From insect allergies to tree nut sensitivity

May 15, 2017

The May issue of the Annals of Allergy, Asthma and Immunology is on its way to your mailboxes and should arrive very soon. It has a variety of features I hope you will find interesting. There are two articles in particular that I would like to call to your attention.

The first, authored by Taruna Khurana, PhD, Jennifer L. Bridgewater, MPH, Ronald L. Rabin, MD, is a thorough description of allergenic extracts for insect allergens from stinging insects or inhalant insect sensitivities. This is particularly of interest as it provides some insight into the recent U.S. shortage of some of the stinging insect venom allergenic extracts. The authors also describe the status of standardization for these types of allergenic extracts for relative potency measures. This is a timely update for the practicing clinician to better understand where we are in the efforts to have well-defined extracts for allergen immunotherapy protocols.

The other article is by Christopher Couch, MD, Tim Franxman, MD, FACAAI, and Matthew Greenhawt, MD, MBA, MSc, FACAAI, and describes the clinical characteristics of patients with positive tree nut sensitization by testing vs true tree nut allergy as confirmed with oral challenges. They reviewed 109 patients from a single referral center who had history of possible tree nut sensitivity and evidence of sensitization by either skin prick test or serum specific IgE determination. Their data showed that tree nut challenges were frequently passed in sensitized patients regardless of their history of previous reaction. Equally provocative, in their cohort, almost all patients with peanut allergy and tree nut “co-allergy” passed the tree nut oral challenge which questions the clinical relevance of the “co-allergy” concept.

As always, we welcome all comments about Annals that will help us in our quest to further tailor the journal for the benefit of our readers. Please don't hesitate to send me your comments and feedback.

Gailen D. Marshall, Jr., MD, PhD, FACAAI