Cashew nut allergy: 36 pediatric oral food challenges of cashew nut prior to rAna o 3

Introduction. - Despite the increased prevalence of allergy to anacardiaceae, oral food challenge tests (OFC) to cashews are more rarely carried out than peanut OFC, Despite a natural history of normal non-healing, this study shows that an allergy to cashews, even severe, can progress towards acquisition of spontaneous tolerance. Materials and methods. - A retrospective, single-center study of 36 children who underwent cashew OFC at the pediatric hospitals of Nice CHU-Lenval. Results. - Twenty-five children reached the maximum cumulative dose of 4441 mg, with 15 OFC being considered negative. 21 OFC were positive for a mean reactive cumulative dose of 2881 mg of cashew, with 13 anaphylactic reactions. 6 of these still-allergic children received food immunotherapy and 15 children continued on a strict avoidance diet. Discussion. - In one-third of our patients, spontaneous tolerance was achieved. Only 15 children underwent the recently available IgE assay for rAna o 3, an allergenic component of cashews, considered a major predictor of reactivity and severity. The presence of IgE directed against Ana o 3 confirmed the predictive value of this test in our patients, although we could not derive a threshold value. (C) 2018 Elsevier Masson SAS. All rights reserved.