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Les Astéracées (Lactucées, artichaut...)

dimanche 15 août 2010, par Allerdata

Les Astéracées sont une très vaste famille botanique. Ces plantes ont impact allergologique important du fait de leur pollinisation : l’ambroisie et l’armoise sont des Astéracées.

Mais de nombreux produits alimentaires sont également tirés de la famille des Astéracées, certains ayant une allergénicité qui n’est pas qu’anecdotique : c’est le cas pour les graines de tournesol et pour diverses espèces dont on consomme les feuilles et autrefois regroupées sous la dénomination de Lactucées (laitue, endive, etc..).

La classification actuelle divise la grande famille des Astéracées en sous-familles :

parmi les Carduées on notera l’artichaut (Cynara scolymus), et le cardon (Cynara dracunculus)
les Cichoriées regroupent diverses salades : la laitue (Lactuca sativa), le pissenlit (Taraxacum officinale), la scarole ou chicorée (Cichorium endivia) et l’endive (Cichorium intybus Witlof). On y trouve aussi la chicorée à café (Cichorium intybus), le salsifis (Tragopogon porrifolius) et le scorsonère (Scorzonera hispanica), ce dernier étant souvent vendu comme du salsifis.
dans le groupe de l’ambroisie (Hélianthées) se trouvent le tournesol (Helianthus annuus), le topinambour (Helianthus tuberosus) et une plante donnant un latex, la guayule (Parthenium argentatum)
dans le groupe de l’armoise (Anthémidées) sont présents l’estragon (Artemisia dracunculus), l’absinthe (Artemisia absinthium), la camomille (Matricaria chamomila), etc..
enfin la graine de Niger (Guizotia abyssinica), utilisée parfois comme nourriture de volière, fait partie des Melleriées. Elle peut susciter des réactions allergiques .

La fréquence des réactions alimentaires aux Astéracées est mal connue :

le Réseau d’Allergo-Vigilance donne 2 cas pour l’endive et 1 pour l’artichaut (mai 2010)
2 cas d’allergie au topinambour, l’un en Italie , l’autre en Belgique : les patientes présentaient des pollinoses différentes et la preuve d’un lien pollen-topinambour reste à établir
un test de provocation labiale positif pour le salsifis a été constaté chez une patiente et un prurit cutané au contact du salsifis chez une autre patiente, les deux étant allergiques à l’artichaut . Plus grave était la réaction d’un patient au salsifis et à l’artichaut du fait d’une réactivité vis à vis de l’inuline contenue dans ces aliments .

Le cas de le chicorée et de l’inuline

L’inuline (et son dérivé oligofructose) sont des polysaccharides de plus en plus utilisés en industrie alimentaire. L’inuline est extraite de la racine de chicorée, mais est présente aussi dans l’artichaut, le topinambour ou la patate douce.

L’inuline peut-elle en soi être allergisante ? Dans les observations rapportées par les auteurs Lillois , un test cutané positif était obtenu avec l’inuline, mais la mesure d’une IgE-réactivité in vitro vis à vis de l’inuline s’est révélée infructueuse. S’agit-il d’un contaminant protéique associé à l’inuline ?

La culture de la chicorée à café est répandue en Belgique et la racine de cette plante sert en partie pour en extraire l’inuline. Une très intéressante observation d’allergie professionnelle à la poudre de cette chicorée a été rapportée par Pirson :

ce patient s’est sensibilisé par voie aéroportée à des allergènes présents dans la poudre de chicorée et a développé une rhino-conjonctivite et un asthme rythmés par les séquences de travail et les périodes de fabrication dans l’année
par la suite se sont manifestés des réactions allergiques vis à vis de produits alimentaires habituellement associés à une pollinose au bouleau : les réactions survenaient tant à l’épluchage qu’à l’ingestion des aliments crus (syndrome oral). Cependant le patient n’avait jamais manifesté de symptômes polliniques au moment de la pollinisation du bouleau
ces derniers sont apparus dans un troisième temps.
la réactivité de ce patient portait sur des PR-10 : Bet v 1 inhibait effectivement une bande de 17 kDa dans le blot chicorée
On est donc en présence d’une association pollen aliments inversée. Ce qui mérite d’être souligné, car le dogme s’agissant du bouleau est plutôt que l’induction d’une réactivité pour les aliments est dépendante d’une sensibilisation préalable à Bet v 1.
il est possible que la voie respiratoire soit plus efficace que la voie digestive pour les PR-10 et que la poudre de chicorée soit sensibilisante par cette voie, à l’instar du pollen des Bétulacées.

L’artichaut

L’artichaut consiste en un bouton floral.

Quelques cas d’allergie à l’artichaut ont été publiés, principalement en Italie et en Espagne . Une anaphylaxie alimentaire est possible .

Un test cutané positif pour l’endive (sans allergie) a été rapporté dans un cas d’allergie à l’artichaut . Inversement, un TC positif pour l’artichaut a été trouvé chez un patient allergique à la laitue . Des communautés moléculaires sont suggérées par ces observations pour ces produits qui sont issus de la même famille botanique.

Si une pollinose n’est pas rare chez ces patients, une réactivité de type LTP est aussi suspectée :

dans une observation l’IgE-réactivité pour l’artichaut était inhibée par Pru p 3 . Plus surprenante était l’inhibition également par Par j 1 et Par j 2, les LTP de pariétaire : on sait, en effet, que ces allergènes de pariétaire, bien que classés comme des LTP, ne croisent habituellement pas avec d’autres LTP.
dans un autre travail, concernant 2 cas d’allergie respiratoire professionnelle à l’artichaut, la pariétaire se montrait là aussi capable d’inhiber l’IgE-réactivité vis à vis de l’artichaut
et parmi 27 patients Espagnols polliniques à la pariétaire, 3 rapportaient des réactions alimentaires avec l’artichaut, dont 2 s’inscrivant dans un syndrome LTP .

L’artichaut pourrait donc être un aliment "LTP".

Les salades « Lactucées »

Parmi les plantes herbacées consommées en tant que "salades", on trouve principalement des plantes de la famille des Astéracées, sous-famille des Cichoriées (ou « Lactucées »).

La mâche est une Valérianacée, et le cresson et la roquette sont des Brassicacées.

Quelques cas isolés d’allergies à des Lactucées ont été rapportés, une seule étude faisant état d’un nombre plus conséquent de patients .

Ces réactions alimentaires sont donc rares, plus rares que les dermites de contact à ces produits dans un contexte professionnel. Notamment avec les Lactucées du fait du latex que ces plantes contiennent.

Une vérification de l’allergie par TPO est rarement pratiquée .

Pour le moment, on n’a caractérisé qu’un allergène précisément, Lac s 1 dans la laitue, qui est une LTP . Lac s 1 se présente sous 2 isoformes ayant (seulement) 62% d’identité entre elles.

Une positivité en blot pour Lac s 1 a été trouvée chez 90% des patients allergiques à la laitue, dans une série catalane .

Lac s 1 montre une homologie significative avec d’autres LTP : 66% avec Pru p 3 (pêche) ou 72% avec la portion N-terminale de Pla a 3 (platane).

Une suspicion de rubisCO IgE-réactive dans la laitue est justifiée par la présence de réactivités en blot compatibles avec cette enzyme (40-50 kDa) , ainsi que par un anticorps anti-rubisCO .

