Celery allergy associated with birch and mugwort pollinosis

Skin prick tests (SPT) with various celery, carrot and potato preparations (raw, cooked, cooking water of each vegetable and allergen extracts) as well as specific IgE determinations by RAST to celery mix, celeriac (or root celery), stick celery and heated celery extracts were performed in 70 patients with positive prick or intracutaneous tests to birch and/or mugwort pollens and celery (extract and/or raw). 94% of the patients showed positive prick tests to raw celeriac, 36% to cooked celeriac and 8/13 to cooking water. Celery-birch positive patients (n = 13) showed negative or low RASTs to heated celery extracts and to stick celery. By contrast, in the celery-mugwort sensitive patients (n = 6) the celery RASTs with heated celery extracts remained clearly positive and high RAST values to stick celery could be found. Celery-birch-mugwort-association (n = 22) favoured more positive results with relatively high values of RAST to celeriac. The results of homologous and heterologous RAST inhibition experiments with birch, mugwort, unheated and heated celery (100 degrees C) carried out in nine celery-RAST positive sera are also discussed.     

Allergy to Apple, Carrot and Potato in Children with Birch Pollen Allergy

Skin sensitivity to apple, carrot and potato, clinically related to birch pollinosis was investigated. Different skin test techniques using fresh fruit were compared. A simple prick test (SPI) technique with a lancet piercing the apple peel just before pricking the skin was shown to be the most practical and to give reproducible results. The allergenic activity in apple was found to be heat labile and deteriorated during storage at room temperature, Apple, carrot, potato, hazelnut and birch reactivity was transferable in Prausnitz-Küstner test like IgE antibodies. SPT reactivity to fresh material from apple, carrot and potato was investigated in 174 children of whom 128 suffered from pollen allergy. Positive SPT results were obtained almost exclusively in children who were SPT positive to a birch pollen extract. Children who noticed clinical symptoms when eating apple, raw carrot or potato were found to have a significantly larger SPT reaction than children with a negative history.     

Spice allergy in celery-sensitive patients

Scratch tests (SCT) with powdered commercial spices were performed in 70 patients with positive skin tests to birch and/or mugwort pollens and celery. Positive SCT to aniseed, fennel, coriander and cumin--all from the same botanical family (Apiaceae) as celery--were observed in more than 24 patients. Spices from unrelated families (red pepper, white pepper, ginger, nutmeg, cinnamon) elicited positive immediate skin test reactions only in three of 11 patients. Specific serum IgE to spices (determined in 41 patients with positive RAST to celery) up to class 3 were seen especially in patients with celery-mugwort or celery-birch-mugwort association, and concerned various botanical families. Celery-birch association pattern was linked to positive reactions (RAST classes 1-2) to spices from the Apiaceae family only.     

IgE cross-reactivity between birch pollen, mugwort pollen and celery is due to at least three distinct cross-reacting allergens: immunoblot investigation of the birch-mugwort-celery syndrome

Background Allergy to celery is often associated with sensitization to birch and/or mugwort pollen. Objective and methods In a multi-centre study, sera from 23 patients suffering from type I allergy to celery and 15 patients with positive celery RAST but wo clinical sensitization were compared. To examine whether cross-reactivity between celery and mugwort pollen iticludes cross-sensitization to birch pollen allergens, we determined cross-reacting structures in birch pollen, mugwort pollen and celery by means of immunoblotting. Inhibition studies were performed by preincubation of sera with extracts of birch pollen, mugwort pollen, and celery. Results We identified three groups of proteins—homologues of Bet v I and birch profilin (Bet v 2) as well asa group of proteins with a molecular range of 46 to 60 kD—displaying IgE-cross-reactivity, which were shared by birch pollen and celery. Two of these groups of allergens (profilin and the 46 to 60 kD proteins) were also present in mugwort pollen. In this paper we demonstrate that most cross-reacting allergens present in mugwort pollen and celery can also be detected in birch pollen extract. Conclusion Therefore we propose, from a serological point of view, to extend the mugwort-celery syndrome to the birch-mugwort-celery syndrome.     

