Autres "fruits exotiques"

Famille	Nom latin	Nom(s) du produit
Actinidiaceae	Actinidia arguta	Kiwai / Kiwi de Sibérie
Actinidiaceae	Actinidia chinensis	Kiwi doré
Actinidiaceae	Actinidia deliciosa	Kiwi vert
Anacardiaceae	Anacardium occidentale	Pomme de cajou
Anacardiaceae	Mangifera indica	Mangue
Anacardiaceae	Spondias cytherea	Prune cythère
Anacardiaceae	Spondias mombin	Mombin
Anacardiaceae	Spondias tuberosa	Imbu
Annonaceae	Annona cherimola	Annone / chérimole / cachiman
Annonaceae	Annona muricata	Corossol épineux / sapotille
Annonaceae	Annona reticulata	Corossol / cœur de bœuf
Annonaceae	Annona squamosa	Pomme cannelle
Arecaceae	Phoenix dactylifera	Datte
Bromeliaceae	Ananas comosus	Ananas
Burseraceae	Canarium sapho	Saphou
Cactaceae	Hylocereus undatus	Pitahaya violette
Cactaceae	Opuntia ficus-indica	Figue de Barbarie
Cactaceae	Selenicereus megalanthus	Pitahaya jaune
Caricaceae	Carica papaya	Papaye
Caricaceae	Carica pentagona	Babaco
Clusiaceae	Garcinia mangostana	Mangoustan
Clusiaceae	Mammea americana	Abricot des Antilles
Cornaceae	Cornus spp.	Arbre à fraises (fruit de l’) / kousa
Ebenaceae	Diospyros digina	Caca-poule / sapote noire
Ebenaceae	Diospyros kaki	Kaki / figue caque / persimon / sharon
Fabaceae	Tamarindus indica	Tamarin
Lauraceae	Persea americana	Avocat
Lythraceae	Punica granatum	Grenade / grenadine
Malpighiaceae	Malpighia glabra	Acérola / cerise des Barbades
Malvaceae	Durio zibethinus	Dourian / durion
Moraceae	Artocarpus altilis	Arbre à pain (fruit de l’)
Moraceae	Artocarpus heterophyllus	Petit jacque / jaque
Moraceae	Ficus carica	Figue
Musaceae	Musa acuminata	Banane sauvage / banane de Chine
Musaceae	Musa acuminata x balbisiana	Banane créole / banane plantain
Musaceae	Musa x paradisiaca	Banane cultivée / banane commune
Myrtaceae	Eugenia javanica	Jambose
Myrtaceae	Feijoa sellowania	Feijoa du Brésil / goyave-ananas
Myrtaceae	Psidium guajava	Goyave
Oxalidaceae	Averrhoa carambola	Carambole / pomme de Goa
Passifloraceae	Passiflora edulis	Passion (fruit de la) / grenadille rouge
Passifloraceae	Passiflora mollissima	Taxo
Passifloraceae	Passiflora quadrangularis	Barbadine
Rhamnaceae	Ziziphus jujuba	Jujube / datte Chinoise / azufaifa
Rhamnaceae	Ziziphus mauritiana	Jujube
Rosaceae	Eriobotrya japonica	Nèfle du Japon / bibace / loquat
Rosaceae	Pseudocydonia sinensis	Coing de Chine
Rubiaceae	Morinda citrifolia	Noni
Rutaceae	Citrus fortunella x reticulata	Calamandin
Rutaceae	Citrus hystrix	Combava
Rutaceae	Fortunella spp.	Kumquat
Sapindaceae	Blighia sapida	Aki
Sapindaceae	Dimocarpus longan	Longane
Sapindaceae	Litchi chinensis	Litchi
Sapindaceae	Nephelium lappaceum	Ramboutan
Sapotaceae	Manilkara zapota	Sapotille / sapote
Solanaceae	Cyphomandra betacea	Tamarille / tomate en arbre
Solanaceae	Physalis alkekengi	Alkékenge / groseille du Cap
Solanaceae	Physalis ixocarpa	Tomatillo
Solanaceae	Physalis peruviana	Coqueret du Pérou