On sait que la rubisCO est présente dans les feuilles de tous les végétaux, et plus généralement dans les parties vertes des plantes.

Une profiline serait logique aussi mais n’a pas été caractérisée pour le moment dans le cas de la laitue. Pour l’endive, des cas rapportés en Belgique et en France montrent une négativité pour les profilines (Bet v 2 négatif) .

Un travail italien concernant l’endive faisait supposer une LTP dans ce produit, mais les preuves manquent .

Une pollinose en particulier est-elle associée à des réactions alimentaires avec les salades ?

Il ne semble pas, la série catalane de San Miguel-Moncin posant, comme pour d’autres aliments de "type LTP", la question du primum movens : pêche ou pollen ?

Ici, même si la positivité systématique pour le platane et très fréquente pour l’armoise (8 cas/14) semble plaider en faveur d’une allergie à la laitue induite par une sensibilisation préalable à des LTP polliniques (Pla a 3, Art v 3), le statut atopique des patients (7 anaphylaxies à la laitue) et leur allergie à la pêche (8 cas) justifie l’autre hypothèse, à savoir atopie + pêche -> allergie croisée LTP (ex. laitue) et large pollinose (ex. platane).

Ce pourrait être le même mécanisme dans d’autres observations d’allergie à la laitue , lesquelles sont parfois sévères .

Des pollens divers s’avèrent coïncider avec une allergie aux salades :

bouleau avec mâche et/ou endive
pariétaire ou graminées avec roquette
ambroisie avec laitue
platane et armoise avec laitue
mono-pollinose armoise avec laitue .

En fait, cette diversité reflète la variété des environnements polliniques et n’est pas en faveur d’un lien moléculaire uniquement LTP .

Bien que l’armoise soit souvent présente, les végétaux consommés en salade n’apparaissent pas non plus accompagner un syndrome bouleau-armoise-céleri.

Des réactions croisées entre salades, au moins entre Lactucées, seraient plausibles. Elles n’ont pas été clairement étudiées. Par contre, des TC positifs et/ou des allergies ont été rapportées pour :

laitue et endive
laitue et scarole
laitue et mâche
endive et mâche .

Enfin, il est intéressant de noter :

un cas où la cuisson n’abolissait pas l’allergénicité de l’endive : ce patient était positif pour l’armoise et négatif pour le bouleau.
des cas où l’allergie à la laitue était restreinte aux seules feuilles internes de la laitue (cœur de laitue) .

[1] - Rodríguez B, Rodríguez A, de Barrio M, Tornero P, Baeza ML. Asthma Induced by Canary Food Mix. Allergy Asthma Proc 2003;24:265-268

A 42-year-old woman reported immediate rhinoconjunctivitis, asthma, and contact urticaria while handling bird food. Skin-prick tests were positive to Lolium, Cynodon, Phragmites, Cupressus sempervirens, Cupressus arizonica, Chenopodium, sunflower pollen and seed, mugwort, chamomile, Chrysanthemum, Taraxacum, canary seed, and black seed (Guizotia abyssinica). The patient's serum-specific immunoglobulin (IgE) to Taraxacum, black seed, and canary seed was positive. Enzyme-linked immunosorbent assay inhibition studies revealed a 97 and 27% IgE-binding inhibition of whole canary food IgE by black seed and Taraxacum pollen, respectively. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting showed two IgE-binding protein bands of 11 and 44 kDa in the G. abyssinica extract. These two bands were totally inhibited by sunflower seed, mugwort, and Taraxacum extracts. Specific bronchial challenge with black seed extract was positive. The patient was able to feed her canary with birdseeds after she removed black seeds. We report a case of asthma caused by black seed (G. abyssinica) used as canary food in a patient previously allergic to pollen (olea europaea, grass, and mugwort) and sunflower seeds.

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[2] - Heffler E, Nebiolo F, Pizzimenti S, Bergia R, Guida G, Badiu I, et al. Labial angioedema after eating Jerusalem artichoke (Helianthus tuberosus) tuber. Allergy 2008;63(suppl. 88):294-295

Background: Jerusalem artichoke (Helianthus tuberosus) is a species of sunflower (member of the compositae family) native to North America and it is grown primarly for tubers which can be eaten. In Italy it is rarely used apart from few regional recipes from Piedmont. Case report: A 28 y.o. female with a known allergic rhinitis due to grass, mugwort and ragweed pollens, and known sensitisation to wheat, soybean and buckwheat flours, developed few episodes of labial angioedema after ingestion of some foods: walnut, pistachio and Jerusalem artichoke tuber. Methods: Skin Prick Tests (SPT) for common inhalant and food allergens (including walnut and pistachio) and for recombinant Lipid Transfer Protein (LPT) (Lofarma, Italy), prick-by-prick with raw Jerusalem artichoke tuber, serum specific IgE for common food allergens, and Double- Blind Placebo-Controlled Food-Challenge (DBPCFC) with Jerusalem artichoke were performed. Five atopic and five non atopic subjects underwent to prick-by-prick with raw Jerusalem artichoke tuber in order to exclude possible irritative skin reactions. Results: SPT and serum IgE dosage resulted positive for wheat, soybean, buckwheat, walnut, grass, mugwort and ragweed, confirming the suspect and known sensitisations. LTP skin prick test was negative. Prick-by-prick with Jerusalem artichoke tuber was positive only in our patient (and not in control subjects) with a wheal diameter of about 7mm (histamine: 5 mm, negative control 0 mm). DBPCFC elicited labial angioedema only with the solution containing Jerusalem artichoke and not with placebo. Conclusions: This is, in our knowledge, the first report of allergy due to sensitisation to Jerusalem artichoke tuber. Labial angioedema was elicited also after ingestion of walnut and pistachio, which are known to contain a 2S-albumin as possible allergen. Buckwheat and soybean (to which our patient is sensitised), other species of Helianthus, and other tubers such as turnip share a 2S-albumin as possible allergen, reinforcing the hypothesis that this could be a possible allergen involved in the reaction to Jerusalem artichoke tuber. Helianthus tuberosus is a member of compositae family and our patient is also affected by allergic rhinitis due to sensitisation to ragweed and mugwort, leaving open the hypothesis of a

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[3] - Ledent C, Leduc V, Doyen V, Mairesse M. Allergie croisée bouleau–topinambour ?. Rev Fr Allergol 2009;49:301-302

