Anaphylaxie au pignon de pin : à propos de vingt cas déclarés au Réseau Allergo Vigilance

Pine nut is the seed of the umbrella pine (Pinus pinea), found in Western Europe and North Africa. It is increasingly used in food, and often hidden in processed foods. Pine nut allergy is rare, but its frequency is increasing gradually. Reactions are often severe and with a high risk. We report a series of 20 cases of pine nut anaphylaxis which were reported to the Allergy Vigilance Network from 2002 to 2013; it is the largest series ever published. The cases included both children and young adults, mostly men (13/20). All the reactions were severe (anaphylaxis grade II or III), occurred immediately after eating pine nuts, and required the intervention of an emergency team. Adrenaline was used 11 times out of 20. Pine nuts were hidden in food in 14 of these cases. Ten cases were monosensitized to pine nuts and 5 cases were also sensitized to peanuts. This study confirms that pine nut allergy is rare but potentially very severe. Most often the allergen is hidden in food. Monosensitized cases are the most common. Cross-sensitivity with other tree nuts, peanuts, pine pollen or mugwort has been described, but cross-reactivity has not yet been proven. The allergens involved in pine nut allergy are still unknown.