Anaphylaxis to pinon nuts

A 21-year-old white male developed life threatening systemic anaphylaxis within seconds of ingesting a small amount of a cookie containing pinon nuts. Skin testing, ELISA, and basophil histamine release studies demonstrated pinon nut-specific IgE. Electrophoresis of the pinon nut extract demonstrated 30 bands, three of which (in the 66 to 68,000 dalton range) bound IgE in the patient's serum in an immunoblot. Ingestion challenge was not performed due to the severity of the patient's reaction. Although used for centuries in certain cultures, pinon nuts are now being eaten more frequently in the American diet. Physicians should be aware of the potential for anaphylactic reactions following ingestion of this food.