Prevalence data are based on different diagnostic procedures. While the prevalence of sensitization (sensitivity) can be estimated by SPT, RAST, and immunoblot, a clinical relevant sensitization (allergy) is evaluated by convincing history (anamnesis) or food challenge tests (ideally by DBPCFC).
1.1 General Population
Prevalence estimates within the author's selected populations
are listed. Those that are assigned randomly selected ("unselected") with
numbers more than 500 may be regarded as representative of the "general
populations". Inclusion criteria may involve circumstances not related
to atopic predisposition according to current knowledge.
| Country / Subjects | Allergy / Sensitivity | References |
| Australia, Victoria
a) 332 unselected new-born infants b) 4078 children with suspected peanut or tree nut allergy (age < 14 years) (study 1990-96) c) 620 children at risk of atopy (followed from birth for 2 years) |
almond 0.02% (calculated)
(frequency of almond allergy in b), corrected for prevalence ratio to peanut allergy in b) and c), extrapolated by risk of atopy in a) |
Hill et al. 1997 |
1.2 Subjects with Atopic or Other Diseases
| Country / Subjects | Allergy / Sensitivity | References |
| Australia, Victoria
4078 children with suspected peanut or tree nut allergy (age < 14 years) (study 1990-96) |
almond 4.2% (SPT >3+, n=336) | Sporik & Hill 1996 |
| Canada, Toronto, Ontario
45 patients with classic food allergic symptoms and/or subjective food related complaints |
almond, walnut 2.2% (SPT) | Parker et al. 1990 |
| Costa Rica
171 children (68 asthmatics, 103 non-asthmatics) |
almond 50% (specific IgE in MAST) | Soto-Quiros et al. 1998 |
| Croatia
71 confectionary workers with occupational respiratory allergies (bronchitis, dyspnea, asthma) |
almond 4.2% (SPT) | Zuskin et al. 1994 |
| Finland
80 food handlers with hand dermatitis |
almond 5% (n=60, scratch chamber test) | Niinimaki 1987 |
| France, Nancy
196 cases of involving plant food allergens (from 509 cases of food allergy) |
Rosaceae fruits including almonds 17% (clinical evaluation) | Moneret-Vautrin et al. 1997 |
| France, Nancy
142 patients with peanut allergy |
almond 50% (clinical evaluation) | Moneret-Vautrin et al. 1998 |
| France, Nancy and Toulouse
544 food allergic children |
almond 0.6% (food challenge) | Rance et al. 1999 |
| France, Pierre Benite
60 cases of anaphylaxis (study period 1984-92) |
almond 1.7% | Andre et al. 1994 |
| Germany, Ulm
80 patients with pollen associated food allergy |
almond 65% (clinical history, SPT) | Boehncke et al. 1998 |
| Italy, Ferrara
169 grass pollen allergic patients (age of 9-54 years, mean 27.9) |
almond 4% (clinical history) | Boccafogli et al. 1994 |
| Italy, Genoa
132 pollen and food sensitive patients |
almond 6.6%
(incidents of hypersensitivity) |
Troise et al. 1992 |
| Italy, Milan
262 fruit and/or vegetable allergic patients |
almond 22% (clinical history) | Ortolani et al. 1988 |
| Italy, Milan
100 fruit and/or vegetable allergic patients |
almond 6% (clinical history) | Ortolani et al. 1989 |
| Italy, Milan
30 apricot allergic patients |
almond 13% (clinical history) | Pastorello et al. 2000 |
| Israel, Tel-Aviv
112 patients with food allergy (onset after 10 years of age) |
a) almond 55% (SPT, n=108)
b) almond 39% (food challenge, n=71) |
Kivity et al. 1994 |
| Spain, Barcelona
102 patients allergic to dried fruits |
almond 89%, 81%, and 60%
(SPT, HR, and RAST) |
Amat Par et al. 1990 |
| Spain, Gran Canaria
102 adults with symptoms after ingestion of specific foods |
almond 7.5% (SPT, RAST) | Castillo et al. 1996 |
| Spain, Madrid???