Introduction.ˆ Le topinambour ˆ Helianthus tuberosus, artichaut de Jérusalem ˆ est une plante vivace de la famille des Astéracées (composées), voisine du tournesol (Helianthus annuus). Observation.ˆ O.N., née le 15 avril 1970, d‚origine turque, en Belgique depuis 1985, note l‚apparition d‚une réaction cutanée en avril 2006 et, en 2007, d‚un syndrome oral lors de la consommation de pommes, cerises, pêches, abricots, poires, noisettes et surtout de topinambours (oedème laryngé). Exploration no 1 (avril 2007). ˆ EFR : normale ; ˆ prick-test (pneumallergènes) : dpt 4 mm ˆ bouleau 5 mm ˆ dactyle et armoise négatif ˆ codéine 4 mm ; ˆ IgEs (kU/L) : dpt : 0,49 ˆ r Bet v1 : 33,2 ˆ dactyle : 0,29. Exploration no 2 : ˆ P.T. topinambour : chair crue : 9 mm ; cuite : 5 mm ; peau crue : 6 mm ; cuite : 2 mm , inuline : négatif ; ˆ IgEs : r Bet v2 < 0,10 ˆ CCD < 0,10 ˆ r Prup 3 < 0,10 ˆ pollen et graine de tournesol < 0,10. Discussion.ˆ Le topinambour est une plante vivace caractérisée par des rhizomes tubérisés ou tubercules, riches en inuline, polymère du fructose. Observé pour la première fois par Champlain au Canada où il était cultivé par les tribus amérindiennes, il a été introduit en Europe au XVII e siècle et est principalement connu par nos populations comme légume de rationnement durant la seconde guerre mondiale. Les investigations réalisées permettent de poser le diagnostic de coryza périodique par allergie au pollen de bouleau avec le classique syndrome oral aux rosacées. En ce qui concerne l‚allergie au topinambour, le rôle éventuel d‚une profiline, d‚un LTP ou des CCD a pu être écarté, mais un allergène Bet v1-like est-il concevable (en cours) ?

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[4] - Gutierrez-Gomez V, Fournier C. Réactions anaphylactiques induites par l'inuline. Rev Fr Allergol Immunol Clin 2005;45:493-495

L'inuline est un hydrate de carbone de plus en plus utilisé dans l'industrie alimentaire en raison de ses propriétés diététiques. Nous décrivons deux cas d'allergie induite par l'inuline présente dans des végétaux et des aliments de régime. Deux patientes âgées respectivement de 52 et 59 ans ont présenté des manifestations allergiques sévères La première présentait un choc anaphylactique après consommation d'artichaut et oedème de Quincke après consommation de gâteaux et soupes contenant de l'inuline. La deuxième patiente présentait un prurit après consommation d'artichaut et une urticaire géante après consommation de sachets hyperprotéinés de régime contenant de l'inuline. L'évolution était favorable dans les deux cas après régime d'éviction

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[5] - Gay-Grosier F, Schreiber G, Hauser C. Anaphylaxis from inulin in vegetables and processed food. N Engl J Med 2000;342:1372

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[6] - Gutierrez-Gomez V, Fournier C. Réactions anaphylactiques induites par l'inuline. Rev Fr Allergol Immunol Clin 2005;45:493-495

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[7] - Pirson F, Detry B, Pilette C. Occupational rhinoconjunctivitis and asthma caused by chicory and oral allergy syndrome associated with bet v 1-related protein. J Investig Allergol Clin Immunol 2009;19:306-310

We report the case of a patient working in a factory producing inulin from chicory who developed rhinoconjunctivitis and asthma to the dust of dry chicory roots and oral allergy syndrome to raw fruits and vegetables. Nonspecific bronchial hyperresponsiveness was diagnosed. A provocation test with dry chicory induced acute rhinoconjunctivitis and an immediate asthmatic response with no further clinical symptoms. Skin prick test results were positive to birch pollen and fresh/dry chicory, and negative for inulin. Specific immunoglobulin (Ig) E was > 100 kU(A)/L for rBet v 1. Specific IgE were detected by immunoblotting chicory extract with the patient's serum, but not with a control serum. The main immunoreactive band corresponded to a protein with a molecular weight of approximately 17 kDa, like Bet v 1, and this immunoreactivity was effectively inhibited by preincubating serum with purified Bet v 1. This case documents occupational rhinoconjunctivitis and asthma due to IgE sensitization to inhaled chicory allergens, including one identified for the first time as a 17-kD Bet v 1 homologous protein, with secondary oral allergy syndrome to related foods.

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[8] - Romano C, Ferrara A, Falagiani P. A case of allergy to globe artichoke and other clinical cases of rare food allergy. J Investig Allergol Clin Immunol 2000;10:102-104

We describe herein four unusual clinical cases of rare allergy to foods in patients affected by allergic rhinitis and asthma. The patients were skin tested both with commercial food extracts and using prick-prick procedure with fresh foods. Total and specific IgE in serum were determined by REAST. Grapes, lupine seeds, black mulberry and artichoke resulted positive in the patients under study. This is the first time allergy to ingested artichoke has been described

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[9] - Macchia L, Passaro SB, di Gioia R, Kourtis G, Caiaffa MF, Tursi A. Allergy to artichoke: a case report. Rev Fr Allergol Immunol Clin 2004;44:646-648

Epidemiology of food allergy is currently the focus of considerable research interest. Recognition of novel or regionally-important food allergens appears to be a priority. Here we report on a case of anaphylaxis occurred upon unintentional ingestion of artichoke (Cynara scolymus ), an edible plant of the Compositae family. The presence of specific IgE was investigated by skin prick tests and RAST. In accordance with a convincing clinical history of artichoke-related anaphylaxis, skin prick tests revealed sensitization to artichoke, chicory and endive (also alimentary plants of the Compositae family), along with multiple food allergen sensitizations. Sensitization to all tested Compositae pollen allergens was also demonstrated. Allergy to artichoke has been considered rare. This report suggests that this typical Mediterranean vegetable may be an unrecognized cause of food allergy, particularly in individuals with multiple food and pollen sensitizations.

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[10] - Caiaffa M, Giliberti L, Lotti A, Rossi M, De Serio A, Bellotti A et al. Allergy to pomegranate and artichoke, novel food allergens of the Mediterranean diet. Allergy 2009;64(Suppl. 90):243

Epidemiology of food allergy is currently the focus of considerable research interest. Particularly important appears the recognition of novel food allergens and the characterization of specific food allergy patterns, relevant to homogeneous geographic areas with distinct alimentary habits, such as the Mediterranean area. Here we report on recent findings on allergy to Mediterranean fruits and vegetables. The Punica granatum (pomegranate) project. A handful of cases of hypersensitivity to this, otherwise valuable, Mediterranean fruit have been described. Three patients with multiple sensitizations to food allergens and an unequivocal history of hypersensitivity upon ingestion of pomegranate were identified. P. granatum specific IgE in vivo were detected by the prick by prick method with fresh pomegranate seeds. We then used a 100,000 x g supernatant of P. granatum homogenate, with a protein content of 0.8 mg/ml, for standard skin prick testing, eliciting skin responses twice as stronger, compared to the fresh fruit. Moreover, by combining ammonium sulphate precipitation, ultrafiltration and gel filtration, we biotinilated proteins with Mr > 10,000 and developed a RAST capture ELISA, which revealed the presence of IgE specific for P. granatum in the sera of the 3 patients (1.4 to 5.4 KU/ml). The assay proved negative in 4 out of 5 controls examined (one false positive). The Cynara scolymus (artichoke) project. A very limited number of cases of food allergy due to artichoke have been reported in the literature. Four patients with a convincing clinical history of adverse reaction following ingestion of artichoke were identified. The diagnosis was confirmed by prick by pricking with the fresh vegetable and standard skin prick tests with a 100,000 x g supernatant of artichoke homogenate. Moreover, by skin prick test and RAST all the patients tested positive to several Compositae pollen allergens. (Interestingly, C. scolymus also belongs to this family). By using the techniques mentioned above we were able to show the presence of IgE specific for C. scolymus in the sera of the patients studied. Finally, by RAST inhibition experiments, we demonstrated IgE cross-reactivity between the weed Artemisia vulgaris pollen and C. Scolymus. Based on these results, we speculate that a food/pollen Compositae allergy may develop in people living in areas with a diet rich in edible Compositae, as the Mediterranean diet.

