Testing for whole allergen proteins can help you better diagnose allergies and prepare personalized management plans.

Hazelnut allergens by the numbers

Hazelnut allergen component testing

Cor

a1

Cor

a8

Cor

a14

Cor

a9

Hazelnut allergen component testing

Measurement of specific IgE by blood test that provides objective assessment of sensitization to hazelnut is only the first step in discovering the likelihood of a systemic reaction and the necessary precautions that may be prescribed.

Allergen components, in conjunction with whole-allergen test results, help you better diagnose allergies, allowing you to prepare more comprehensive management plans.

High levels of hazelnut IgE can predict the likelihood of hazelnut sensitivity, but may not be solely predictive of reactions or allergic response.1

RISK ASSESSMENT TEST INTERPRETATIONS AND NEXT STEPS

IgE antibodies for Indication Patient Suggestions

a14

a9

Cor a14 and/or Cor a9

Associated with systemic reactions in hazelnut-sensitized patients.1,2,8,9

Test for sensitization to peanuts and other tree nuts (e.g., walnuts and Brazil nuts), as cross-reactivity may occur.10,12

If both, avoid raw as well as roasted/heated hazelnuts.7

a8 Cor a8Both local oral symptoms and systemic reactions may occur. 2,6

a1Cor a1Mono-sensitization

Typically associated with local reactions although systemic reactions to raw hazelnuts may occur in some cases, especially in adults.2

Often tolerate roasted or heated hazelnuts.7

LOWER RISK of systemic reaction primarily associated with local reactions2

• Heat and digestion labile3

• Cross-reactive with pollens (e.g., birch)1,4

VARIABLE RISK associated with local and systematic reactions including anaphylaxis2,5,6

• Heat and digestion stabile7

• Indicates cross-reactivity, often from a primary peach sensitization5

HIGHER RISK of systemic reaction including anaphylaxis1,2,8,9

• Heat and digestion stabile10

• Sensitization to these can appear early in life and indicates a primary hazelnut allergy1

As in all diagnostic testing, a diagnosis must be made by the physician based on test results, individual patient history, the physician’s knowledge of the patient, and the physician’s clinical judgment.

Hazelnut allergen component test results can help determine which specific proteins your patient is sensitized to.

Take the diagnosis and management of hazelnut-sensitized patients to a whole new level.

Cor

a1Cor

a8Cor

a9Cor

a14

Test Name Test CodeFood Allergy Panel - Milk, (NTC-2802) f2; IgE Egg white,

(NTC-2801) f1; IgE Peanut, (NTC-2813) f13; IgE Walnut, (NTC-3489) f256; IgE Corn, (NTC-2808) f8; IgE Wheat, (NTC-2804) f4; IgE Soybean, (NTC-2814) f14; IgE Codfish, (NTC-2803) f3; IgE Clam, (NTC-8929) f207; IgE Shrimp, (NTC-2824) f24; Total IgE

38767

Food Allergy Profile - Egg white, (NTC-2801) f1; Milk,

(NTC-2802) f2; Codfish, (NTC-2803) f3; Wheat, (NTC-2804) f4; Corn, (NTC-2808) f8; Sesame seed, (NTC-2810) f10; Peanut, (NTC-2813) f13; Soybean, (NTC-2814) f14; Shrimp, (NTC-2824) f24; Clam, (NTC-8929) f207; Walnut, (NTC-3489) f256; Scallop, (NTC-273) f338

10715

Food Allergy Profile w/Reflexes - Contains all components of the

Food Allergy Profile (NTC-10715) with reflex to the following components, with reflex to Egg Component Panel, (NTC-91372); Ovomucoid, (NTC-3046) f233; Ovalbumin, (NTC-2719) f232; Milk Component Panel, (NTC-91403); Casein, (NTC-2853) f78; Alpha-lactalbumin, (NTC-2851) f76; Beta-lactoglobulin, (NTC-2852) f77; Peanut Component Panel, (NTC-91681) Ara h1, f422; Ara h2, f423; Ara h3, f424; Ara h8, f352; Ara h9

91682

Test Name Test CodeHazelnut w/Reflexes - Hazelnut f17 IgE with reflex to

component panel94468

Nut Mix Group 18 - IgE allergy testing for: Almond,

(NTC-2820) f20; Cashew nut, (NTC-2608) f202; Coconut, (NTC-2836) f36; Hazelnut, f17; Peanut, (NTC-2813) f13; Pecan, (NTC-2864) f201; Sesame seed, (NTC-2810) f10