40 patients with fruit or vegetable allergy |
almond 43% (SPT, RAST, PK tests) | Hernandez et al. 1985 |
| Spain, Madrid
a) 48 children with pollinosis b) 42 children with fruit or vegetable allergy |
a) almond 0% (SPT), 2.1% (RAST)
b) almond 17% (SPT), 12% (RAST) |
Caballero et al 1994 |
| Spain, Madrid
355 food allergic children |
almond 3.7% (clinical history, open food challenge, SPT, RAST) | Crespo et al. 1995a |
| Spain, Madrid
29 plant-derived food allergic patients |
almond 6.9% (SPT)
almond 0% (RAST) |
Diez-Gomez et al. 1999 |
| Spain, Plasencia (Caceres)
262 patients with pollinosis |
almond 2.2% (self-reported)
almond 1.5% (SPT) |
Garcia-Ortiz et al. 1995 |
| Spain, Salamanca
a) 84 mugwort sensitive patients without other pollen sensitizations b) 57 fruit allergic patients (age of 6-56 years, mean 21.5) |
a) almond 1.2% (RAST)
b) almond 14%(clinical history) |
a) Garcia-Ortiz et al. 1996
b) Garcia Ortiz et al. 1998 |
| Spain, Salamanca
95 pollen allergic patients (age 10-58 years, mean 27) |
almond 16% (SPT)
almond 1% (food challenge) |
Cuesta-Herranz et al. 2000 |
| Sweden
60 severe allergic reactions caused by food |
soybean, nuts, and almonds >70% | Foucard et al. 1997 |
| Sweden, Halmstad / Malmö
a) 380 birch pollen allergic patients b) 103 patients without birch pollen allergy |
a) almond 27%
b) almond 3% (questionaire) |
Eriksson et al. 1982 |
| Switzerland, Zurich
a) 402 food allergic adults (study period 1978-87) b) 383 food allergic patients (study period 1990-94) |
a) almond 1.7%
b) almond 11% (anamnesis, clinical relevance, diagnostic tests) |
a) Wüthrich 1993
b) Etesamifar & Wüthrich 1998 |
| United Kingdom, London
119 patients with possible food allergies |
almond 3.4% (RAST, elimination-challenge test) | Wraith et al. 1979 |
| USA, Boston, MA
63 asthmatic adults with positive food-induced skin scratch tests |
almond 3.2% (skin scratch test) | Rackemann 1931 |
| USA, Galveston, TX / Philadelphia, PA
26 patients with atopic dermatitis associated with ingestion of various foods |
almond 3.8% (clinical history, elimination diet) | Livingood & Pillsbury 1949 |
| UK, Manchester
90 patients expierenced anaphylactic reactions to foods (from 1994-1996) |
almond 3.3% (suspected cause of patients' worst reaction) | Pumphrey & Stanworth 1996 |
| USA, Little Rock, AR / New York City, NY
54 tree nut allergic patients |
almond 24% (acute allergic reactions) | Sicherer et al. 1998b |
| USA, Los Angelos, CA
127 pediatric patients who reported one or more food allergies |
almond 3.9% (RAST) | Hoffman & Haddad 1974 |
| USA, Memphis, TN
89 patients with food- induced anaphylaxis (age of 12-75 years, study period 1978-92) |
almond or peach 5.6% (clinical history) | Kemp et al. 1995 |
| USA, Mineola, NY
30 patients with gastrointestinal symptoms associated with food allergies |
almond and Brazil nut 1 case
almond, walnut, and Brazil nut 1 case (intracutaneous skin test, oral challenge with mixture of foods) |
Fries & Zizmor 1940 |
| USA, Rochester, MN
a) 18 patients with food- related anaphylaxis b) 81 patients |
a) almond 5.6% (history, SPT, and
RAST)
b) almond 19% (SPT) |
Yocum & Khan 1994 |
| USA, Torrance, CA
8 patients with oral allergy syndrome to avocado and positive history |
almond 12.5% (self-reportedly cause of OAS; no clinical confirmation) | Telez-Diaz et al. 1995 |
| USA, Torrance, CA
40 of 62 patients from an adult outpatient HIV clinic who reported symptoms compatible with food allergy |
almonds and peanuts 1 case
