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Original Article


Is Microarray Analysis Really Useful and Sufficient to Diagnose Nut Allergy in the Mediterranean Area?


Goikoetxea MJ*1, D’Amelio CM*1, Martínez-Aranguren R1, Gamboa P2, Garcia BE3, Gómez F4, Fernández J5, Bartra J6, Parra A7, Alvarado MI8, Alonso MI9, González E10, Terrados S11, Moya C12, Blanca-López N13, Feo-Brito F14, Villalba M15, Díaz-Perales A16, Sanz ML1

1Department of Allergy and Clinical Immunology, Clinica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
2Allergy Department, Hospital de Basurto, Bilbao, Spain
3Allergy Department, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
4Allergy Department, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
5Allergy Department, Hospital General Universitario de Alicante, Alicante, Spain
6Allergy, Respiratory, and Respiratory Allergy Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES)
7Allergy Department, Hospital de A Coruña, A Coruña, Spain
8 Allergy Department, Hospital Virgen del Puerto, Plasencia, Cáceres, Spain
9Allergy Department, Hospital de Alcorcón, Madrid, Spain
10Allergy Department, Hospital de Fuenlabrada, Madrid, Spain
11Allergy Department, Hospital Ramón y Cajal, Madrid, Spain
12Allergy Department, Complejo Hopitalario Torrecárdenas, Almeria, Spain
13Allergy Department, Hospital Infanta Leonor, Madrid, Spain
14Allergy Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
15Molecular Biology Department, Facultad de Químicas, Universidad Complutense, Madrid, Spain
16Biotechnology Department, Centro de Biotecnología y Genómica de Plantas, Pozuelo de Alarcón, Madrid, Spain
*Both authors contributed equally to this work.

J Investig Allergol Clin Immunol 2016; Vol. 26(1): 31-39
doi: 10.18176/jiaci.0005



Background: Component-based diagnosis on multiplex platforms is widely used in food allergy but its clinical performance has not been evaluated in nut allergy.

Objective: To assess the diagnostic performance of a commercial protein microarray in the determination of specific IgE (sIgE) in peanut, hazelnut, and walnut allergy.

Methods: sIgE was measured in 36 peanut-allergic, 36 hazelnut-allergic, and 44 walnut-allergic patients by ISAC 112, and subsequently, sIgE against available components was determined by ImmunoCAP in patients with negative ISAC results. ImmunoCAP was also used to measure sIgE to Ara h 9, Cor a 8, and Jug r 3 in a subgroup of lipid transfer protein (LTP)-sensitized nut-allergic patients (positive skin prick test to LTP-enriched extract). sIgE levels by ImmunoCAP were compared with ISAC ranges.

Results: Most peanut-, hazelnut-, and walnut-allergic patients were sensitized to the corresponding nut LTP (Ara h 9, 66.7%; Cor a 8, 80.5%; Jug r 3, 84% respectively). However, ISAC did not detect sIgE in 33.3% of peanut-allergic patients, 13.9% of hazelnut-allergic patients, or 13.6% of walnut-allergic patients. sIgE determination by ImmunoCAP detected sensitization to Ara h 9, Cor a 8, and Jug r 3 in, respectively, 61.5% of peanut-allergic patients, 60% of hazelnut-allergic patients, and 88.3% of walnut-allergic patients with negative ISAC results. In the subgroup of peach LTP–sensitized patients, Ara h 9 sIgE was detected in more cases by ImmunoCAP than by ISAC (94.4% vs 72.2%, P<.05). Similar rates of Cor a 8 and Jug r 3 sensitization were detected by both techniques.

Conclusions: The diagnostic performance of ISAC was adequate for hazelnut and walnut allergy but not for peanut allergy. sIgE sensitivity against Ara h 9 in ISAC needs to be improved.

Key words: Hazelnut. Lipid transfer protein. Microarray. Peanut. Walnut.