Armelline Almond Allergy: The First Reported Case

The paper reports the first documented case of allergy to armelline almond (apricot kernel) in a pediatric patient. A 7‑year‑old child developed severe anaphylaxis immediately after ingestion of a dessert containing hazelnut, cocoa, milk, eggs, and amaretti cookies, characterized by vomiting, facial angioedema, generalized urticaria, laryngeal edema, and wheezing, with oxygen desaturation to 83%. The reaction resolved after administration of adrenaline, aerosolized β₂‑agonists, corticosteroids, and antihistamines. Because the patient regularly tolerated other common food allergens and tree nuts—including hazelnut, almond, pistachio, pine nut, and cashew—the diagnostic focus shifted to armelline almonds, the main ingredient in the amaretto biscuit. Extensive skin prick and prick‑by‑prick testing, as well as specific IgE assays for multiple nut and seed allergens, were negative. Subsequent reintroduction of most nuts and tree fruits did not elicit reactions, indicating tolerance. These findings suggest a primary sensitization to armelline almond proteins, rather than cross‑reactivity with other tree nuts. Notably, a novel immunoreactive protein, possibly specific to armelline oleosins, was identified and may underlie this unique allergenic response. Further studies are needed to clarify the molecular mechanisms and clinical relevance of these proteins in armelline almond allergy.