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[11] - Macchia L, Passaro SB, di Gioia R, Kourtis G, Caiaffa MF, Tursi A. Allergy to artichoke: a case report. Rev Fr Allergol Immunol Clin 2004;44:646-648

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[12] - Ibero M, Castillo M, Viñas M, Bartolomé B. Sensitization to Non-Specific Lipid Transfer Protein from Parietaria Judaica Pollen and Cross Sensitization to Foods. AAAAI 62nd Annual Meeting, Miami, 3-7 March 2006, Poster n°187

CASE REPORT: A 16-year-old boy, diagnosed of rhinoconjunctivitis and sensitizated to: dust, molds, cat epithelium, dog epithelium and pollens (Olea europea, Cupressus arizonica, Lolium perenne, Cynodon dactylon, Parietaria judaica and Plantago lanceolata), that suffered from anaphylaxis after eating chicken with potatoes and artichoke. Several months later the patient suffered from swelling of the lips with almonds Later he has tolerated chicken and potatoes METHODS AND RESULTS: Skin prick tests were positive to extracts from: artichoke (crude and cooked) and nuts. Specific IgE (EAST) were: Flower of Artichoke (flower+head-food): 8.6 kU/l; Stem of Artichoke: 3.6 kU/l; Artichoke (head-food): 2.9 kU/l; peanut: 26.6 kU/l and almonds: 2.23 kU/l.. SDS-PAGE Immunoblotting with artichoke extract showed IgE-binding bands at 14 kDa, 15,5 kDa and 17 kDa. Cross reactivity was studied between the artichoke extract and the extract from these pollens to which the patient was sensitizated. EAST inhibition using artichoke extract as solid phase showed an inhibition of 60% with P. judaica pollen extract. Immunoblotting with artichoke extract showed a complete inhibition of the IgE-binding when patient serum was preincubated with P. judaica pollen extract. Inhibition studies showed the artichoke IgEbinding proteins cross-react with the lipid transfer protein (LTP) from peach CONCLUSIONS: In our knowledge it is the first case of oral allergy to artichoke. The clinical evolution of the patient and the in vitro test suggest an initial sensitization by respiratory tract to pollen from P. judaica, and a later cross sensitization by digestive tract to artichoke.

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[13] - Gay-Grosier F, Schreiber G, Hauser C. Anaphylaxis from inulin in vegetables and processed food. N Engl J Med 2000;342:1372

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[14] - Macchia L, Passaro SB, di Gioia R, Kourtis G, Caiaffa MF, Tursi A. Allergy to artichoke: a case report. Rev Fr Allergol Immunol Clin 2004;44:646-648

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[15] - Franck P, Kanny G, Dousset B, Nabet P, Moneret-Vautrin DA. Lettuce allergy. Allergy 2000;55:201-202

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[16] - Ibero M, Castillo M, Viñas M, Bartolomé B. Sensitization to Non-Specific Lipid Transfer Protein from Parietaria Judaica Pollen and Cross Sensitization to Foods. AAAAI 62nd Annual Meeting, Miami, 3-7 March 2006, Poster n°187

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[17] - Miralles JC, Garcia-Sellés J, Bartolomé B, Negro JM. Occupational rhinitis and bronchial asthma due to artichoke (Cynara scolymus). Ann Allergy Asthma Immunol 2003;91:92-95

BACKGROUND: The artichoke is a perennial horticultural plant that belongs to the Compositae family. OBJECTIVE: To present case studies of 2 vegetable warehouse workers who developed occupational rhinitis and bronchial asthma by sensitization to artichoke. METHODS: Skin prick tests with common inhalants and foods were performed. Specific IgE to artichoke, Parietaria judaica pollen, and Olea europaea pollen extracts was measured by a specific IgE enzyme immunosorbent assay kit. Molecular mass of the allergens was studied by the sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) immunoblotting technique. Patients underwent a nasal challenge test, and one patient provided peak expiratory flow rate (PEFR) measurements in her workplace. RESULTS: In both patients, results of skin prick tests to artichoke were positive. Levels of specific IgE for artichoke were 0.68 kU/L in patient 1 and 2.14 kU/L in patient 2. The protein composition of the artichoke extract, studied by SDS-PAGE, showed that most bands ranged from 30 to 14 kDa. The IgE-binding bands with the serum samples of patient 1 showed apparent molecular masses of 56, 48, 38, 31, 27, 25, 16, and 15 kDa; however, the serum samples of patient 2 showed IgE bands of 21 and 19 kDa. Western blotting of artichoke extract showed a complete inhibition of IgE-binding bands when serum samples were preincubated with P. judaica pollen extract. Nasal challenge with artichoke extract triggered a peak nasal inspiratory flow decrease of 81% and 85% in patient 1 and patient 2, respectively. Finally, patient 1 recorded a PEFR decrease of up to 36% after exposure to artichoke in her workplace. CONCLUSIONS: SDS-PAGE immunoblotting inhibition performed for the artichoke extract showed a total disappearance of the specific IgE binding bands when serum samples were previously incubated with P. judaica pollen extract, thus establishing the existence of a serologic cross-reactivity between artichoke and P. judaica pollen.

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[18] - Castillo M, Ibero M, Vinas M, Bartolome B. Cross Sensitization between Parietaria judaica Pollen and Vegetal Foods. J Allergy Clin Immunol 2008;121:S184

RATIONALE: Some researchers demonstrated that sensitization to various pollens predispose to suffer from food allergy. We decided to investigate the relation between the sensitization to Parietaria judaica pollen and the subsequent develop of food allergy. METHODS: We recruited 27 patients allergic only or in major degree to Parietaria judaica pollen who underwent a protocol consisting on: cutaneous tests to extracts from Parietaria judaica pollen, artichoke, hazelnut, peanut, pistachio, peach peel and peach pulp; clinical history on adverse reactions with peach, nuts or artichoke and specific IgE to Parietaria judaica pollen, artichoke (flower, stem and leaves), hazelnut, peanut, peach (peel and lipid transfer protein (LTP)) and almond (roasted and raw). Finally we performed SDS-PAGE immunoblotting with Parietaria judaica pollen extract. RESULTS: All patients had serum specific IgE to Parietaria judaica pollen (class 2 to 4) without significant differences in the IgE levels to Par j 1 and Par j 2. Nine from 27 (33.3%) of them had clinical and/or positive tests and/or clinical allergic history to peach, nuts or artichoke. All patient sera revealed the same IgE-binding bands at 16, 29, 40 and 55 kDa; all of these bands turned to be different molecular forms of the major allergens (Par j 1 and Par j 2). CONCLUSIONS: As the main allergens from Parietaria judaica pollen are non-specific LTP, the fact that only some of the P. judaica pollen allergic patients develop food allergy, could be explained in terms of Par j 1, Par j 2 specific IgE concentration, differences on epitope recognition or both mechanisms.

