Allergen Profile, Brazil Nut, IgE With Component Reflexes*

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Turnaround Time: 3-5 days
CPT Code:


Test Type: 1mL Serum


The measurement of specific immunoglobulin E (IgE) to individual components of an allergen, either purified native or recombinant, is referred to as component resolved diagnosis (CRD).1-5 This approach represents an improvement over traditional measurement of IgE to allergen extracts that contain a mixture of proteins. The pattern of specific IgE reactivity to component allergens can predict which patients are at higher risk for systemic allergic reactions versus those who are sensitized but clinically tolerant. CRD can also be used to predict which patients are at risk for more severe reactions and which patients are likely to have milder symptoms.

Allergies to plant-derived foods can occur as the result of sensitization to relatively stable proteins, such as the seed storage or lipid transfer proteins. Sensitization to this type of protein can be associated with more severe, systemic reactions and a higher risk for anaphylaxis. Alternatively, allergies to plant-derived foods may occur in pollen-sensitized individuals due to pollen allergens that cross-react with food allergens. Examples of pollen-associated allergens are the profilins or PR10 proteins that are homologues of the major white birch pollen antigen Bet v 1. Allergy to this family of proteins is associated with symptoms that are generally limited to the oropharyngeal area (commonly referred to as the oral allergy syndrome of pollen food allergy syndrome).

Component resolved diagnostics can help to1-5:

• Distinguish between allergy due to cross-reactivity and primary allergy.

• Improve risk assessment using allergen components.

• Improve management of allergic patients.

• Ber e 1 is a storage protein that is highly abundant in Brazil nut and serves as an energy source for the seed during growth of a new plant.7,8

• Sensitization to 2S albumins, such as Ber e 1, is known to be associated with systemic food reactions.7-13

Brazil Nut Allergy

Allergy to Brazil nut is relatively common in the United States.6

Brazil Nut Component

Ber e 1

• Ber e 1 is heat- and digestion-stable14,15

• Associated with systemic reactions16,17

• Positive Brazil nut extract IgE results with negative Ber e 1-specific IgE results may be explained by sensitization to:

− Other Brazil nut storage proteins or lipid transfer protein (LTP)

− Pollen proteins like profilin or PR10 proteins

− CDC (cross-reacting carbohydrate determinants)

1. Chokshi NY, Sicherer SH. Interpreting IgE sensitization tests in food allergy. Expert Rev Clin Immunol. 2016 Apr; 12(4):389-403. PubMed 26666347

2. Canonica GW, Ansotegui IJ, Pawankar R, et al. A WAO - ARIA- GA2LEN consensus document on molecular-based allergy diagnostics. World Allergy Organ J. 2013 Oct 3; 6(1):17. PubMed 24090398

3. Incorvaia C, Rapetti A, Aliani M, et al. Food allergy as defined by component resolved diagnosis. Recent Pat Inflamm Allergy Drug Discov. 2014; 8(1):59-73. PubMed 24483212

4. Sampson HA, Aceves S, Bock SA, et al. Food allergy: A practice parameter update-2014. J Allergy Clin Immunol. 2014 Nov; 134(5):1016-1025.e43. PubMed 25174862

5. Kattan JD, Sicherer SH. Optimizing the diagnosis of food allergy. Immunol Allergy Clin North Am. 2015 Feb; 35(1):61-76. PubMed 25459577

6. McWilliam V, Koplin J, Lodge C, Tang M, Dharmage S, Allen K. The prevalence of tree nut allergy: A systematic review. Curr Allergy Asthma Rep. 2015 Sep; 15(9):54. PubMed 26233427

7. Pastorello EA, Farioli L, Pravettoni V, et al. Sensitization to the major allergen of Brazil nut is correlated with the clinical expression of allergy. J Allergy Clin Immunol. 1998 Dec; 102(6 Pt1):1021-1027. PubMed 9847444

8. Rayes H, Abid Raza A, Williams A, Matthews S, Arshad SH. Specific IgE to recombinant protein (Ber e 1) for the diagnosis of Brazil nut allergy. Clin Exp Allergy. 2015 Dec 18. doi: 10.1111/cea.12693. PubMed 26684696

9. Roux KH, Teuber SS, Sathe SK. Tree nut allergens. Int Arch Allergy Immunol. 2003 Aug; 131(4):234-244. PubMed 12915766

10. Sastre J. Molecular diagnosis in allergy. Clin Exp Allergy. 2010 Oct; 40(10):1442-1460. PubMed 20682003

11. Robotham JM, Wang F, Seamon V, et al. Ana o 3, an important cashew nut (Anacardium occidentale L.) allergen of the 2S albumin family. J Allergy Clin Immunol. 2005 Jun; 115(6):1284-1290. PubMed 15940148

12. Savvatianos S, Konstantinopoulos AP, Borgå A, et al. Sensitization to cashew nut 2S albumin, Ana o 3, is highly predictive of cashew and pistachio allergy in Greek children. J Allergy Clin Immunol. 2015 Jul; 136(1):192-194. PubMed 25959668

13. Masthoff LJ, Hoff R, Verhoeckx KC, et al. A systematic review of the effect of thermal processing on the on the allergenicity of tree nuts. Allergy. 2013; 68(8):983-993. PubMed 23582909

14. Murtagh GJ, Archer DB, Dumoulin M, et al. In vitro stability and immunoreactivity of the native and recombinant plant food 2S albumins Ber e 1 and SFA-8. Clin Exp Allergy. 2003 Aug; 33(8):1147-1152. PubMed 12911791

15. Borja JM, Bartolome B, Gómez E, Galindo PA, Feo F. Anaphylaxis from Brazil nut. Allergy. 1999 Sep; 54(9):1007-1008. PubMed 10505470

16. Ridout S, Matthews S, Gant C, Twiselton R, Dean T, Arshad SH. The diagnosis of Brazil nut allergy using history, skin prick tests, serum-specific immunoglobulin E and food challenges. Clin Exp Allergy. 2006 Feb; 36(2):226-232. PubMed 16433861

Collection Details:

Collection Instructions:

Red-top tube or gel-barrier tube.

Room Temperature.