Food Hypersensitivity in Patients with Pollen Allergy

Six hundred patients with pollen allergy answered a questionnaire about food hypersensitivity. Hypersensitivity to various nuts, fruits and roots was reported more often by patients with birch pollen allergy(70%) than be patients without birch pollen allergy (19%). The stronger the skin test reaction to birch pollen, the higher was the incidence of food hypersensitivity. A negative correlation was found between grass pollen allergy and food hypersensitivity.
In the diagnosis of springtime hayfever, the presence of hypersensitivity to nuts, fruits and roots supports a diagnosis of birch pollen allergy.     

The clinical relevance of sensitization to pollen-related fruits and vegetables in unselected pollen-sensitized adults

BACKGROUND: Previous studies have described cross-reactivity between fresh fruits, vegetables and pollen. However, no data demonstrates the clinical relevance of sensitization to pollen-related fruits and vegetables in unselected pollen-sensitized adults with and without symptoms in the pollen season. OBJECTIVE: The aim of this study was to estimate the clinical relevance of sensitization to pollen-related fruits and vegetables in unselected pollen-sensitized adults and to examine the diagnostic value of skin-prick test (SPT), histamine release and specific IgE compared with the outcome of oral challenge. METHODS: In total, 936 unselected adults (female : male 479 : 457, median age 33.7 years) were examined for pollen sensitization and clinical cross-reactivity with pollen-related fruits and vegetables by questionnaire, SPT, histamine release, specific IgE and oral challenge. RESULTS: The prevalence of pollen sensitization was 23.8% (n = 223). The probability of a clinical reaction to pollen-related foods in the respective pollen-sensitized groups was: 24% (birch), 4% (grass), 10% (mugwort), 35% (birch + grass), 8% (grass + mugwort) and 52% (birch + grass + mugwort). The odds ratio of a clinical reaction to pollen-related fruits and vegetables in symptomatic pollen-sensitized adults was as high as four times (birch + grass) the odds ratio of a clinical reaction in asymptomatic pollen-sensitized adults. CONCLUSION: This study not only demonstrates a high prevalence of clinical reactions to fruits and vegetables in pollen-sensitized adults, but also a discrepancy between the prevalence of sensitization to fruits and vegetables and the clinical relevance in different pollen-sensitized groups with symptoms in the pollen season as a significant factor.     

Allergy to Birch Pollen and Apple, and Gross-Reactivity of the Allergens Studied with the RAST

Apple-pulp allergens arc unstable, but fresh material can be used for skin testing. In this study stable allergens, probably of a protein nature, were extracted from apple seed and used in radioallergosorbent tests (RAST). Apple-seed allergens were shown by RAST inhibition to cross-react with birch pollen allergen(s). Cross-reactivity may explain the frequent co-occurrence of birch pollen and apple allergy. Approximately 50% of patients in a group with immediate hypersensitivity to birch pollen were also sensitive to apple as judged by a history of symptoms, skin tests with apple-pulp and apple-seed preparations, and apple-seed RAST.     

Characterization of allergens in kiwi fruit and detection of cross‐reactivities with allergens of birch pollen and related fruit allergens

The sera of 29 patients who suffered from pollen‐related food hypersensitivities and complained of allergic reactions to kiwi fruit and other tropical fruits were tested for specific IgE antibodies against kiwi fruit, apple, carrot, celery and birch pollen using an enzyme allergosorbent test (EAST). In 20 sera, specific IgE antibodies were detected against all five extracts. Sodium dodecyl sulphate polyacrylamide gel electrophoresis/ immunoblot of kiwi fruit extract revealed two major allergens with molecular weights of approximately 43 and 67 kDa. In EAST inhibition assays, cross‐reactivities between kiwi fruit, apple, birch pollen and, to a lesser degree, carrot and celery were demonstrated. The cross‐reactivities seen between kiwi fruit, birch pollen and apple were not caused by the major allergen of birch pollen (Bet v 1). Allergens with molecular weights of approximately 68 kDa in birch pollen and 67 kDa in apple cross‐reacted with the allergens of kiwi fruit, as demonstrated by immunoblotinhibition. Profilins, which are known plant pan‐allergens, do not seem to be relevant allergens in kiwi fruit.     