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[19] - San Miguel-Moncin M, Krail M, Scheurer S, Enrique E, Alonso R, Conti A, et al. Lettuce anaphylaxis: identification of a lipid transfer protein as the major allergen. Allergy 2003;58:511-517

BACKGROUND: Allergy to plant-derived foods is associated with birch pollinosis in central and northern Europe. Symptoms elicited are usually limited to the oropharyngeal system. By contrast, in the Mediterranean area, allergy to the same foods manifests more frequently with systemic reactions caused by nonspecific lipid transfer proteins (nsLTP), independently of an associated pollinosis . OBJECTIVE: We sought to investigate the pattern of immunoglobulin E (IgE) binding protein bands implicated in lettuce allergy, in particular the presence of an nsLTP . METHODS: Consecutive lettuce allergic patients were selected. Determination of serum-specific IgE, immunoblot, and inhibition experiments were performed in order to study the pattern of IgE binding proteins and the potential cross-reactivity to pollens. Inhibition studies with recombinant allergens were conducted to identify the lettuce allergens. The major allergen was subjected to N-terminal amino acid sequencing . RESULTS: Fourteen patients were diagnosed as being allergic to lettuce. All were sensitized to Platanus pollen. Ten of them showed specific IgE to a lettuce protein of 9-kDa. The IgE binding to this protein was completely inhibited by the cherry-LTP and peach extract. The N-terminal sequence of the 9-kDa protein showed a high degree of amino acid sequence identity to other nsLTPs. A clear partial cross-reactivity was observed between lettuce-LTP and Platanus-pollen extract . CONCLUSIONS: An LTP has been demonstrated to be a major allergen in patients suffering from lettuce allergy.

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[20] - Pajno GB, Passalacqua G, La Grutta S, Vita D, Feliciotto R, Parmiani S, et al. True multifood allergy in a 4-year-old child: a case study. Allergol Immunopathol (Madr) 2002;30:338-341

BACKGROUND: Food allergy is quite common in children, but it usually trends to improve with ageing. When an individual has specific IgE to a large variety of foods (multifood allergy) the clinical picture may be of remarkable severity and the avoidance of the offending foods may lead to severe dietary impairment.We describe a case of a child with ascertained multifood allergy. METHODS: The prick-by-prick testing with fresh foods and serum IgE tests were used to evaluate the patient's sensitivity to food allergens. The clinical effect of sensitizations were evaluated by DBPCFC which was carried out for egg, fish, peanuts, walnut, fig, asparagus, orange, chicory, medlar, peach, strawberry and cherry. Each challenge was performed on a separate day. Medical assistance and resuscitation facilities were available during the whole challenge procedures. RESULTS: SPT with fresh food gave a 4 mm wheal for fig, asparagus, cherry and walnut; a 5 mm wheal for medlar and orange; a 6 mm wheal for chicory and strawberry; a 7 mm wheal for fish and peanuts; an 8 mm wheal for peach and a 9 mm wheal for egg. The RAST assay confirmed the presence of specific IgE to egg, fish, peanuts, walnut, fig, orange, strawberry, peach, and cherry. The total serum IgE was 730,6 kU/l.The DBPCFC was positive, at various degrees, for all foods tested according to skin sensitizations. CONCLUSIONS: The case herein described is a true multifood allergy, as confirmed by the DBPCFC. Multifood allergy is not common, but when present it can lead to severe dietary limitation.

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[21] - Hartz C, Del Mar San Miguel-Moncin M, Cistero-Bahima A, Fotisch K, Metzner KJ, Fortunato D, et al. Molecular characterisation of Lac s 1, the major allergen from lettuce (Lactuca sativa). Mol Immunol 2007;44:2820-2830

BACKGROUND: IgE sensitisation to non-specific lipid transfer proteins (nsLTP), e.g., Pru p 3 the major allergen from peach and most important allergenic LTP, is strongly associated with severe symptoms in food allergic patients. Lac s 1, a member of the nsLTP protein family, was recently identified as major allergen in lettuce (Lactuca sativa), but has not yet been investigated on the molecular basis. OBJECTIVE: Molecular characterisation and immunological comparison of Lac s 1 to peach allergen Pru p 3. METHODS: Lac s 1 cDNA was cloned by RT-PCR and natural (n) Lac s 1 was purified by a two-step chromatography. Protein structure was verified by N-terminal sequencing, mass spectrometry, and circular dichroism spectroscopy. Immunoblotting, ImmunoCAPtrade mark, and competitive IgE binding experiments were performed to study the IgE sensitisation pattern and cross-reactivity with Pru p 3. Allergenic potency was analysed by histamine release assay. RESULTS: Twenty-nine lettuce allergic patients, with or without concomitant peach allergy, and 19 peach allergic patients without lettuce allergy were included in this study. IgE reactivity to lettuce was due to mono-sensitisation to Lac s 1 or cross-reactive glycan structures. Two Lac s 1 isoforms were identified which showed amino acid identitiy (aa-id) of 62% to each other, up to 66% to Pru p 3, and 72% to the N-terminal peptide of plane pollen LTP Pla a 3. The prevalence of IgE binding to nLac s 1 was 90% using lettuce extract in immunoblotting experiments. Enhanced sensitivity was observed in ImmunoCAPtrade mark using purified nLac s 1 in comparison to extracts (93% versus 76%). Although IgE sensitisation to Lac s 1 and Pru p 3 was strongly associated, the two LTPs showed different IgE binding properties. Sensitisation to LTPs does not necessarily reflect the clinical disease, but Lac s 1 was capable of triggering histamine release as shown by positive skin test results in Lac s 1 mono-sensitised patients and by in vitro mediator release assays. CONCLUSION: Purified nLac s 1 will enhance the sensitivity in component resolved diagnosis of lettuce allergy. Similar to other cross-reactive food allergies, exclusive testing of IgE reactivities to LTP cannot be used as biomarker for clinical relevance. Our data provide indirect evidence that Pru p 3 might act as the primary sensitising agent in patients allergic to both lettuce and peach.

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[22] - Hartz C, Del Mar San Miguel-Moncin M, Cistero-Bahima A, Fotisch K, Metzner KJ, Fortunato D, et al. Molecular characterisation of Lac s 1, the major allergen from lettuce (Lactuca sativa). Mol Immunol 2007;44:2820-2830

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[23] - Vila L, Sanchez G, Sanz ML, Dieguez I, Martinez A, Palacios R, et al. Study of a case of hypersensitivity to lettuce (Lactuca sativa). Clin Exp Allergy 1998;28:1031-1035

BACKGROUND: Allergic reactions to lettuce (Lactuca sativa) are not too frequent and few cases of systemic adverse reactions after its ingestion have been described. OBJECTIVE: We report a case of clinical sensitization to lettuce on a patient who presented mucocutaneous manifestations after its ingestion, with positive skin tests, histamine release test and serum specific-IgE to lettuce. The allergens responsible for this sensitization were also characterized by means of SDS-PAGE immunoblotting. MATERIALS AND METHODS: We performed skin tests, histamine release test, serum specific IgE determination and CAP inhibition with lettuce and mugwort (Artemisia vulgaris) extracts. An aqueous and enriched lettuce (from loose leaf type) extract was subjected to SDS-PAGE immunoblotting for determination of its IgE-binding components. RESULTS AND CONCLUSIONS: CAP inhibition showed antigenic community between lettuce and mugwort. Four protein bands from the lettuce extracts with molecular weights of 50, 43, 39 and 16 kDa exhibited IgE-binding properties.