[1] - Hegde VL, Venkatesh YP. Oral allergy syndrome to sapodilla (Achras zapota). J Allergy Clin Immunol 2002;110:533-534

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[2] - Raulf-Heimsoth M, Stark R, Sander I, Maryska S, Rihs HP, Brüning T, et al. Anaphylactic reaction to apple juice containing acerola: Cross-reactivity to latex due to prohevein. J Allergy Clin Immunol 2002;109:715-716

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[3] - Bhattacharya R, Bhattacharyya D. Preservation of natural stability of fruit 'bromelain' from Ananas comosus (pineapple). J Food Biochem 2009;33:1-19

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[4] - Lavine ES, Atkinson AR, Ellis AK. Isolated Food Pollen Syndrome in Response to Fresh Pineapple. J Allergy Clin Immunol 2007;119(1 suppl):S195

RATIONALE: We report a case of isolated food pollen allergy syndrome, a recognized form of IgE mediated food hypersensitivity, to pineapple. METHODS: Case report and literature review. RESULTS: A healthy 29 year old woman presented with a ten year history of oral parasthesia, dyspepsia, abdominal cramping, and vomiting after consumption of mixed fresh fruit salad. Ingestion of plain fresh pineapple produced the identical symptoms. Canned pineapple and all other fresh fruits were eaten without causing symptoms. After five years of complete dietary exclusion of fresh pineapple, an accidental ingestion of fresh pineapple juice caused oral parasthesias followed by severe abdominal cramping, nausea, and presyncope within thirty minutes. While walking to seek medical attention, syncope occurred. The patient was confirmed to be hypotensive and bradycardic by medical staff. Conservative management yielded resolution of symptoms within two hours. Subsequent skin testing demonstrated a wheal (6 ◊ 10 mm) in response to fresh pineapple, a negative test to commercial pineapple extract, and a positive test to birch tree (10 ◊ 15 mm) along with positive tests to mixed tree, mixed grass, short ragweed, cat, dog, and dust mite species. CONCLUSIONS: While pineapple is among several fruits implicated in the food pollen allergy syndrome, review of the literature suggests that isolated reactivity to pineapple would be considered an uncommon entity.

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[5] - Lavaud F, Meirhaeghe D, Fontaine JF, Angelier AS, Sabouraud D, Lebargy F. Vraies et fausses allergies alimentaires à l’ananas : à propos de quatre cas. Rev Fr Allergol 2009;49:305

Introduction.ˆ Les allergies alimentaires à l‚ananas sont rares et les problèmes posés par ce fruit sont le plus souvent non spécifiques. Nous rapportons trois observations d‚allergie alimentaire à l‚ananas documentées par test de provocation labial ou oral et une observation de sensibilisation asymptomatique trompeuse avec tests de provocation labial et oral négatifs. Méthode.ˆ Cas no 1 à 3 : la première patiente, âgée de 58 ans, aux antécédents atopiques et d‚allergie au latex, à l‚avocat et au melon, signale un prurit buccopharyngé parfois accompagné d‚une urticaire après consommation d‚ananas ou de boisson apéritive à base d‚ananas. La deuxième patiente, âgée de 37 ans, allergique connue aux acariens, au pollen de bouleau et aux pollens de graminées, signale un prurit labial et pharyngé avec réactivation d‚une urticaire chronique après consommation de chou, betterave et ananas frais. La consommation d‚ananas en boîte est tolérée et le CAP-RAST retrouve un taux d‚IgE sériques de 3,5 U/ml pour l‚ananas et de 0,24 U/ml pour rBet v2. Le troisième patient, âgé de 25 ans, atopique suivi pour une rhinoconjonctivite allergique (acariens, graminées, chat) et une allergie alimentaire à l‚arachide, présente un syndrome oral après consommation d‚ananas. Dans ces trois cas le test cutané à l‚ananas frais et le test de provocation labial sont positifs. Cas no 84 : le quatrième patient, âgé de 67 ans, non atopique, présente une réaction anaphylactique dans les suites d‚un repas comprenant des poireaux en vinaigrette et un yaourt à l‚ananas. Les tests cutanés sont légèrement positifs pour les épices, la muscade, le citron et l‚ananas. Le CAP-RAST retrouve des taux d‚IgE de 0,54 U/ml pour la muscade et de 0,15 U/ml pour l‚ananas. Le test de provocation labial et le test de provocation oral à l‚ananas sont négatifs. La responsabilité de la muscade, contenue dans la sauce vinaigrette, est retenue. Discussion.ˆ Rarement impliqué dans les allergies vraies aux fruits, en particulier dans le cadre d‚une allergie au latex, l‚ananas contient également une profiline (Ana c1) croisant avec celle du pollen de bouleau et de la banane, et la broméline, cystine protéase riche en CCD rendant compte de sensibilisations croisées asymptomatiques. Comme la plupart des fruits exotiques, il est aussi potentiellement histaminolibérateur. Cette diversité des mécanismes à évoquer en cas de suspicion d‚intolérance à l‚ananas fait des tests de provocation une aide précieuse au diagnostic.