(self-reportedly cause of diarrhea and headache; no clinical confirmation) |
Tubiolo et al. 1997 |
1.3 Prevalence of Associated Allergies
| Country / Subjects | Sensitization / Allergy | References | ||||||||||||||||||||||||||||||||||||
| France, Italy, Netherlands
37 patients with Rosaceae allergy and positive SPT to lipid-transfer protein enriched extracts (plum / peach peel) |
|
Asero et al. 2000 | ||||||||||||||||||||||||||||||||||||
| Germany, Ulm
52 almond allergic patients selected out of 80 patients with pollen associated food allergy |
birch pollen 98% (clinical history, SPT) | Boehncke et al. 1998 | ||||||||||||||||||||||||||||||||||||
| Spain, Barcelona
78 almond allergic patients |
tree pollen tree (elm, olive, birch, plane, ash) 59%
weed pollen (parietaria, mugwort) 38% grass pollen 13% (2 positive results from SPT, HR, and RAST) |
Amat Par et al. 1990 | ||||||||||||||||||||||||||||||||||||
| Spain, Madrid
55 children sensitized to almonds |
pollen 80% (SPT) | Crespo et al. 1995b | ||||||||||||||||||||||||||||||||||||
| Spain, Madrid and Toledo
Patients with allergy to Rosaceae fruits a) 11 without pollinosis (mean age 26 years) b) 22 with associated pollinosis (mean age 22 years) |
|
Fernandez-Rivas et al. 1997 | ||||||||||||||||||||||||||||||||||||
| Spain, Madrid
28 patients with positive SPT and/or specific IgE to one or more fruits of the Rosaceae family |
peach 79%
apple 21% apricot 18% plum 14% almond 3.6% pear 3.6% strawberry 3.6% (DBPCFC or convincing episode of anaphylaxis) |
Rodríguez et al. 2000 | ||||||||||||||||||||||||||||||||||||
| Spain, Salamanca
8 almond allergic patients |
latex 75% (SPT and/or RAST)
latex 25% (clinical history) |
Garcia Ortiz et al. 1998 | ||||||||||||||||||||||||||||||||||||
| UK, Cambridge
62 patients with peanut and/or nut allergy (age of 11 months to 53 years) |
peanut 65%
brazil nut 29% almond 23% hazelnut 21% walnut 13% cashew nut 4.8% (clinical history, SPT) |
Ewan 1996 |
| Symptoms & Case Reports | References |
| Systemic reactions
anaphylaxis (5), life-threatening reactions (7), loss of consciousness (4) Symptoms of skin and mucous membranes
Gastrointestinal symptoms
Respiratory symptoms
Other symptoms
|
(1) Schloss 1912
(2) Ortolani et al. 1988 (3) Boccafogli et al. 1994 (4) Ewan 1996 (5) De las Marinas et al. 1998 (6) Garcia Ortiz et al. 1998 (7) Roux et al. 1999 (8) Asero et al. 2000 (9) Pasini et al. 2000 |
| Percentage of reactions
Oral allergy syndrome in 75% (plus systemic reactions in 16%) and extra-oral symptoms in 25% in 57 almond allergic patients (1) |
(1) Ortolani et al. 1988 |
3 Diagnostic Features of Almond Allergy
| Parameters / Subjects | Outcome | References | |||||||||
| Skin test
A boy with urticaria provoked by ingestion of almond, egg, and oatmeal |
Skin testing with demonstration of urticarial lesion | Schloss 1912 | |||||||||
| Skin test, Systemic Reaction
An almond sensitive individual |
A case of systemic reaction following skin test | Kahn 1942 | |||||||||
| IgE
tree nut allergic patients: a) 11 reacting b) 25 not reacting to almonds |
Almond specific serum IgE (RAST):
|
Sicherer et al. 1998b | |||||||||
| IgE and Clinical Relevance
25 patients with atopic dermatitis |
44% had positive RAST to almonds. However, none of the patients apparently mentioned almonds as a cause of allergic sensitivity | Hoffman et al. 1975 | |||||||||
| IgE and Clinical Relevance
67 asthmatic children |
Agreement of history of almond
allergy and almond specific serum IgE (MAST):
