Common Symptoms

Tree nut allergy symptoms typically occur within minutes of ingestion and can range from hives to anaphylaxis, a potentially lifethreatening reaction that impairs breathing and can send the body into shock.^2,7 In fact, tree nut allergy accounts for 18 to 40 percent of anaphylaxis cases. This severity is particularly problematic because many people cannot recognize tree nuts. In one study, for example, only half of participants with a tree nut allergy correctly identified all forms of the nut to which they were allergic.¹

Tree nut allergy symptoms can include:⁷

• Abdominal pain, cramps, nausea, and vomiting
• Diarrhea
• Difficulty swallowing
• Itching of the mouth, throat, eyes, skin, or other areas
• Nasal congestion, runny nose
• Shortness of breath
• Anaphylaxis, a potentially life threatening event

Allergic reactions from tree nuts can also come from cross reactivity to birch pollen in the form of oral allergy syndrome (OAS), also known as pollen food syndrome (PFS) and/or pollen food allergy syndrome (PFAS).^2,8

Symptoms of OAS can include:⁸

• Itchy mouth and hives on the mouth
• Scratchy throat
• Swelling of the lips, mouth, tongue, and throat
• Itchy ears

How do I know if I'm allergic?*

Your symptom history, skin-prick testing and/or specific IgE blood testing can help determine if you are allergic to a particular allergen. If you are diagnosed with an allergy, your healthcare provider will work with you to create a management plan.

Please note that allergies can change over time, and 10 to 20 percent of children with peanut and tree nut allergies may outgrow them.¹²

*These products may not be approved for clinical use in your country. Please work with your healthcare provider to understand availability.

Is there a risk for a severe event?

Knowing the proteins, or components, within each allergen that are triggering your symptoms can help guide your management plan. With that in mind, and based on your symptom history, your healthcare provider may suggest something called a specific IgE component test, which can help reveal other pollens and foods you may react to.⁴

Already have your specific IgE component test results?

Your component test results will include the name of the components (a series of letters and numbers). Your healthcare provider will likely review the results with you, but here you will find an at-a-glance breakdown you can use as a reference. Simply match the component names to the list below to see what they mean in terms of symptom management.⁶

rJug r 1 (storage protein)

• Usually associated with a risk for severe reactions or anaphylaxis.
• Stable to heat and digestion; cooked, roasted, and raw walnut may cause symptoms.

rJug r 3 (LTP)

• Usually associated with an intermediate risk for severe reactions but also with milder symptoms such as oral allergy syndrome (OAS).
• May cause symptoms due to cross reactivity with pollens (e.g., parietaria, ragweed, mugwort, olive, plane tree), plant foods (e.g., peach, apple, citrus fruits, grape, tomato, asparagus, lettuce, etc.), nuts (e.g., hazelnut, peanut), and more.
• Stable to heat and digestion; cooked, roasted, and raw walnut may cause symptoms.

rBet v 1 (PR-10)

• Usually associated with mild, localized symptoms, such as OAS, but may also include severe allergic reactions.
• May cause symptoms due to cross reactivity to pollens (e.g., birch, alder, hazel, oak, hornbeam, beech), raw plant foods (e.g., strawberry, apple, peach, pear, raspberry, kiwi, celery, carrot, soy, hazelnut, chestnut, tomato), and more.
• Sensitive to heat and digestion; cooked or roasted walnut may be tolerated.

rBet v 2 (Profilin)

• Usually associated with mild, localized symptoms such as OAS.
• May cause symptoms due to cross reactivity to pollens (e.g., birch, alder, hazel, oak, hornbeam, beech), grass pollen, raw plant foods (e.g., tomato, melon, citrus fruits, banana, pineapple, persimmon, zucchini, tomato), and more.
• Sensitive to heat and digestion; cooked or roasted walnut may be tolerated.

MUXF3 (CCD)

• Positive specific IgE for walnut in combination with MUXF3 CCD (Cross-reactive Carbohydrate Determinant) being the only positive component test, indicates that the cause of symptoms may be something other than walnut.

In addition to the above, the following allergen components have been recently added to the specific IgE allergen component testing:

rJug r 2 (7S globulin, vicilin)

• Explains severe reactions even when rJug r 1, which is known to cause such reactions, is negative.
• Considered as marker for primary sensitization, that is, a positive result is associated with increased risk of more severe reactions or anaphylaxis.^{17, 18}

rJug r 6 (7S globulin, vicilin)

• Cross-reactions to other tree nuts and seeds.¹⁶
• Key component for identifying high-risk patients.^{17, 18}

rJug r 2 has been linked to confirmed anaphylaxis in monosensitized patients, supporting its classification as a clinically important allergen.^{19, 20}

In a study, 63 percent of patients who tested negative to rJug r 1 were positive to rJug r 6 and rJug r 2.¹⁹

Both rJug r 2 and rJug r 6 are highly stable to heat and digestion and thus linked with an increase in the risk of systemic allergic and fatal reactions.^{19, 22, 23}

Please note that test results should be interpreted by your healthcare provider in the context of your clinical history. Final diagnosis and decisions on further management should be made by your healthcare provider. Based on your symptoms, your healthcare provider may ask for testing of these newly introduced allergen components.

*These products may not be approved for clinical use in your country. Please work with your healthcare provider to understand availability.