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[6] - Reindl J, Rihs HP, Scheurer S, Wangorsch A, Haustein D, Vieths S. IgE Reactivity to Profilin in Pollen-Sensitized Subjects with Adverse Reactions to Banana and Pineapple. Int Arch Allergy Immunol 2002;128:105-114

Background: The so-called 'latex-fruit syndrome' is a well-documented phenomenon in cross-reactive allergies. By contrast, there is a lack of information about allergy to exotic fruits in patients with a predominant pollen sensitization. Since the ubiquitous protein profilin has been identified as an allergen in natural rubber latex as well as in pollen-related foods, the aim of this study was to investigate the role of profilin in allergy to certain exotic fruits. Methods: Recombinant profilins from banana and pineapple were cloned by a PCR technique after isolation of total RNA using degenerated profilin-specific primers. The unknown 5' ends of copy DNA (cDNA) were identified by rapid amplification of 5'cDNA ends (5'-RACE) and expression in Escherichia coli BL21(DE3) cells. The recombinant profilins were purified by affinity chromatography using poly-(L)-proline as the solid phase. IgE-binding capabilities were characterized by means of immunoblot and Enzyme Allergosorbent Test (EAST). The cross-reactivity to birch pollen profilin and latex profilin was studied by EAST as well as by immunoblot inhibition experiments. Results: Both banana and pineapple profilin were found to consist of 131 amino acid residues with high amino acid sequence identity to known allergenic pollen and food profilins (71-84%). IgE binding to the recombinant profilins was observed in 7/16 sera from subjects with suspected banana allergy (44%) and in 8/19 sera from subjects with suspected pineapple allergy (42%). Inhibition experiments indicated similar IgE reactivity of natural and recombinant allergens. In addition, high cross-reactivity to birch pollen profilin Bet v 2 and latex profilin Hev b 8 was demonstrated by immunoblot inhibition as well as EAST inhibition experiments. Conclusions: Since a high IgE-binding prevalence of about 40% was obtained in both banana and pineapple allergy, we conclude that profilin is an important mediator of IgE cross-reactivity between pollen and exotic fruits

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[7] - Rowan AD, Buttle DJ, Barrett AJ. The cysteine proteinases of the pineapple plant. Biochem J 1990;266:869-875

The pineapple plant (Ananas comosus) was shown to contain at least four distinct cysteine proteinases, which were purified by a procedure involving active-site-directed affinity chromatography. The major proteinase present in extracts of plant stem was stem bromelain, whilst fruit bromelain was the major proteinase in the fruit. Two additional cysteine proteinases were detected only in the stem: these were ananain and a previously undescribed enzyme that we have called comosain. Stem bromelain, fruit bromelain and ananain were shown to be immunologically distinct. Enzymic characterization revealed differences in both substrate-specificities and inhibition profiles. A study of the cysteine proteinase derived from the related bromeliad Bromelia pinguin (pinguinain) indicated that in many respects it was similar to fruit bromelain, although it was found to be immunologically distinct.

