Allergy information for: Cashew (Anacardium occidentale)

  • Name: Cashew
  • Scientific Name: Anacardium occidentale
  • Occurrence: Chopped nuts in foods and as garnishes, nut spread. More information..
  • Allergy Information:

    Allergies to tree nuts and seeds tend to be of a more severe nature, causing life-threatening and sometimes fatal reactions. People with tree nut allergies also often suffer from reactions triggered by a number of different types of nuts, even though they do not come from closely related plant species. In general these allergies are triggered by the major proteins found in nuts and seeds which are resist processes such as cooking.

    There is also a milder form of tree nut allergy which is associated with birch pollen allergy, where symptoms are confined largely to the mouth, causing a condition called “oral allergy syndrome” (OAS). This condition is triggered by molecules found in tree nuts which are very similar to pollen allergens like the major birch pollen allergen called Bet v 1. These molecules tend to be destroyed by cooking, which can reduce the allergenicity of nuts and seeds for these allergic consumers.

    Reactions to nuts and seeds can also occur as a consequence of hidden nut ingredients or traces of nuts and certain seeds introduced as a consequence of food handling or manufacturing. As a result tree nuts and seeds have been included in Annex IIIa of the EU food labelling directive. The following (including products thereof) must be declared on a label if they have been deliberately included in a food:

    Almond, hazelnut, Walnut, Cashew, Pecan nut, Brazil nut, Pistachio nut, Macadamia nut Queensland nut, Mustard and Sesame seeds

    Temporary exceptions to the labelling rule (derogations) have been granted for

    Alcoholic berverages
    Flavours
  • Other Information: Nuts i.e. Almond, Hazelnut, Walnut, Cashew, Pecan nut, Brazil nut, Pistachio nut, Macadamia nut and Queensland nut and products thereof are listed in annex IIIa of the EU directive on labelling of foods.
  • Taxonomic Information: NEWT http://www.ebi.ac.uk/newt/display?from=null&search=171929
  • Last modified: 18 October 2006

Reviews (0)

    References (0)

      Clinical History

      • Number of Studies:1-5
      • Number of Patients:>50
      • Symptoms:

        Rance et al (2003) [704] reports symptoms from 42 children (mean age at diagnosis 2.7 years) with cashew nut allergy including urticaria (31 cases, 26%), nonlaryngeal angio-oedema (36 cases, 32%), asthma (eight cases, 7%), rhinitis and rhinoconjunctivitis (nine cases, 8%), oral allergy syndrome (two cases, 2%), vomiting (15 cases, 13%), diarrhoea (one case, 0.8%) and asthenia (one case, 0.8%)

        Nguyen and Gern (2003) [710] report a case in which cashew allergy was mistaken for foreign body obstruction. Subsequently the patient showed cough, stridor and hives.

        Hourihane et al. (2001) [700] report 29 patients with cashew nut allergy aged 1-30 years. 14 reacted to minimal contact without actually eating cashew. 14 reported wheeze and 11 reported collapse or feeling faint.

        Garcia et al. (2000) [701] reported angioedema and urticaria; oral itching, urticaria, wheezing dyspnea and dizziness; generalized erythema, aqueous rhinorhea, dyspnea, dysphagia, nausea, vomiting and diarrhea in 3 patients

        Shortness of breath, widespread urticaria, angioedema within 20min of eating a piece of chocolate candy containing cashew (Rasanen et al. 1998 [486])

        Angioedema, generalised urticaria in one child (Tariq et al. 1996 [525])

        Anaphylaxis (Strickler et al. 1986 [522]) and a case of fatal anaphylaxis (Sampson et al 1992 [711]) reported in reviews of anaphylaxis .

        Urticaria, angioedema (Gillespie et al. 1976 [342])

      Skin Prick Test

      • Number of Studies:1-5
      • Food/Type of allergen:Rance et al. (2003) [704] used commercial extracts. They also used cashew nut extracts for prick-prick tests.
      • Protocol: (controls, definition of positive etc)

        Positive SPT was >3mM and 50% larger than positive control while negative remained negative (Rance et al. 2003 [704])

      • Number of Patients:

        Rance et al. (2003) [704] tested 42 patients.

        Rasanen et al. (1998) [486] reported 1 patient.