Characterization of IgE epitopes of Cuc m 2, the major melon allergen,and their role in cross‐reactivity with pollen profilins

Background Plant profilins are described as minor allergens, although with some exceptions in foods such as melon, watermelon or orange. In fact, they could be responsible for many cross‐reactions among distantly related species. This is likely to be a consequence of the presence of common epitopes. Objective To characterize the B epitopes of Cuc m 2, a model of plant food profilin, using phage display techniques and to compare with other profilins, such as those of timothy grass and birch pollen, and human I profilin, to understand the mechanism of cross‐reaction among members of this family. Methods IgE of melon‐allergic patients was used to select clones from a phage display 12 mer peptide library. After two rounds of screening, Cuc m 2‐specific clones were eluted and the DNA insertion sequenced. The residues of each clone were mapped on the Cuc m 2 surface to define a mimotope, which was also localized on the three‐dimensional surfaces of other profilins. Results Seventeen melon‐allergic patients were selected. Sera from each of them recognized the melon profilin, Cuc m 2, but the majority also recognized Phl p 12 or Bet v 2, timothy grass‐, and birch‐pollen profilins, respectively. A Cuc m 2 mimotope was defined and mapped onto its surface giving the following sequence: S₂W₃A₅Y₆D₉H₁₀T₁₁₁P₁₁₂G₁₁₃Q₁₁₄N₁₁₆M₁₁₇R₁₂₁L₁₂₂. The homologous residues in Phl p 12 and Bet v 2 had almost identical sequences. By contrast, the homologous sequence in human profilin showed many differences. Conclusions The identified mimotope could be involved in cross‐reactions among food and pollen profilins. Many of these cross‐reactions observed in the clinical realm could be explained by the presence of a common epitope found in food and pollen allergens. A new strategy of immunotherapy based on this IgE region could be used in alternative immunotherapy strategies. Cite this as: L. Tordesillas, L. F. Pacios, A. Palacín, J. Cuesta‐Herranz, M. Madero and A. Díaz‐Perales, Clinical & Experimental Allergy, 2010 (40) 174–181.     

Immunotherapy in Hay Fever with Two Major Allergens 19, 25 and Partially Purified Extract of Timothy Grass Pollen

Grass pollen hay fever patients were hyposensitized in a prospective 3-year double blind study with two timothy extracts. Group WPA (20 patients) was treated with partially purified extract = whole pollen allergens (WPA) (Alutard®SQ) and group PPA (20 patients) was treated with a purified pollen allergen (PPA) = two isolated major allergens, Ag19 and Ag25. Both aluminiumhydroxide adsorbed extracts were biologically standardized. Clinical results from the first season have been recently published and WPA showed significantly fewer symptoms (P= 0.001) than PPA. Corresponding preseasonal and seasonal in vitro results are presented here. Serum total IgE, specific IgE versus total and individual allergens of timothy pollen and allergen-specific IgG showed a rapid increase in both groups until the season but showed no further increase or decrease during the season. Specific IgE was shown to correlate to specific IgG during hyposensitization. Group WPA, with fewer symptoms in grass pollen season than group PPA showed a significantly higher increase of specific IgG and IgE than group PPA, but individual symptom scores were not correlated to specific IgG or IgE, or their ratio. Specific IgE and IgG increases were not correlated to dosage. Surprisingly, almost all females were low-responders to specific IgG and IgE though they had equal symptom scores, dosage, and side effects as males, while the characteristics of high-responders to antibody were: youngest individuals and shortest duration of symptoms prior to treatment. Crossed radioimmunoelectrophoresis (CRIE) showed specific reaction to stimuli but no development of allergy against new timothy antigens. High response of IgE to Ag 19 in CRIE during initial hyposensitization seems suitable as marker for prospective evaluation of clinical effect in grass pollen hyposensitization. Nasal secretion was collected after methacholine provocation, and total IgE and specific IgE detected. There was no response to treatment, only a slight increase during the season. No decrease in nasal reactivity to methacholine was noted during one preseasonal hyposensitization.