Allergen Profile, Brazil Nut, IgE With Component Reflexes

CPT: 86003
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Test Details

Test Includes

The Brazil nut component profile includes allergen-specific IgE to whole Brazil nut extract. This test reflexes Brazil nut component Ber e 1 when the Brazil nut extract result is >0.10 kU/L.

Use

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.

Methodology

Thermo Fisher ImmunoCAP® allergen-specific IgE

Additional Information

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 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

• 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)

Specimen Requirements

Volume

1 mL

Minimum Volume

0.5 mL (Note: this volume does not allow for repeat testing.)

Container

Red-top tube or gel-barrier tube

Storage Instructions

Room temperature

Clinical Information

Footnotes

1. Chokshi NY, Sicherer SH. Interpreting IgE sensitization tests in food allergy. Expert Rev Clin Immunol. 2016 Apr; 12(4):389-403. 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. 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. 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. 25174862
5. Kattan JD, Sicherer SH. Optimizing the diagnosis of food allergy. Immunol Allergy Clin North Am. 2015 Feb; 35(1):61-76. 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. 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. 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. 26684696
9. Roux KH, Teuber SS, Sathe SK. Tree nut allergens. Int Arch Allergy Immunol. 2003 Aug; 131(4):234-244. 12915766
10. Sastre J. Molecular diagnosis in allergy. Clin Exp Allergy. 2010 Oct; 40(10):1442-1460. 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. 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. 25959668
13. Masthoff LJ, Mattsson L, Zuidmeer-Jongejan L, et al. Sensitization to Cor a 9 and Cor a 14 is highly specific for a hazelnut allergy with objective symptoms in Dutch children and adults. J Allergy Clin Immunol. 2013 Aug; 132(2):393-399. 23582909
14. 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. 23582909
15. 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. 12911791
16. Borja JM, Bartolome B, Gómez E, Galindo PA, Feo F. Anaphylaxis from Brazil nut. Allergy. 1999 Sep; 54(9):1007-1008. 10505470
17. 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. 16433861

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
603972 IgE Brazil Nut w/Component Rfx 602444 Class Description N/A
603972 IgE Brazil Nut w/Component Rfx 602477 F018-IgE Brazil Nut kU/L 6050-9
Reflex Table for F018-IgE Brazil Nut
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 602444 Class Description 602444 Class Description N/A
Reflex Table for F018-IgE Brazil Nut
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 604350 Panel 604350 604158 F354-IgE Ber e 1 kU/L Pending
Reflex 2 000000 602444 000000 N/A
Reflex Table for F018-IgE Brazil Nut
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 604350 Panel 604350 603850 Reflex Allergy Tracking N/A

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