positive history and positive MAST in 3 children, positive MAST and no positive history in 4 children and, positive history and a negative MAST in 3 children |
Adler et al. 1991 | |||||||||
| IgE and Clinical Relevance
43 patients with clinical history and positive SPT to almond |
Almond specific RAST:
positive 42% negative 58% |
Boehncke et al. 1998 | |||||||||
| IgE and Clinical Relevance
A 3 year old boy with peanut allergy |
Strong positive RAST to almond, although no almond allergy was described in history; also high RAST to peanut, hazelnut, Brazil nut, pecan, pistachio, walnut, and pea. | Sicherer et al. 1998a | |||||||||
| SPT, IgE and Clinical Relevance
a) 24 and b) 43 patients with clinical history of almond allergy |
a) RAST (specific IgE):
positive results in 25% b) SPT with fresh food: positive results in 30% |
Ortolani et al. 1988 | |||||||||
| SPT, IgE and Clinical Relevance
6 patients with clinical history of almond allergy |
RAST (specific IgE > 0.7 kU/L):
positive results in 17% SPT with fresh food: positive results in 17% |
Ortolani et al. 1989 | |||||||||
| SPT, RAST, Histamine Release and Clinical
Relevance
102 patients allergic to dried fruits |
Correlation of tests to clinical history of almond allergy:
89% for SPT 87% for HR 68% for RAST |
Amat Par et al. 1990 | |||||||||
| SPT, IgE, and DBPCFC
28 patients with suspected allergy to fruits of the Rosaceae family |
|
Rodríguez et al. 2000 | |||||||||
| Immunoblot and Clinical Relevance
a) 2 symptomatic patients with almond allergy (SPT positive, RAST negative) b) 3 asymptomatic subjects with positive RAST |
IgE binding almond proteins:
a) 37-kDa protein b) 50-kDa and 62-kDa glycoproteins (Con A reactive bands) (SDS-PAGE Immunoblot) |
Pasini et al. 2000 | |||||||||
| Open Challenge
17 children with perceived peanut or tree nut allergy (almond suspected cause in 2 cases) |
Open challenge procedure, where negative tests (SPT, RAST) indicate tolerance of nuts: 15 showed no reactions, all of them continued to ingest foods containing nuts without incidents. | Baker et al. 1999 |
| Treatment* | Outcome | References | ||||||||||||||||||||
| Tree Pollen Immunotherapy
72 children with birch pollinosis (age of 6-16 years), prevalence of adverse reactions to almond before immunotherapy 50% I. subcutaneous immunotherapy for 3 years with a) birch pollen preparation or b) a mixture of birch, alder, and hazel pollen II. oral immunotherapy for 10 months with c) birch pollen preparation or d) placebo capsules |
Assessment of food allergy after treatment (self-reported):
|
Möller 1989 |
| Proteins / Glycoproteins | Allergen Nomenclature | References |
| 37-kDa Allergen | Pasini et al. 2000 | |
| Almond Profilin | van Ree et al. 1992, 2000 | |
| Allergens: 45-50, and 70 kDa
Minor Allergens: 15 kDa |
Bargman et al. 1992 | |
| Allergens: 50 kDa and 66 kDa
Minor Allergens: 10, 28, 37, and 39-44 kDa |
Roux et al. 1999 |
6.1 Sensitization to Almond Allergens
| Country / Subjects | Sensitivity to | References | |||||||||||||||||||||||||||||||||
| Italy, Padova
2 almond allergic patients |
37 kDa allergen
(SDS-PAGE immunoblot) |
Pasini et al. 2000 | |||||||||||||||||||||||||||||||||
| Netherlands, Amsterdam
2 patients with pollen profilin specific serum IgE |
Specific IgE against
almond profilin 6.9 and 3.0 IU/ml (RAST, L-proline Sepharose bound profilin) |
van Ree et al. 2000 | |||||||||||||||||||||||||||||||||
| USA, Davis, CA