      • Summary of Results:

        Rance et al. (2003) [704] found all patients had positive SPT. 29 were also positive with another nut

        Rasanen et al. (1998) [486] reported an immediate wheal of 11mm, which grew to 20mm within 30min of SPT .

      IgE assay (by RAST, CAP etc)

      • Number of Studies:0
      • Food/Type of allergen:Commercial extract
      • IgE protocol:CAP; RAST
      • Number of Patients:

        Garcia et al. (2000) [701] tested sera from 3 patients.

        Rance et al. (2003) [704] tested sera from 42 patients.

        Teuber et al. (2002) [695] report 15 patients with a mean age of 39 years. All had required treatment after eating cashew nuts and were allergic to other nuts.

        Wang et al. (2003) [697] report 21 cashew allergic patients and 3 tolerant.

      • Summary of Results:

        Rance et al. (2003) [704] reported that 3/42 patients gave negative CAP assay but that 2 of these gave a positive open challenge and the third had a convincing history.

        Wang et al. (2003) [697] report positive CAP or RAST results from 21 cashew allergic adults and only one 0.43 kU/l response from 3 cashew tolerant patients. 13/21 sera reacted to a 33 kDa legumin identified as a new major allergen, Ana o 2.

      Immunoblotting

      • Immunoblotting separation:

        Teuber et al. (2002) [695] used 1D SDS-PAGE (13% polyacrylamide) with 5 minutes heating of cashew extract in sample buffer with or without DTT. 16% polyacrylamide tricine gels were also used to improve the resolution for low mass proteins.

        Wang et al. (2002) [699] and (2003) [697] used 1D SDS-PAGE on reduced cashew extracts or recombinant allergens using a 10% acrylamide gel.

      • Immunoblotting detection method:

        Teuber et al. (2002) [695], Wang et al. (2002) [699] and (2003) [697] transferred proteins to strips of 0.22-µm nitrocellulose, blocked with milk powder with Triton X-100 or Tween. Diluted sera (1:5 or 1:20) were added and incubated overnight at RT. The strips were then washed and incubated overnight at RT with equine polyclonal iodine 125I–labeled anti-human IgE diluted 1:5 in the nonfat milk buffer.
        Wang et al. (2002) [699] transferred proteins to Trans-Blot PVDF membrane (0.2 µm, BioRad) for sequencing.

      • Immunoblotting results:

        The 2S albumins and legumin-like 13S proteins were identified as major allergens and a vicillin was also identified as an allergen by Teuber et al. (2002) [695] .

        Wang et al. (2003) [697] report that 13/21 sera reacted to a 33 kDa legumin identified as a new major allergen, Ana o 2.

      Oral provocation

      • Number of Studies:1-5
      • Food used and oral provocation vehicle:Cashew nut that had been crushed and mixed with saline
      • Blind:No
      • Number of Patients:

        Rance et al. (2003) [704] used labial food challenge with 8 patients

        Hourihane et al. (2001) [700] report positive open challenge on 2 patients with cashew nut allergy.

      • Dose response:Not reported
      • Symptoms:Continous urticaria of cheek or chin or generalized reaction was reported by Rance et al. (2003) [704]

      IgE cross-reactivity and Polysensitisation

      Extracts from the botanically closely related plant pistaccio also bind IgE from several cashew allergic patients at similar masses and were also sensitive to reduction (Fernandez et al. (1995) [53]; Garcia et al. 2000 [701]). Rance et al. (2003) [704] found that 7/42 of their patients were also allergic to pistaccio. Teuber et al. (2002) [695] report that their patients cross reacted to walnut but note that this could result from bias as they had started from prodominately walnut allergic patients.

      Other Clinical information

      Many studies report allergy to "tree nuts". Allergy to cashew was the second most common of the tree nuts reported by Sicherer et al. (2001) [826] with 20% of the 1667 nut allergic registrants reporting cashew allergy. Similarly Sicherer et al. (1998) [517] report 11/54 nut allergic patients as cashew allergic. However, the symptoms, described as 89% involved the skin (urticaria, angioedema), 52% the respiratory tract (wheezing, throat tightness, repetitive coughing, dyspnea), and 32% the gastrointestinal tract (vomiting, diarrhea) were not associated with specific nuts. Clark and Ewan (2003) [615] report 29/1000 peanut or nut allergic patients showed their strongest reaction to cashew (however, the number of patients who tolerated cashew was not reported).