7918

Nut Panel - Macadamia nut, (NTC-38475);

Pecan, (NTC-2864); Brazil nut, (NTC-2818); Walnut, (NTC-3489); Cashew nut, (NTC-2608); Pistachio, (NTC-2726); Hazelnut; Almond, (NTC-2820); Peanut, (NTC-2813)—no reflexes

94462

Nut Panel w/Reflexes - Macadamia nut, (NTC-38475);

Pecan, (NTC-2864); Brazil nut, (with reflex) (NTC-94464); Walnut (with reflexes), (NTC-94467); Cashew nut (with reflexes), (NTC-94465); Pistachio, (NTC-2726); Hazelnut (with reflexes), (NTC-94468); Almond, (NTC-2820); Peanut (with reflex), (NTC-91747)

94463

Peanut Component Panel - Ara h1, f422; Ara h2, f423; Ara h3,

f424; Ara h8, f352; Ara h991681

Hazelnut 2817

Multiple test codes are available. Refer to the Quest Diagnostics Directory of Services or the online Test Center (QuestDiagnostics.com/testcenter) for test information.

NTC = National test code

Hazelnut is among the

top 5causes of serious food allergic reactions.11

Make a substantiated decision Better differentiation helps you distinguish between primary and cross-reactive sensitization.

Make a precise assessment Allergen-component test results can help you asses your patient’s risk for systemic reactions.

Make a difference Better differentiation gives relevant information that helps you determine optimal treatments.

Optimize management

References

1. Masthoff L, et al. Sensitization to Cor a 9 and Cor a 14 is highly specific for a severe hazelnut allergy in Dutch children and adults. J Allergy Clin Immunol. 2013(In press).

2. De Knop KJ, et al. Age-related sensitization profiles for hazelnut (Corylus avellana) in a birch-endemic region. Pediatr Allergy Immunol. 2011 Feb; 22(1Pt 2): e139–49.

3. Hansen KS, et al. Roasted hazelnuts-allergenic activity evaluated by double-blind, placebo-controlled food challenge. Allergy. 2003 Feb; 58(2): 132-138.

4. Pastorello EA, et al. Identification of hazelnut major allergens in sensitive patients with positive double-blind, placebo-controlled food challenge results. J Allergy Clin Immunol. 2002; 109(3): 563-570.

5. Lauer I, et al. The non-specific lipid transfer protein, Ara h 9, is an important allergen in peanut. Clinical & Experimental Allergy. 39: 1427–1437.

6. Schocker F, et al. Recombinant lipid transfer protein Cor a 8 from hazelnut: A new tool for in vitro diagnosis of potentially severe hazelnut allergy. J Allergy Clin Immunol. 2004;113:141-7.

7. Masthoff L, et al. A systematic review of the effect of thermal processing on the allergenicity of tree nuts. Allergy. 2013; 68: 983–993.

8. Hansen KS, et al. Component-resolved in vitro diagnosis of hazelnut allergy in Europe. J Allergy Clin Immunol. 2009 Apr 1; 123(5): 1134-1141.

9. Garino C, et al. Isolation, cloning, and characterization of the 2S albumin: A new allergen from hazelnut. Mol Nutr Food Res. 2010; 54: 1257–1265.

10. Asero R, et al. Walnut-induced anaphylaxis with cross-reactivity to hazelnut and Brazil nut. J Allergy Clin Immunol. 2004 Feb; 113(2): 358-360.

11. Flinterman AE, et al. Hazelnut allergy: from pollen-associated mild allergy to severe anaphylactic reactions. Curr Opin Allergy Clin Immunol. 2008 Jun; 8(3): 261-265.

12. Verweij M, et al. Young infants with atopic dermatitis can display sensitization to Cor a 9, an 11S legumin-like seed-storage protein from hazelnut (Corylus avellana). Pediatric Allergy Immnol. 2011; 22: 196-201.

QuestDiagnostics.comQuest, Quest Diagnostics, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics. All third-party marks—® and ™—are the property of their respective owners. © 2017 Quest Diagnostics Incorporated. All rights reserved. SB5996 05/2017

For more information about hazelnut component testing, contact your local sales representative.