a) 14 patients with history of life-threatening reaction to almonds b) 11 patients with history of non-life- threatening reactions to almonds |
|
Roux et al. 1999 | |||||||||||||||||||||||||||||||||
| USA, Lincoln, NE
8 almond sensitive patients |
|
Bargman et al. 1992 |
| Extract / Purified Allergens | Methods | References |
| Protein extract | Ground whole almonds defatted with acetone and ethyl ether; dried almond powder extracted with NaCl pH 7.0, centrifuged, dialyzed, centrifuged again, and membrane filtered | Bargman et al. 1992 |
| Protein extract | Almonds finely chopped, extracted with Tris-HCl-buffer pH 8.0 (containing glycerol, polyethylene glycol 8000, citric acid, L-cysteine, L-ascorbic acid, EDTA, and polyvinylpyrrolidone); followed by homogenization on ice, centrifugation, membrane filtration and membrane concentration | Teuber & Peterson 1999 |
| Salt-soluble proteins | Raw whole almonds grounded, defatted with petroleum ether, extracted with 0.5-M NaCl for 2h; after centrifugation protein was precipitated with acetone at 4°C for 30 min; after centrifugation protein extract was resolubilized in SDS-PAGE sample buffer | Pasini et al. 2000 |
| Almond major protein [460 kDa] | Defatted almond flour extracted with Tris-HCl buffer (pH 8.1), centrifuged and isolation of the almond major protein from supernatant by anion exchange (DEAE column) and gel filtration (Sephacryl column) chromatography, collected fractions pooled and concentrated by membrane filtration, further purification by gel filtration | Acosta et al. 1999 |
| Food extracts | Food samples ground and extracted with PBS-buffer at 60°C for 2h, centrifuged and supernatant stored at -20°C | Hlywka et al. 2000 |
| Cross-Reacting Allergens | Subjects / Methods | References |
| Almond (Peanut)
peanut |
Inhibition of IgE-binding:
by peanut to almond proteins (1 patient, RAST inhibition) |
Gillespie et al. 1976 |
| Almond (Peanut, Nuts)
significant associations: peanut, hazelnut, walnut* |
262 fruit and/or vegetable allergic patients
(clinical history, SPT, RAST) |
Ortolani et al. 1988 |
| Almond (Nuts, Seeds)
hazelnut, brazil nut, sesame seeds * |
111 peanut and/or tree nut allergic patients: strong correlation (r >0.7) between almond and hazelnut, brazil nut, and sesame (RAST) | Sicherer et al. 1998b |
| Almond (Nuts)
hazelnut |
6 hazelnut allergic adults: Inhibition of IgE binding to hazelnut proteins by almond proteins (appr. 8%) (RAST inhibition) | Koppelman et al. 1999 |
| Almond (Nuts)
coconut, walnut |
Strong inhibition of IgE binding to coconut allergens (35, 36.5 and 55 kDa) and to walnut allergen (36 kDa) by almond extract (SDS-PAGE immunoblot, 2 tree nut allergic patients) | Teuber & Peterson 1999 |
| Almond (Apple)
apple (indicating allergenic lipid-transfer proteins) |
Approximately 98% inhibition of IgE binding to almond proteins by apple peel extract in 1 patient serum specific for lipid-transfer proteins without reactivity to Bet v 1, profilin, and carbohydrate epitopes (RAST inhibition) | Asero et al. 2000 |
| Almond (Rye)
rye flour * |
Correlation between specific IgE to rye flour and nuts (peanut, almond, brazil nut, coconut, hazelnut) (3310 atopic patients, RAST, r = 0.5 to 0.8) | Seifert et al. 1988 |
9 Allergenicity of Different Almond Varieties
| Varieties / Subjects | Differences | References |
| 3 Almond Varieties
8 almond sensitive patients |
No significant differences in relative amounts and binding patterns of allergens (SDS-PAGE / immunoblot) | Bargman et al. 1992 |