      Wei et al. (2003) [712] report development of an ELISA for analysing cashew in food.

      Rasanen et al. (1998) [486] report moderate inhibition of IgE binding to cashew nut extract by pectin in one patient, determined by RAST.

      Moneret-Vautrin et al. (1998) [943] reported 40% of 140 peanut allergic patients were sensitised to cashew.

      Tariq et al. (1996) [525] reported that 1/1218 of a birth cohort (0.08%) was allergic to cashew.

      26.04% of patients in a food allergy clinic in India (Mumbai) reported allergy to cashew (Suraiya 1999 [574]).

      Reviews (0)

        References (19)

        • Sicherer SH, Furlong TJ, Munoz-Furlong A, Burks AW, Sampson HA.
          A voluntary registry for peanut and tree nut allergy: characteristics of the first 5149 registrants.
          J Allergy Clin Immunol. 108(1):128-32.. 2001
          PUBMEDID: 11447394
        • Sicherer SH, Burkes AW, Sampson HA.
          Clinical features of acute allergic reactions to peanut and tree nuts in children
          Pediatrics 102 1-6. 1998
          PUBMEDID: 9651458
        • Wang F, Robotham JM, Teuber SS, Sathe SK, Roux KH
          Ana o 2, a major cashew (Anacardium occidentale L.) nut allergen of the legumin family
          Int Arch Allergy Immunol. 132(1):27-39.. 2003
          PUBMEDID: 14555856
        • Teuber SS, Sathe SK, Peterson WR, Roux KH.
          Characterization of the soluble allergenic proteins of cashew nut (Anacardium occidentale L.).
          J Agric Food Chem. 50(22): 6543-6549. 2002
          PUBMEDID: 12381147
        • Nguyen AD, Gern JE.
          Food allergy masquerading as foreign body obstruction.
          Ann Allergy Asthma Immunol. 90(2):271-272.. 2003
          PUBMEDID: 12602679
        • Garcia F, Moneo I, Fernandez B, Garcia-Menaya JM, Blanco J, Juste S, Gonzalo.
          Allergy to Anacardiaceae: description of cashew and pistachio nut allergens.
          J Investig Allergol Clin Immunol. 10(3):173-177.. 2000
          PUBMEDID: 10923594
        • Rance F, Bidat E, Bourrier T, Sabouraud D.
          Cashew allergy: observations of 42 children without associated peanut allergy.
          Allergy 58(12):1311-4.. 2003
          PUBMEDID: 14616109
        • Gillespie DN, Nakajima S, Gleich GJ
          Detection of allergy to nuts by the radioallergosorbent test.
          J Allergy Clin Immunol 57:302-309.. 1976
          PUBMEDID: 1262606
        • Stricker WE, Anorve-Lopez E, Reed CE,
          Food skin testing in patients with idiopathic anaphylaxis.
          J Allergy Clin Immunol 77: 516-519.. 1986
          PUBMEDID: 3950255
        • Tariq SM, Stevens M, Matthews S, Ridout S, Twiselton R, Hide DW
          Cohort study of peanut and tree nut sensitisation by age of 4 years
          BMJ 313: 514-517.. 1996
          PUBMEDID: 8789974
        • Fernandez C, Fiandor A, Martinez-Garate A, Martinez Quesada J
          Allergy to pistachio: crossreactivity between pistachio nut and other Anacardiaceae.
          Clin Exp Allergy 25: 1254-1259.. 1995
          PUBMEDID: 8821307
        • Suraiya C
          Food allergies
          In: Indian Journal of Clinical Practice, Allergy and asthma: a clinical primer Shaikh W, Editor, pp94-98. 1999
          PUBMEDID:
        • Rasanen L, Makinen-Kiljunene S, Harvima R J
          Pectin and cashew nut allergy: cross-reacting allergens?
          Allergy 53: 627-628.. 1998,
          PUBMEDID: 9689352
        • Wang F, Robotham JM, Teuber SS, Tawde P, Sathe SK, Roux KH.
          Ana o 1, a cashew (Anacardium occidental) allergen of the vicilin seed storage protein family.
          J Allergy Clin Immunol. 110(1):160-166.. 2002
          PUBMEDID: 12110836
        • Hourihane JO, Harris H, Langton-Hewer S, Kilburn SA, Warner JO.
          Clinical features of cashew allergy.
          Allergy. 56(3):252-253.. 2001
          PUBMEDID: 11251411
        • Clark AT, Ewan PW.
          Interpretation of tests for nut allergy in one thousand patients, in relation to allergy or tolerance.
          Clin Exp Allergy 33(8):1041-1045.. 2003
          PUBMEDID: 12911776
        • Sampson HA, Mendelson L, Rosen JP.
          Fatal and near-fatal anaphylactic reactions to food in children and adolescents.
          N Engl J Med. 327(6): 380-384.. 1992
          PUBMEDID: 1294076
        • Wei YH, Sathe SK, Teuber SS, Roux KH
          A sensitive sandwich ELISA for the detection of trace amounts of cashew (Anacardium occidentale L.) nut in foods
          J Agric Food Chem. 51(11): 3215-3221.. 2003
          PUBMEDID: 12744645
        • Moneret-Vautrin DA, Rance F, Kanny G, Olsewski A, Gueant JL, Dutau G, Guerin L.
          Food allergy to peanuts in France--evaluation of 142 observations.
          Clin Exp Allergy. 1998 Sep;28(9):1113-1119.. 1998
          PUBMEDID: 9761015

