D2.275 - Pine nuts, an emerging food allergen: data from the Allergy-Vigilance Network

With the globalization of eating habits and the development of vegan/vegetarian diets, pine nuts are increasingly used in the diet. Allergy to this seed, although rare 10 years ago, seems to have become more common in recent years. We aimed to analyze food anaphylaxis cases induced by pine nuts, declared to the Allergy Vigilance Network.

From 2002 to 2024, 3285 food anaphylaxis cases (grade 2-4 according to Ring classification modified by Behrendt) from France, Belgium and Luxembourg have been reported to the Allergy Vigilance Network. Anaphylaxis cases induced by pine nuts were collected for this study. Demographic data, history, characteristics of the anaphylaxis, place of onset, cofactors and treatment were analysed.

Out of the 3285 food anaphylaxis cases, 61 (1.9%) were induced by pine nuts. The allergen was ingested in its native form or in a hidden form (sauces, salads, pastries, confectionery (nougat), meat, breaded fish, industrial or ‘home-made’ dishes). 39.3% (n=24) of the subjects had allergies/sensitisation to other nuts; 29.5% (n=18) had a history of asthma or atopic dermatitis. 75.4% (n=46) were children, aged between 1.6 and 18 years, with a sex ratio of 1. Men outnumbered women over the age of 18 (n=10, 66.7%). Co-factors were identified in 13 cases (21.3%), with effort as the most frequently reported (n=6, 46%). Severity was assessed as grade 2, 3 or 4 in 44 (80.0%), 10 (18.2%) and 1 (1.6%) cases, respectively. Anaphylaxis was inaugural of pine nut allergy in 70% of patients. Treatment was reported for 55 cases: adrenaline was administered to 19 patients (34.5%), and antihistamines and/or corticosteroids to 50 patients (90.9%).

According to data from the Allergy Vigilance Network, pine nut is the culprit allergen in almost 2% of food anaphylaxis cases and is considered to be an emerging allergy. This allergy is early-onset, potentially serious and frequently associated with other food sensitivities. These data highlight the need for better recognition of this allergen, which should be included on the list of the mandatory food allergens in Europe