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[8] - Lee KL, Albee KL, Bernasconi RJ, Edmunds T. Complete amino acid sequence of ananain and a comparison with stem bromelain and other plant cysteine proteases. Biochem J 1997;327:199-202

The amino acid sequences of ananain (EC3.4.22.31) and stem bromelain (3.4.22.32), two cysteine proteases from pineapple stem, are similar yet ananain and stem bromelain possess distinct specificities towards synthetic peptide substrates and different reactivities towards the cysteine protease inhibitors E-64 and chicken egg white cystatin. We present here the complete amino acid sequence of ananain and compare it with the reported sequences of pineapple stem bromelain, papain and chymopapain from papaya and actinidin from kiwifruit. Ananain is comprised of 216 residues with a theoretical mass of 23464 Da. This primary structure includes a sequence insert between residues 170 and 174 not present in stem bromelain or papain and a hydrophobic series of amino acids adjacent to His-157. It is possible that these sequence differences contribute to the different substrate and inhibitor specificities exhibited by ananain and stem bromelain.

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[9] - Scheurer S, Pastorello EA, Wangorsch A, Kästner M, Haustein D, Vieths S. Recombinant allergens Pru av 1 and Pru av 4 and a newly identified lipid transfer protein in the in vitro diagnosis of cherry allergy. J Allergy Clin Immunol 2001;107:724-731

BACKGROUND: In central and northern Europe food allergy to fruits of the Rosaceae family is strongly associated with birch pollinosis because of the existence of IgE cross-reactive homologous allergens in birch pollen and food. By contrast, in the Mediterranean population allergic reactions to these fruits frequently are not related to birch pollen allergy and are predominantly elicited by lipid transfer proteins (LTPs). OBJECTIVE: We sought to determine the prevalence of IgE sensitization to the recombinant cherry allergens Pru av 1 and Pru av 4 in comparison with cherry extract within a representative group of patients who were allergic to cherries recruited in Germany and to compare the relevance of IgE to cherry LTPs in Italian patients. METHODS: Recombinant Pru av 1 and rPru av 4 were available from earlier studies. The cDNA of the cherry LTPs was obtained by using a PCR-cloning strategy. The protein was expressed in Escherichia coli and purified by means of metal chelate affinity chromatography. Sera from 101 German patients with birch pollinosis and oral allergy syndrome to cherry and sera from 7 Italian patients with cherry allergy were investigated by using enzyme allergosorbent tests for IgE reactivity with cherry extract, rPru av 1, rPru av 4, and the recombinant cherry LTP. Inhibition experiments were performed to compare the IgE reactivity of natural and recombinant cherry LTPs and to investigate potential cross-reactivity with birch pollen allergens. RESULTS: The LTP from cherry comprises 91 amino acids and a 26 amino acid signal peptide. The mature cherry LTP shows high amino acid sequence identity with allergenic LTPs from peach (Pru p 3, 88%), apricot (Pru ar 3, 86%), and maize (Zea m 14, 59%) and displays no IgE cross-reactivity with birch pollen. The IgE prevalences in the German patients were as follows: LTP, 3 of 101 (3%); rPru av 1, 97 of 101 (96.0%); rPru av 4, 16 of 101 (16.2%); and cherry extract, 98 of 101 (97%). All 7 Italian patients had IgE against the cherry LTP. CONCLUSIONS: Recombinant allergens are useful tools for a more accurate in vitro IgE-based diagnosis of cherry allergy. Taken together, they mimic the allergenic activity of cherry extract, having slightly higher biologic activity. Sensitization to the cherry LTP is relevant for a minority of patients recruited in Germany, but our data indicate that it may be a major allergen in Italy.