        Biochemical Information for Ana o 1

        • Allergen Name:Ana o 1
        • Alternatve Allergen Names:
        • Allergen Designation:Major
        • Protein Family:7S seed storage globulin, Cupin, Pfam PF00190
        • Sequence Known?:Yes
        • Allergen accession No.s:http://ca.expasy.org/cgi-bin/niceprot.pl?Q8L5L5 Ana o 1.0101
          http://ca.expasy.org/cgi-bin/niceprot.pl?Q8L5L6 Ana o 1.0102
        • 3D Structure Accession No.:Not determined
        • Calculated Masses:61841 Da before post-translational processing
        • Experimental Masses:50 kDa
        • Oligomeric Masses:Trimer
        • Allergen epitopes:11 epitopes were detected by Wang et al. (2002) [699] with 3 immunodominant epitopes corresponding to AIMGPPTKFSFSLFL 1-15; KECEKYYKEKKGRER 57-71 and EEFFFQGPEWRKEKE 521-535.
        • Allergen stability:
          Process, chemical, enzymatic:          Not known
        • Nature of main cross-reacting proteins:Pistachio proteins at 34, 41, 52 and 60 kD cross-react with cashew extract by CAP-inhibition but were not identified (Parra et al. 1993 [952]). Thus Pistachio 7S may cross react.
        • Allergen properties & biological function:7S seed storage protein. The 62 kD sucrose binding proteins of soya are also closely related in sequence.
        • Allergen purification:Not reported
        • Other biochemical information:

        References (4)

        • Wang F, Robotham JM, Teuber SS, Tawde P, Sathe SK, Roux KH.
          Ana o 1, a cashew (Anacardium occidental) allergen of the vicilin seed storage protein family.
          J Allergy Clin Immunol. 110(1):160-166.. 2002
          PUBMEDID: 12110836
        • Teuber SS, Sathe SK, Peterson WR, Roux KH.
          Characterization of the soluble allergenic proteins of cashew nut (Anacardium occidentale L.).
          J Agric Food Chem. 50(22): 6543-6549. 2002
          PUBMEDID: 12381147
        • Fernandez C, Fiandor A, Martinez-Garate A, Martinez Quesada J
          Allergy to pistachio: crossreactivity between pistachio nut and other Anacardiaceae.
          Clin Exp Allergy 25: 1254-1259.. 1995
          PUBMEDID: 8821307
        • Parra FM, Cuevas M, Lezaun A, Alonso MD, Beristain AM, Losada E.
          Pistachio nut hypersensitivity: identification of pistachio nut allergens.
          Clin Exp Allergy. 23(12):996-1001.. 1993
          PUBMEDID: 10779292

        Biochemical Information for Ana o 2

        • Allergen Name:Ana o 2
        • Alternatve Allergen Names:Anacardein, 13S globulin
        • Allergen Designation:Major
        • Protein Family:11S seed storage globulin; Cupin; Pfam PF00190
        • Sequence Known?:Partial
        • Allergen accession No.s:http://ca.expasy.org/cgi-bin/niceprot.pl?Q8GZP6
        • 3D Structure Accession No.:Not determined
        • Calculated Masses:50478.36 (residues 15-457)
        • Experimental Masses:33 kDa and 53 kDa
        • Oligomeric Masses:

          Hexamer

        • Allergen epitopes:Wang et al. (2003) [697] analyzed the IgE binding of 3 pools of 4 sera from 12 patients to 58 overlapping linear peptides. 86% of the IgE binding was to the N-terminal acidic 66% of the protein (heavy subunit). Only 2 epitopes, 15-29 SRQEWQQQDECQIDR and 105-119 YQAPQQGRQQGQSGR, were recognised by IgE from all 3 pools. Only 7 epitopes bound IgE strongly from any one pool. There was little similarity to the epitopes of Ara h 3. Soya glycinin was more similar. One cashew epitope, 233-247, is positionally related to epitopes from glycinin and Ara h 3.
        • Allergen stability:
          Process, chemical, enzymatic:          Not known
        • Nature of main cross-reacting proteins:Pistachio proteins at 34, 41, 52 and 60 kD cross-react with cashew extract by CAP-inhibition but were not identified (Parra et al. 1993 [952]). Thus Pistachio 11S may cross react.
        • Allergen properties & biological function:The 13S storage globulin of cashew, originally called anacardein, is synthesised as approximately 55 kDa chains (as, for example, proglycinin) which form trimers. On cleavage into 30-35 kDa N-terminal heavy subunits and 20-27 kDa C-terminal light subunits, which remain disulphide linked, the trimers form a hexamer of about 330 kDa.
        • Allergen purification:

          Whole raw cashew nuts were ground in a blender and defatted with cold acetone. The defatted flour was extracted with 0.1M Tris-HCl, pH 8.1, and subjected to anion exchange on DEAE DE-53 (Whatman) and gel filtration (Sephacryl S300) (Teuber et al. 2002) [695].

          Wang et al. (2003) [697] report preparation of recombinant Ana o 2 as a fusion protein in Escherichia coli that was cleaved to a 52 kDa protein. This is similar to the native precursor after removal of the leader peptide but is unlikely to form native oligomers.

        • Other biochemical information:The sequence Q8GZP6 lacks the signal sequence of the protein. There are also small differences compared to the peptides sequenced by Teuber et al. (2002) [695], suggesting that this may be a multigene family.

        References (3)

        • Teuber SS, Sathe SK, Peterson WR, Roux KH.
          Characterization of the soluble allergenic proteins of cashew nut (Anacardium occidentale L.).
          J Agric Food Chem. 50(22): 6543-6549. 2002
          PUBMEDID: 12381147
        • Wang F, Robotham JM, Teuber SS, Sathe SK, Roux KH
          Ana o 2, a major cashew (Anacardium occidentale L.) nut allergen of the legumin family
          Int Arch Allergy Immunol. 132(1):27-39.. 2003
          PUBMEDID: 14555856
        • Parra FM, Cuevas M, Lezaun A, Alonso MD, Beristain AM, Losada E.
          Pistachio nut hypersensitivity: identification of pistachio nut allergens.
          Clin Exp Allergy. 23(12):996-1001.. 1993
          PUBMEDID: 10779292

        Biochemical Information for Ana o 3

        • Allergen Name:Ana o 3
        • Alternatve Allergen Names:2S albumin
        • Allergen Designation:Major
        • Protein Family:Pfam PF00234; tryp_alpha_amyl;
        • Sequence Known?:Yes
        • Allergen accession No.s:http://ca.expasy.org/cgi-bin/niceprot.pl?Q8H2B8
        • 3D Structure Accession No.:Not determined
        • Calculated Masses:16335 Da
        • Experimental Masses:

          12 kDa unreduced
          6 kDa reduced (small subunit was not observed)

        • Oligomeric Masses:Not known
        • Allergen epitopes:Not known
        • Allergen stability:
          Process, chemical, enzymatic:          2S albumins are disulfide cross-linked and are often relatively stable to proteolysis.
        • Nature of main cross-reacting proteins:Not known
        • Allergen properties & biological function:Seed storage proteins
        • Allergen purification:Not reported.
        • Other biochemical information:

        References (1)

        • Teuber SS, Sathe SK, Peterson WR, Roux KH.
          Characterization of the soluble allergenic proteins of cashew nut (Anacardium occidentale L.).
          J Agric Food Chem. 50(22): 6543-6549. 2002
          PUBMEDID: 12381147