10 Stability of Almond Allergens
| Treatment | Effects | References |
| Almond extract (Storage)
storage of water extract of almond meal |
Incubation of a water extract in the presence of azide for about 12 days revealed degradation of the acidic polypeptides of amandin probably by endogenous proteinase(s) | Wolf & Sathe 1998 |
| Almonds (Heat, Processing)
commercial samples of almond butter, blanched, and roasted almonds |
IgE-binding of protein extract from almond butter similar
to that of raw almonds;
blanching and roasting did not affect IgE binding of 45-50 kDa almond allergen, essentially reduced IgE binding of 70 kDa allergen, and eliminated IgE binding of 15 kDa allergen (SDS-PAGE immunoblot, 8 almond sensitive individuals) |
Bargman et al. 1992 |
| Almonds (Heat, pH)
a) commercial samples of blanched almonds, roasted almonds, and almond paste b) moist heating of purified almond major protein at 121°C for 15 min c) incubation of almond major protein at pH 12.5 and 1.5-2.5 |
Immunoreactivity of protein extracts in comparison to
purified almond major protein (polyclonal rabbit antibodies, noncompetitive
ELISA):
a) reactivity of blanched almonds, roasted almonds, and almond paste was respectively reduced by 50.0%, 56.6%, and 68.4% b) moist heat pretreatment reduced reactivity by 87% c) pH extremes (12.5 and 1.5-2.5) caused a 53% and 57% reduction in reactivity, respectively |
Acosta et al. 1999 |
| Almond protein isolate
(Hydrolysis)
Pepsin digestion of almond protein isolate in 0.1-M HCl at 37°C for 0-60 min (protein enzyme ratios from 50:1 to 1000:1) |
Major polypeptides with 38-42 kDa completely hydrolyzed within 2 min, with 20-22 kDa within 5 min; digestion products in the range of 15-36 kDa and 15-20 kDa are hydrolyzed after 45-60 min (SDS-PAGE) | Sze-Tao & Sathe 2000 |
| Reported Adverse Reactions | References |
| Essence in Curry
Severe allergic reactions in a 30 year old woman after ingestion of almond traces from an essence in curry (1) |
(1) Ewan 1996 |
| Various Foods
Registration of adverse reactions to foods in Sweden show that 51 out of 77 cases were the result of inadequate labelling; 3 of these cases were due to almond (1) |
(1) Kjelkevik et al. 1997 |
| Allergens in Food Products | Content / Products | References |
| Almonds in Cereals
commercial breakfast cereals |
Detection of almond major protein by competitive ELISA inhibition (rabbit polyclonal antibody) | Acosta et al. 1999 |
| Chocolate-coated Peanuts
retail samples with undeclared almond content |
2 of 4 samples contained 4 and 57 mg/kg almond in whole samples of chocolate-coated peanuts (ELISA, polyclonal antibodies specific for whole almond protein extract) | Hlywka et al. 2000 |
| Almond Oils
4 Commercially available almond oils (serum pool from 17 peanut and/or nut allergic patients) |
IgE-binding potencies:
blend of unrefined and refined oil (90 / 190°C max. processing temperature) > unrefined oil (57°C) > 2 refined, bleached, and deodorized oils (230-260°C) (dot immunoblot) Protein contents of unrefined oils 62 µg/mL, 2 refined oils: 2.2 and 17 µg/mL, and blended oil 13 µg/mL |
Teuber et al. 1997 |
| Food Allergen | Labelling / Regulation Status | References |
| International Regulations
Tree nuts* and products of these |
mandatory labelling of prepackaged food / advisary status (1) | (1) Codex Alimentarius Commission 1999 |
| European Regulations
Tree nuts* and products of these |
labelling appropriate / recommendation (1) | (1) Bousquet et al. 1998 |