Supplementary Material for: Exploring Terebinth Cross-Sensitivity in Individuals with Pistachio Sensitivity

Introduction: Terebinth (Pistacia terebinthus) belongs to the same botanical family as pistachio (Pistacia vera) and cashew (Anacardium occidentale). Although it is known that there is cross sensitivity between pistachio and cashew, the cross sensitivity of terebinth with pistachio or cashew has not been investigated. The objective of our study is to evaluate the sensitivity to terebinth in children with pistachio sensitivity. Methods: This study was conducted between September 2021 and June 2022 at Adıyaman University Faculty of Medicine Hospital. It analyzed the results of children who underwent skin prick testing (SPT) for food allergy. Of the 712 food skin prick tests reviewed, 27 children were identified with pistachio sensitivity. Prick tests with commercial extract for cashew and prick-to-prick tests for terebinth were applied to these children. Results: The median age was two, and 78% were male. Of the children with pistachio sensitivity, 96% demonstrated cross-sensitivity to terebinth and 100% to cashew. There was a strong correlation between the size of SPT responses in pistachio, cashew, and terebinth. Only four children had previously consumed terebinth, and two of these children had allergic reactions. Conclusion: Our study demonstrates a high cross-sensitivity between terebinth, pistachio and cashew. We recommend that individuals with pistachio or cashew allergy/sensitivity avoid terebinth until tests confirm it is safe to consume. Further studies are needed to demonstrate the clinical significance of this cross-sensitivity and to identify the major allergen involved.