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Meet Sophie

Sophie, an 8-year-old girl with a history of rhinitis and oral allergy syndrome, goes to see her healthcare professional following a recent emergency room admission after developing severe angioedema. Sophie recovered well after administration of antihistamines and oral steroids; she did not require epinephrine. Her mother reported that she had muesli containing hazelnut before the onset of symptoms.

She was previously tested for respiratory allergens and was diagnosed with birch pollen allergy. Her healthcare professional conducts a full clinical history and physical examination and decides to test using whole allergen hazelnut specific IgE  and hazelnut components.

Patient History

Family history

  • Atopic father

Personal history

  • Sophie has had on-going mild allergic symptoms for 6 years 
  • When she was 1, she had milk allergy which she has now outgrown 

  • Sophie has suffered from rhino-conjunctivitis during spring and early summer for the last couple of years and she has had oral symptoms from eating hazelnuts. She was previously tested and subsequently diagnosed with birch pollen allergy.

Her previous healthcare professional recommended that Sophie use oral antihistamines during birch pollen season and avoid hazelnuts if unpleasant as the symptoms indicate cross-reactivity between pollen and hazelnut.

Her test results were:

Skin prick test results
Test Type Results
Birch Whole Allergen +3
Hazelnut Whole Allergen +2

Negative skin prick test to grass, mugwort, cat, dog and mite 

ImmunoCAPTM test results (kUA/l)
Test Type Results
Birch Whole Allergen 3.4
Hazelnut Whole Allergen 0.6

Her previous healthcare professional recommended that Sophie use oral antihistamines during birch pollen season. It's also recommended that she avoid hazelnuts, as the symptoms indicate cross-reactivity between pollen and hazelnut.

New test results 

These results, together with Sophie's case history and symptoms, may help her healthcare professional confirm the diagnosis.

ImmunoCAP test results (kUA/l)
Test Type Results
Hazelnut Whole Allergen 3.9
Birch Whole Allergen 5.3
ImmunoCAP test results (kUA/l)
Test Type Results
Cor a 1 Allergen Component 2.2
Cor a 8 Allergen Component <0.1 
Cor a 9 Allergen Component 1.3
Cor a 14 Allergen Component 2.0
Bet v 1 Allergen Component 4.5

More refined diagnosis

Sophie’s severe reaction could be explained by her sensitization to the storage proteins Cor a 9 and Cor a 14, which shows that Sophie has a primary hazelnut sensitization to proteins that can cause severe and systemic reactions.1 With components, this could have been revealed before any severe reaction occurred.

Sophie’s birch allergy also gives rise to cross-reactivity with the PR-10 protein Cor a 1 in hazelnut.1,2

Refined diagnosis

  • Primary hazelnut allergy and birch allergy

Healthcare professional's management plan

  • Sophie's healthcare professional referred her to a dietitian for help in adjusting her diet
  • Sophie was advised to should strictly avoid hazelnuts and always carry her emergency epinephrine autoinjector
  • Sophie's healthcare professional arranged follow-up education and training on autoinjector use for Sophie and her family
  • Sophie was advised to continue to use antihistamines for the birch-pollen symptoms, starting treatment two weeks before the season

Follow Up

Sophie is seen by her healthcare professional one year later. She has had no further episodes and is fit and well. Her autoinjector technique is satisfactory.

The people, places and events depicted in these case studies and photographs do not represent actual patients, nor are they affiliated in any way with Thermo Fisher Scientific.

References
  1. Blankestijn MA, Knulst AC, Knol EF, et al. Sensitization to PR-10 proteins is indicative of distinctive sensitization patterns in adults with a suspected food allergy. Clinical and Translational  Allergy. 2017;7:42. doi:10.1186/s13601-017-0177-4.
  2. Masthoff LJ, 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