Threshold Dose Distribution and Eliciting Dose of Cashew Nut Allergy

Authors

Johanna P. M. van der Valk, Erasmus MC, Rotterdam, NetherlandsFollow
Roy Gerth van Wijk, Erasmus MC, Rotterdam, NetherlandsFollow
J. L. Baumert, University of Nebraska-LincolnFollow
Julie A. Nordlee, University of Nebraska-LincolnFollow
Berber J. Vlieg-Boerstra, Onze Lieve Vrouwe Gasthuis, Amsterdam, NetherlandsFollow
Hans de Groot, Diaconessenhuis Voorburg, Delft, Netherlands
Anthony E. J. Dubois, University of GroningenFollow
Nicolette W. de Jong, Erasmus MC, Rotterdam, NetherlandsFollow

Document Type

Article

Date of this Version

2016

Citation

Annals of Allergy, Asthma & Immunology (2016) 117(6): 712–714

doi: 10.1016/j.anai.2016 .09.007

Letter

Comments

Copyright © 2016, American College of Allergy, Asthma and Immunology. Published by Elsevier. Used by permission

Abstract

A previous study found that 137 of 179 cashew nut sensitized children (76.5%) suspected of having cashew nut allergy had a positive double-blind, placebo-controlled food challenge (DBPCFC result), with 63 of 137 children (46%) manifesting subjective and/or objective symptoms to the lowest dose (1 mg of cashew nut protein). The primary aim of this study was to determine the distribution of threshold doses and the eliciting doses (EDs) in this population. The secondary aim was to investigate whether children who reacted to 1 mg of cashew nut (n = 63) could react to even lower doses than 1 mg (low-dose follow-up study).

Conclusion

The statistically determined ED₀₅ was very low (0.8–1.6 mg of cashew nut protein). Individual patients may react to as little as 0.3 and 0.01 mg of cashew nut protein with mild objective symptoms and subjective symptoms, respectively. However, the low-dose challenge tests were performed only in 12 children, they were not reproducible, and the children reported mainly subjective symptoms, which makes interpreting the low-dose data with caution necessary.