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[24] - Escudero AI, Bartolome B, Sanchez-Guerrero IM, Palacios R. Lettuce and chicory sensitization. Allergy 1999;54:183-184

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[25] - de Lacoste-Delaval A, Guérin L, Leduc V. Allergie alimentaire à la salade. Rev Fr Allergol Immunol Clin 2006;46:374

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[26] - Cadot P, Kochuyt AM, Deman R, Stevens EA. Inhalative occupational and ingestive immediate-type allergy caused by chicory (Cichorium intybus). Clin Exp Allergy 1996;26:940-944

We report a first case of occupational allergy to chicory (Cichorium intybus) in a vegetable wholesaler. Symptoms occurred after oral, cutaneous or inhalatory exposure. The patient also reported reactions after ingestion of botanically related endive (Cichorium endivia) and lettuce (Lactuca sativa). We identified the responsible allergen by SDS-PAGE and immunoblot to be a 48-kDa protein, confined to the non-illuminated parts of the plants. No cross-reactivity was found with mugwort (Artemisia vulgaris), ryegrass (Lolium perenne), and birch (Betula verrucosa) pollen, which suggests that the vegetable is the primary allergenic material.

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[27] - Cadot P, Kochuyt AM, van Ree R, Ceuppens JL. Oral Allergy Syndrome to Chicory Associated with Birch Pollen Allergy. Int Arch Allergy Immunol 2003;131:19-24

CKGROUND: A few cases of IgE-mediated chicory allergy with oral, cutaneous, and/or respiratory symptoms are reported. We present 4 patients with inhalant birch pollen allergy and oral allergy syndrome to chicory. IgE-binding proteins in chicory and cross-reactivity with birch pollen were studied . METHODS: Chicory extract was prepared and immunoblotting was used to study IgE reactivity and cross-reactions with birch pollen . RESULTS: The pattern of IgE binding to chicory was variable among the patients, with protein bands recognized at 18, 21, 40, 52 and 71 kD. Bet v 1-like proteins were detected in chicory by monoclonal antibody binding. Chicory-birch pollen cross-reactivity, as studied in 2 patients from whom enough serum was available, could be demonstrated but did not involve the Bet v 1 protein family. In one of these cases, a 51-kD protein of birch pollen was found to be responsible for cross-reactivity . CONCLUSIONS: Chicory should be added to the list of foods that can cross-react with birch pollen and cause the birch pollen-associated oral allergy syndrome

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[28] - Geny S, Bessot JC, de Blay F, Pauli G. Survenue d'une allergie aux astéracées et aux champignons chez une malade allergique aux pollens de bétulacées. Communication: 10èmes Journées Parisiennes d'Allergie - Paris 9-11 janvier 2002

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[29] - Gangemi S, Minciullo PL, Giannetto L, Patafi M, Bonanno D, Bertuccio O, et al. Radicchio (Cicorium intybus) type-1 allergy. EAACI 23th Congress, Amsterdam, 12-16 June, 2004, Poster n°999

Background. Radicchio (Cichorium intybus) is a red, broadleaf, mildly bitter tasting, heading vegetable, also called Italian Chicory, belonging to the Compositae family. This vegetable is very popular in Italy, is appreciated in several European countries and has gained in popularity in the United States in the last few years. It is known that chicory can cause IgE-mediated hypersensitivity. Case report. We report on a first case of allergy to radicchio. A 26-years-old woman, came to our outpatients for urticaria and facial angioedema arisen after eating a salad with lettuce and radicchio. She ate lettuce after the manifestations without any adverse reaction. Skin prick test was negative for standard panel of inhalant allergens including Betula verrucosa and Compositae pollen. Skin prick test for food allergens showed positivity for sunflower (+++), apple (+++), peach (++++), hazelnut (+++) and walnut (+++). A prick by prick with fresh radicchio showed an intense reaction (++++); on the contrary prick by prick with fresh lettuce and chicory was negative. The patient referred oral hitch and swell of the lips after eating peach and in site of contact with this fruit; after eating hazelnut and walnut she presented oral hitch; but she did not presented any manifestation after eating apple, or sunflower oil. Discussion. It is known that lipid transfer proteins (LTPs) are major allergens of apple and peach in the Rosaceae fruit-allergic population in the Mediterranean area, not related to birch pollen allergy. A 9-kd hazelnut allergen is totally inhibited by purified peach LTP, witch, when purified, corresponded to a LTP. Recent studies demonstrated cross-reactivity between LTP from many botanically unrelated fruits and vegetables, such as hazelnut, walnut and peanut and other vegetable family, and concluded that LTP are pan-allergens. In fact, in ELISA inhibition studies, absorption of sera with peach LTP caused complete inhibition of IgE reactivity to walnut. Do not exist data about the presence of LTPs in Compositae vegetables, but many of patients with Rosaceae fruit allergy show cosensitization to Compositae pollen. In fact, purified LTPs from Artemisia pollen showed 43-50% sequence identity with the equivalent allergens of apple and peach. At the light of these data we can hypothesize the involvement of LTPs in radicchio sensitisation of our patient. However, further studies are needed to evaluate the presence of LTPs in Compositae vegetable also.

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[30] - San Miguel-Moncin M, Krail M, Scheurer S, Enrique E, Alonso R, Conti A, et al. Lettuce anaphylaxis: identification of a lipid transfer protein as the major allergen. Allergy 2003;58:511-517

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[31] - Schocker F, Lüttkopf D, Scheurer S, Petersen A, Cisteró-Bahima A, Enrique E, et al. Recombinant lipid transfer protein Cor a 8 from hazelnut: A new tool for in vitro diagnosis of potentially severe hazelnut allergy. J Allergy Clin Immunol 2004;113:141-147

BACKGROUND: Cor a 1.04 has been identified as the major hazelnut allergen in 65 European patients with positive double-blind, placebo-controlled food challenge results to hazelnut. Recently, the 11S globulin Cor a 9 was shown to be a pollen-independent hazelnut allergen in the United States, whereas preliminary data suggest the lipid transfer protein (LTP) as an important birch pollen-unrelated hazelnut allergen in Europe . OBJECTIVE: We sought to recruit a group of European patients allergic to hazelnut without birch pollen allergy and to identify and clone the major food allergen(s) in this study population . METHODS: We recruited 26 such Spanish patients, including 10 patients with anaphylaxis. IgE immunoblotting was performed with hazelnut extract. Hazelnut LTP Cor a 8 was cloned by using a PCR strategy, purified, and subjected to IgE immunoblotting. Recombinant Cor a 8, rCor a 1.0401, and rCor a 2 (profilin) were further investigated by means of enzyme allergosorbent test. Immunoblot inhibition experiments were used to compare the immunologic properties of natural and recombinant LTP . RESULTS: A 9-kd major allergen was identified in hazelnut extract. Cloning, sequencing, heterologous expression, and inhibition experiments identified it as an LTP. The prevalence of specific IgE antibody reactivity to LTP was 62% in hazelnut extract and 77% when recombinant LTP was tested by means of immunoblotting. IgE immunoblot inhibition with hazelnut extract showed that natural Cor a 8 and rCor a 8 shared identical epitopes. Only one patient had positive reactivity to Cor a 1.04, and no patients had positive reactivity to Cor a 2. Two sera bound to high-molecular-weight allergens. The LTP was denominated as Cor a 8 and submitted to the allergen database of the World Health Organization/International Union of Immunological Societies Allergen Nomenclature Subcommittee . CONCLUSIONS: Cor a 8 is a relevant allergen for a majority of Spanish patients with hazelnut allergy that can cause severe allergic reactions.