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[10] - Ferrer A, Andreu C, de Larramendi C, García-Abujeta J, Huertas J, Tella R, et al. Skin test evaluation of the allergenicity of seven tomato varieties, including peel, pulp, boiled and fried tomato extracts. EAACI 25th Congress, Vienna, 10-14 June, 2006, Poster n°1541

Background: There is no evidence that different tomato varieties may express a different allergenicity in vivo. Therefore, we decided to analyse the allergenicity of several commonly consumed tomato varieties by skin testing in a group of tomato skin test positive individuals. Material & Methods: All consecutive individuals evaluated at the outpatient clinics of the participating Hospitals (located in different regions of the Mediterranean coast of Spain) for respiratory and/or cutaneous symptoms were skin tested with a battery of aeroallergens and with peel and pulp of the Canary variety tomato at 10 mg of freeze dried material/ml. Patients were also asked for any food related complaints, including oral allergy syndrome, contact urticaria, angioedema, anaphylaxis and/or gastrointestinal symptoms with the ingestion, or contact with tomato. All patients with a positive skin test and/or complaints related with tomatoes were asked to participate in the study and were skin tested with extracts of the following varieties: Canario, Pera, Kumato, Rambo, Raft, Cherry and Rama and canned fried tomato. All were purchased at a local market. The wheal sizes were measured and expressed in squared mm (± SD). Results: One hundred thirty six patients were recruited. The mean wheal sizes produced by the different extracts were: Canary peel: 33.6 ± 36.4; Canary pulp: 9.1 ± 13.2; Rama peel: 26.5 ± 36.7; Rama pulp: 9.8 ± 13.5; Cherry whole: 9.5 ± 14.7; Kumato peel: 26.9 ± 29.3; Kumato pulp: 17.7 ± 22.2; Rambo peel: 26.2 ± 26.9; Rambo pulp: 4.6 ± 8.6; Pera peel: 20.3 ± 26.7; Pera pulp: 13 ± 16.3; Raft peel: 25.3 ± 33; Raft pulp: 7.3 ± 13.5; Canned fried tomato: 11.4 ± 16.8; Rama boiled peel: 19.5 ± 29.5; Rama boiled pulp: 9.8 ± 16. Conclusions: The wheals skin test results obtained with all the peel extracts was, in all cases, greater than that obtained with the respective pulp extracts. The greatest mean skin test reaction induced by the peel extracts was obtained with the Canario and by the pulp extracts with the Kumato variety. Most of the Canario tomato positive patients were sensitised to all varieties studied. The Canario variety seems to be a good variety to diagnose in vivo sensitisation to tomatoes.

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[11] - Levy DA, Mounedji N, Noirot C, Leynadier F. Allergic sensitization and clinical reactions to latex, food and pollen in adult patients. Clin Exp Allergy 2000;30:270-275

Many latex-allergic patients are sensitized to one or more foods. Patients allergic to tree and/or grass pollens are also often sensitized to plant-derived foods. Atopy, defined in most studies as sensitivity to an aeroallergen, is a risk factor for latex allergy. The relative importance of pollen sensitivity, a sign of atopy, as a risk factor for food allergy in latex-allergic patients has not, however, been examined. OBJECTIVE: To investigate the relationship between pollen sensitivity and sensitivity to food in latex-allergic patients. METHODS: Forty-four latex-allergic patients (Groups 1 and 2), 24 of whom were also allergic to tree and/or grass pollen (Group 1) and 25 pollinosis patients who were not allergic to latex (Group 3) were studied. We obtained a history of reactions to food and skin tested them with 12 fresh-frozen fruits. RESULTS: All 12 foods induced a skin test reaction in at least one patient in each of the three Groups. There were, however, twice as many positive skin test reactions to food in patients with pollinosis, whether or not they were allergic to latex, as there were in patients allergic to latex but not to pollen. Latex-allergic patients were most likely to have a positive skin test and a history of a reaction to avocado or banana whereas patients with pollinosis only were most likely to have a positive skin test and a history of a reaction to apple, peach or celery. CONCLUSIONS: These results suggest that concomitant allergy to pollen is an important risk factor in determining which plant-derived foods sensitize latex-allergic patients.

