Pistachio and cashew nut allergy in childhood: Predictive factors towards development of a decision tree

Background: Pistachio and cashew nut, which belong to the same botanical family, are tree nuts that induce serious allergic reactions. Objective: We aimed to determine the predictive factors for pistachio and cashew nut reactivity during oral food challenge (OFC). Methods: A total of 112 pistachio and/or cashew nut sensitized children, aged 58.45 (IQR:40.38-88.32) months, were included. Cutoff values and probability curves for skin prick test (SPT), sIgE, sIgE/Total IgE that predict reactivity were determined for pistachio and cashew nut. Additionally, a diagram was created that can be useful while making a decision for OFC based on SPT and sIgE values. Results: A total of 73 patients underwent OFC with pistachio and/or cashew nut. Twelve children with current ana-phylaxis history were not challenged and accepted as allergic. SPT was the only predictive factor for positive pistachio/ cashew nut OFC. According to area under curve (AUC) analysis, SPT was more predictive than sIgE and sIgE/Total IgE both for pistachio and cashew nut. Optimal cutoff values according to ‘’Youden index’’ for pistachio SPT, sIgE, and sIgE/Total IgE were 7.25 mm, 4.14 kUA/L, and 1.32%, respectively. And those values for cashew nut SPT, sIgE, and sIgE/Total IgE were 6.25 mm, 1.125 kUA/L, and 3.30%, respectively. The diagram showed that SPT predicted the reac-tivity together with sIgE better than only the SPT values. Conclusion: SPT was the best predictor for reactivity both for pistachio and cashew nut. Combined use of SPT and sIgE may improve the prediction of reactivity at pistachio and cashew nut OFCs in children.