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[32] - Bascones O, Rodríguez-Pérez R, Juste S, Moneo I, Caballero ML. Lettuce-Induced Anaphylaxis. Identification of the allergen Involved. J Investig Allergol Clin Immunol 2009;19:154-157

BACKGROUND: Only 2 allergenic proteins have been described in lettuce allergy: a 16-kDa protein (putative profilin) and a lipid transfer protein (LTP) named Lac s 1 . OBJECTIVE: Our aim was to identify the allergens involved in the anaphylactic reactions of 2 patients who had eaten lettuce . METHODS: The study was performed by Ig (immunoglobulin)-E immunodetection and immunodetection-inhibition assays . RESULTS: Both patients' sera showed specific IgE binding to a single protein from the crude lettuce extract (apparent molecular weight of 14 kDa). To characterize the allergen detected, the lettuce extract underwent proteolytic digestion and heat treatment and was highly resistant to both. The patients' sera also recognized the major peach allergen Pru p 3 by immunodetection. When the lettuce allergen was incubated with both Pru p 3 from peach peel and recombinant Pru p 3, the immunodetection-inhibition assay indicated that patients were sensitized to the lettuce LTP Lac s 1 . CONCLUSIONS: The allergen involved in the lettuce-induced anaphylaxis of our patients was the LTP Lac s 1.

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[33] - Eriksson C, Marion D, Åkerström H, Bernhardsson F, DeMateo A, Denery-Papini S et al. Lipid transfer protein involved in a case of anaphylaxis following intake of wheat, apple and lettuce. Allergy 2009;64(Suppl. 90):480

Wheat is together with milk, egg, peanut, fish and soy, responsible for most food allergies in children. A number of different wheat allergens have been described including omega-5 gliadin, alpha amylase inhibitors (AAI) and lipid transfer protein (LTP). Here we report a case of a 14- year old Spanish girl with a history of anaphylaxis after intake of wheat, apple and lettuce. The patient is also allergic to peach, hazelnut, almond, walnut, olive tree pollen and mites. The objective was to investigate which wheat protein(s) the patient was sensitised to and also if the protein(s) is involved in cross-reactions between wheat, apple and lettuce. Specific IgE against water/salt soluble wheat extract (wheat), apple, lettuce, peach, olive tree pollen, mites, omega-5 gliadin, wheat LTP, timothy profilin and cross-reactive carbohydrate determinants was determined with ImmunoCAP (Phadia AB). RAST inhibition was performed with wheat LTP or peach LTP and after that specific IgE was determined against wheat, apple, lettuce, peach, wheat LTP and peach LTP. Serum antibody analysis showed that the patient was sensitised to wheat (36,2 kU/L), apple (134 kU/L), lettuce (30,0 kU/L), peach (132 kU/L), olive pollen and mites. The patient was not sensitised to omega-5 gliadin (0,01 kU/L) but sensitised to wheat LTP (37,0 kU/L). Further she was not sensitised to profilin (0,02 kU/L) and CCD (0,14 kU/L). RAST inhibition with wheat LTP reduced the reactivity to wheat with 75% and to wheat LTP with 84%. The reactivity to apple, lettuce and peach was also reduced, but only with 20-30%. Inhibition with peach LTP reduced the reactivity to wheat with 28%, to wheat LTP with 29% and to apple, lettuce and peach with around 90%. The results indicate that LTP is the most important wheat allergen for this patient and thus LTP seems to be involved in anaphylaxis after intake of wheat. Inhibition with wheat or peach LTP reduced the reactivity to wheat extract, apple, lettuce and peach which indicate that cross reactions occur. However, the reduction of the reactivity to wheat was much lower when peach LTP was used as inhibitor which is expected since the sequence homology between wheat and peach LTP is below 50%. In conclusion, in this case it is likely that LTP is involved in the anaphylaxis following intake of wheat and that LTP also take part in cross reactions between wheat, apple, lettuce and peach.

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[34] - Geny S, Bessot JC, de Blay F, Pauli G. Survenue d'une allergie aux astéracées et aux champignons chez une malade allergique aux pollens de bétulacées. Communication: 10èmes Journées Parisiennes d'Allergie - Paris 9-11 janvier 2002

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[35] - Cadot P, Kochuyt AM, van Ree R, Ceuppens JL. Oral Allergy Syndrome to Chicory Associated with Birch Pollen Allergy. Int Arch Allergy Immunol 2003;131:19-24

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[36] - Cirillo A, Patella V, Ciccarelli A, Leone G, Gallo L. Food allergy to rocket (Eruca sativa) in patients sensitizited to parietaria pollen. 8th International Symposium on Problems of Food Allergy, Venice 2001, March 11-13

Introduction. In southern Italy respiratory allergy to Parietaria pollen is very common. In our Allergy Unit in the current year 240 patients (178 males, 62 females, with a mean age of 24.3 ± 8.4 years) were diagnosed as monosensitised to Parietaria pollen. Some of these patients reported also allergic reactions to foods, and four of them identified the culprit food as rocket (Eruca sativa), a vegetable belonging to the Cruciferae family increasingly used in a number of food preparations Methods. Skin tests were done by the prick + prick technique with fresh rocket, since commercial extracts are not available. Clinical cases. The four patients were three females respectively 23, 24 and 27 years old, and one male 31 year old. All had rhinoconjunctivitis and/or asthma in the pollen season of Parietaria, while the allergic reactions to the ingestion of rocket were urticaria in two patients, urticaria and asthma in one patient, and asthma alone in one patients. Results. The skin responses to the prick + prick with fresh rocket were intensely positive in all patients, being graded in 3+/4+ reactions in respect to the reference positive wheal elicited by the histamine solution. Conclusions. The vegetable food Eruca sativa was so far very rarely reported as a cause of food allergy, and most case reports regard contact urticaria. The cases we describe demonstrate that this food can elicit different patterns of systemic reactions, involving the skin or the airways, and that such reactions are not so rare in subjects suffering from Parietaria pollinosis. This suggests the presence of cross-reacting allergens in the two sources.

