should avoid any intentional or un-intentional consumption of almond.
Epidemiology
Worldwide distribution
Almond allergy ranks fourth among the prevalence of tree nut allergies. Almonds are the third most common tree nut to cause allergy in the United States. About 9%–15% of pre-sensitized tree nut individuals reported almond allergy in the United States.
An investigational study conducted on 134 Korean patients having food allergies reported sensitization to almond in 11.2% of participants. About 16.3% belonged to the age group of 19-29 years, 13% to 40-49 years and 9.1% to 50-59 years. Almond sensitization was found to be higher in males (13.5%) than females (9.8%).
The most common tree nut allergy in pre-sensitized people of the United Kingdom is almond (22% to 33%). A cross-sectional study reported the lower prevalence of almond allergy in Libyan children than the percentage in the general UK control population.
A study conducted in Mexico City reported a higher rate (43%) of almond sensitization in older children (6-17 years) (sIgE ≥0.1kUA/L).
A cross-sectional questionnaire study, based on 1042 responses obtained from subjects aged 17–78 years, living in Sweden, reported that about 32.5% of adults had food hypersensitivity and among 16% immunoglobulin E-sensitized to common foods individuals, 3.0% were sensitized to almond.
Risk factors
Allergy to almond is a risk factor for developing an allergy to other types of nuts. A study reported multiple tree nut allergies in 19% of 2 years old children and 86% in 5 to 14 years.
Route Of Exposure
Main
Direct sensitization by food allergens takes place by consumption only. Almonds might lead to sensitization or intolerance.
Clinical Relevance
Oral allergy syndrome
Pollen-food syndrome is characterized by mild oral symptoms, that occur in conditions of pollen sensitization, triggered by nuts. It is also known as oral allergy syndrome. It may rarely lead to anaphylaxis. It causes when serum sIgE is directed against PR-10 homologous to those in pollen.
Allergic rhinitis
A single-center study in southern Taiwan included 216 patients, aged 2-93 years. The majority of the included patients had cutaneous and respiratory symptoms. The study reported a 36.97% prevalence of allergic rhinitis because of almonds in the non-sensitization group.
Asthma
Taiwan single-center study reported the prevalence of asthma as 13.70% for the almonds in the nut sensitization group and 7.4% in the non-sensitization group.
Atopic Dermatitis
In a study conducted in Taiwan, atopic dermatitis because of almonds was reported by 42.47% of 333 nut sensitized patients.
Other diseases
A study stated that 15% of the 1024 sensitized subjects, reported more frequent gastrointestinal symptoms, out of which 2.7% of the individuals reported symptoms due to almond.
Prevention And Therapy
Prevention strategies
Avoidance
Dietary management is needed to avoid the consumption of almonds. Almond sensitized people are advised to look at the packaging for ingredient details, to avoid any un-intentional ingestion of almond.
Other topics
Modest amounts of nuts should be consumed during infancy and by mothers during pregnancy or lactation, to prevent the development of almond allergy in babies.
Cross-Reactivity
Cross-reactivity between almond and mahleb, is of particular concern for almond-allergic patients. Mahleb is a cherry seed-derived spice, recognized by anti-almond antibodies including almond-allergic patient IgE. Factors that exhibited cross-reactivity with cherry kernel protein are almond-specific murine monoclonal IgG, rabbit polyclonal IgG, and almond-allergic serum IgE.
Birch-pollen-sensitized individuals develop pollen food allergy syndrome on the consumption of almond due to cross-reactivity. Out of subjects with birch sensitization, 71% were co-sensitized to almonds. About 83% of almond sensitized patients reported no or mild symptoms.
Cross-reactivity may also be with peach and other tree nut allergens. Pru du 3.0101 of almond shows around 99% amino acid sequence similarity with peach.
A study including 59 peanut-allergic adolescents and adults reported almond allergy in 46% of these patients.
A study reported that out of 18 almond-allergic patients, 89% were sensitized to any allergen and only 33% were positive to all the almond allergens. Pru du 8 sensitizations were found in 44% of almond allergic patients and Pru du 10 sensitizations in 67% of patients. Out of all the allergens, Pru du 6 sensitization was found to be the highest (83%).
Ara h 2 (a major peanut allergen) shares the IgE-binding epitopes with that of Almond and Brazil nut allergens. This was demonstrated in a study including 17 peanut-allergic patients, wherein Ara h 2 specific serum IgE antibodies were bound to proteins present in Almond and Brazil nut extracts.
Apricot lipid transfer protein (LTP) has shown a sequence identity of 94% with Almond LTPs,.
Cross-reactivity can be observed between the Almond profilin (Pru du 4) and other profilin-containing plants.
An in vitro study demonstrated cross-reactivity between Pru du Amandin and a minor 50 kDa protein of Maize (a gamma-zein), however, low cross-reactivity with the 27 kDa gamma-zein was observed. The 50 kDa Maize gamma-zein reacted with IgE from pooled human sera of patients with self-reported severe Almond allergy.
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