Clinical and laboratory characteristics of cashew nut allergy in Korean children: Findings from a tertiary hospital

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Objective: Cashew nut (CN) allergy is becoming increasingly prevalent and represents a major cause of tree nut-induced anaphylaxis in Korean children. This study investigated the clinical characteristics and laboratory findings of CN allergy in Korean children. Patients and methods: Sixty-four children with a history of CN ingestion, who underwent serum CN-specific immunoglobulin E (CN-sIgE) measurements from January 2013 to February 2023, were enrolled through a retrospective medical record review. The demographic characteristics, clinical profiles, and laboratory findings were evaluated. Result: Thirty-five patients had immediate-type reactions after exposure to CN (CN-allergic group), whereas 29 showed no symptoms after ingesting CN (CN-tolerant group). Over 60% of patients in the CN-allergic group were allergic to ≥ 1 other tree nuts and 17.1% had peanut allergies. In the CN-allergic group, cutaneous symptoms were most common (94.1%), followed by respiratory (35.3%), gastrointestinal (32.4%), and cardiovascular (2.9%) symptoms. Anaphylaxis due to CN exposure was observed in 51.4% of patients in the CN-allergic group. The median CN-sIgE level of the CN-allergic group was significantly higher than that of the CN-tolerant group (5.5 kUA/L vs. 0.06 kUA/L, P < 0.001). The optimal cutoff level for distinguishing the CN-allergic group from the CN-tolerant group was 0.55 kUA/L (sensitivity 94.29%, specificity 93.10%). Conclusion: Co-allergies to other tree nuts were common in children with CN allergy and more than 50% of patients with CN allergy experienced anaphylaxis. The optimal cutoff level for distinguishing between the CN-allergic and CN-tolerant groups was 0.55 kUA/L.

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