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[37] - Pitsios C, Vartholomaios S. Rocket allergy. Allergy 2007;62(suppl. 83):361

Background: Rocket (Eruca sativa), is a plant belonging to the Cruciferae family, used as an uncooked ingredient in many Mediteranean dishes such as salads, pizza and pasta. IgE-mediated reactions due to rocket are rarely reported. In this abstract a case report of food allergy to rocket is described. A 25-year-old male experienced anaphylaxis (itchy mouth, rhinitis, conjunctivitis and emesis), in the first 30' after ingesting a salad containing rocket, parmesan cheese, olive oil and tomato. He had a history of seasonal rhinitis, food allergy to basil (Labiatae family) and cashew nut and also complained of oral allergy symptoms every time he used to eat walnut or almond. Method: SPT with standard allergenic extracts were performed for inhalant allergens and food allergens. Although the successive consumption of parmesan, oil and tomato didn't cause any problem to our patient the prick-prick technique was used to test all ingredients of the salad. Specific IgE-testing was not available to rocket. Prick-prick testing to rocket was also performed to three volunteers. The number of healthy controls was consindered adequate, since in bibliography all "normal controls" tested were found negative, and no false-positive or irritative reaction to rocket is reported. Food allergy to tree nuts and basil had already been investigated. Results: SPT to all Grasses, hazelnut, almond, walnut and celery (Apiaceae family) resulted positive. Prick-prick to rocket resulted positive with a wheal area of 77mm2 (wheal/erythema diameter; 9/23mm). The rest prick-prick tests resulted negative in our patient and in all volunteers. A food challenge test was proposed, but the patients refused to consent. Conclusions: Rocket allergy is observed to patients with pollen sensitisations as well as to plants of other families. No cross-reactivity, though, has been confirmed in studies published, so far. Cross-reactivity with other Cruciferae plants (mustard, cabbage, kale, broccoli, turnip) is probable, but not observed in out patient.

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[38] - Helbling A, Schwartz HJ, Lopez M, Lehrer SB. Lettuce and carrot allergy: are they related? Allergy Proc 1994;15:33-38

Lettuce is commonly included in many elimination diets of subjects with either food allergy or atopic dermatitis since IgE-mediated allergic reactions have not been reported. We have observed a positive carrot skin test and/or RAST in two clinically lettuce sensitive, ragweed allergic subjects and positive lettuce skin test and/or RAST in two ragweed allergic patients with oral allergy syndrome to carrot. In this study lettuce allergy and the allergenic relationship between iceberg lettuce (Lactuca sativa L.), a member of the Asteraceae and carrot, a member of the Apiaceae, were investigated using sera from those four individuals. SDS-PAGE immunoblotting results indicated that iceberg lettuce can induce an IgE-mediated response. Fourteen allergens were detected between 13 and > 113 kD. RAST inhibition demonstrated that carrot does share common allergens with lettuce, although carrot allergens are more potent than those of lettuce. These findings may have some importance in patients with food-related symptoms, such as atopic dermatitis, because lettuce, when included in their diets, may aggravate the underlying disease.

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[39] - San Miguel-Moncin M, Krail M, Scheurer S, Enrique E, Alonso R, Conti A, et al. Lettuce anaphylaxis: identification of a lipid transfer protein as the major allergen. Allergy 2003;58:511-517

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[40] - Olive-Perez A, Pineda F. Anaphylactic reaction to 'Tudela' lettuce hearts. Allergy 2003;58:1205-1206

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[41] - Vila L, Sanchez G, Sanz ML, Dieguez I, Martinez A, Palacios R, et al. Study of a case of hypersensitivity to lettuce (Lactuca sativa). Clin Exp Allergy 1998;28:1031-1035

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[42] - Garcia Ortiz JC, Cosmes Martin P, Lopez-Asunsolo A. Allergy to foods in patients monosensitized to Artemisia pollen. Allergy 1996;51:927-931

It is known that patients with pollinosis may display clinical characteristics caused by allergy to certain fruits and vegetables, but subjects allergic to Artemisia seem to show particularly peculiar characteristics. The clinical features of 84 patients with rhinitis, asthma, urticaria, and/or anaphylaxis whose inhalant allergy was exclusively to Artemisia vulgaris were studied and compared with a control group of 50 patients monosensitized to grass pollen. The mean age for the beginning of symptoms was 30.2 years, and this was higher than in the control group (P < 0.05). We found the main incidence to be in women (70.2%). Some 42.3% had family history of atopia, lower than in the control group (P < 0.05), while the prevalence of asthma and urticaria was significantly higher (P < 0.05). Food hypersensitivity was reported by 23 patients (27.3%) allergic to Artemisia. The foods responsible (with respective numbers of cases) were honey (14), sunflower seeds (11), camomile (four), pistachio (three), hazelnut (two), lettuce (two), pollen (two), beer (two), almond (one), peanut (one), other nuts (one), carrot (one), and apple (one). None of the patients monosensitized to grass had food allergy. CAP inhibition experiments were carried out on a single patient. Results showed the existence of common antigenic epitopes in pistachio and Artemisia pollen for this patient. We concluded that mugwort hay fever can be associated with the Compositae family of foods, but that it is not normally associated with other foods.

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[43] - Alonso R, Enrique E, Pineda F, Basagaña M, San Miguel-Moncín MM, Bartra J, et al. An Observational Study on Outgrowing Food Allergy during Non-Birch Pollen-Specific, Subcutaneous Immunotherapy. Int Arch Allergy Immunol 2007;143:185-189

BACKGROUND: Birch pollen-specific immunotherapy (SIT) decreases allergy to foods containing birch pollen-homologous allergens. Cross-reactivity was also observed between plane tree pollen and some vegetable foods . OBJECTIVE: The aim of this study was to evaluate the outgrowing of food allergy by patients suffering from vegetable food allergy associated with plane tree pollinosis (rhinoconjunctivitis and/or asthma) during plane tree pollen SIT . METHODS: An observational and prospective study was conducted in 16 adult patients suffering from vegetable food allergy (hazelnut, walnut, lettuce, peach and cherry) and from plane tree pollinosis receiving plane tree pollen SIT for 1 year. Open oral challenges with the implicated food were performed before and after SIT. Blood samples were drawn for measurement of pollen- and food-specific IgE and IgG4 before and after treatment . RESULTS: Plane tree SIT resulted in a significant decrease in food allergy, since the mean food quantity provoking objective symptoms increased from 2.19 to 13.74 g (p < 0.05), and 6 of the 11 patients tolerated the highest level (25 g) of the challenged food after plane tree SIT. Laboratory data also showed a decrease in IgE levels and an increase in IgG4 levels after immunotherapy . CONCLUSION: SIT with plane tree pollen has a positive impact on food allergy in plane tree pollen-allergic subjects.

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[44] - Cadot P, Kochuyt AM, Deman R, Stevens EA. Inhalative occupational and ingestive immediate-type allergy caused by chicory (Cichorium intybus). Clin Exp Allergy 1996;26:940-944

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[45] - Olive-Perez A, Pineda F. Anaphylactic reaction to 'Tudela' lettuce hearts. Allergy 2003;58:1205-1206

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[46] - Escudero AI, Bartolome B, Sanchez-Guerrero IM, Palacios R. Lettuce and chicory sensitization. Allergy 1999;54:183-184

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[47] - Escudero AI, Bartolome B, Sanchez-Guerrero IM, Palacios R. Lettuce and chicory sensitization. Allergy 1999;54:183-184

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[48] - Franck P, Kanny G, Dousset B, Nabet P, Moneret-Vautrin DA. Lettuce allergy. Allergy 2000;55:201-202

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[49] - de Lacoste-Delaval A, Guérin L, Leduc V. Allergie alimentaire à la salade. Rev Fr Allergol Immunol Clin 2006;46:374