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[12] - van Kampen V, Merget R, Brüning T. [Occupational allergies to bromelain]. Pneumologie 2007;61:159-161

The protease bromelain originating from the pineapple fruit (Ananas comosus) finds frequent use in industry. Exposure to enzyme dusts has long been known to cause occupational allergies. The present paper reviews the results of the evaluation of literature data concerning occupational airway sensitization due to bromelain. Cases of specific airway sensitization caused by bromelain could be shown clearly by the presented studies. Since the symptoms, results of skin prick tests, detection of specific IgE antibodies and results of specific bronchoprovocation tests are consistent, an immunological mechanism can be assumed.

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[13] - Matito A, Seoane M, Alcorta A, Jimenez M, Cabanillas B, Rodriguez J, et al. Allergic occupational asthma caused by pineapple fruit inhalation in a pharmaceutical industry worker. Allergy 2008;63(suppl. 88):445-446

Background: Bromelain, the pineapple most important allergen, causes work related asthma in pharmaceutical industry workers. We describe a case of occupational asthma caused by pineapple fruit contained in a diet product. Method: Case report: A 35-year old woman, developed rhinitis and asthma one month after she had begun to work in a pharmaceutical industry. The symptoms only appeared in her workplace when she manipulated a dust product composed of tea, pineapple, papaya, grape, chicory and prebiotics. She did not remember the ingestion of these foods after the onset of the symptoms. Skin tests (prick by prick) and serum specific-IgE determination (CAPSystem FEIA) were carried out with tea, pineapple, papaya, grape and chicory. Methacoline inhalation challenge and bronchial provocation test with pineapple extract were performed according to the ATS guidelines. A double-blind placebo-controlled oral challenge (DBPCFC) with pineapple was carried out. Results: Skin testing with pineapple was positive (15-mm wheal). Skin-tests carried out with the other components of the product were all negative. Pineapple and bromelain serum-specific IgE were positive (1.76KUA/L and 3.32KUA/L, respectively). A dual positive response (FEV1 descent 21%, and PFR descent 20%) was observed in the specific bronchial provocation test with the pineapple extract. A positive response was also observed in a DBPCFC with raw pineapple. Conclusions: Pineapple fruit can evoke asthma on inhalation in the workplace.

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[14] - Galleguillos F, Rodriguez JC. Asthma caused by bromelin inhalation. Clin Allergy 1978;8:21-24

Two cases are reported of bronchial asthma caused by inhalation of bromelin, a proteolytic enzyme utilized in some anti-inflammatory medicine. Prick test results with bromelin extract were positive. Inhalation tests gave immediate reactions which were blocked by sodium cromoglycate, but not corticosteroids

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[15] - Baur X, Fruhmann G. Allergic reactions, including asthma, to the pineapple protease bromelain following occupational exposure. Clin Allergy 1979;9:443-450

A 58-year-old pharmaceutical worker regularly developed asthma and rhinitis when handling bromelain, a purified protease of pineapple (Ananas comosus), at her work-place, where she had been employed for about 10 years. RAST and prick test showed strong positive reactions to bromelain. Both inhalation test with 0.03 mg bromelain and peroral challenge by ingestion of 190 g pineapple resulted in asthmatic reactions; the latter challenge was accompanied by gastrointestinal symptoms. Five of six workers sensitized to papain, showed positive RAST and skin test results to bromelain, two of them also showed immediate asthmatic reactions after bronchial challenge with bromelain. Out of sixty asthmatics not exposed to airborne proteases but probably to these as constituents of foods, two had positive skin test results and eight had positive RAST results to bromelain; but in no case was there clear evidence for clinical sensitization. The presented data prove conclusively that bromelain is capable of inducing IgE mediated respiratory and gastrointestinal allergic reactions. Furthermore, there is evidence for immunological cross-reaction between the two plant proteases bromelain and papain in human subjects.

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[16] - Levy DA, Mounedji N, Noirot C, Leynadier F. Allergic sensitization and clinical reactions to latex, food and pollen in adult patients. Clin Exp Allergy 2000;30:270-275

Many latex-allergic patients are sensitized to one or more foods. Patients allergic to tree and/or grass pollens are also often sensitized to plant-derived foods. Atopy, defined in most studies as sensitivity to an aeroallergen, is a risk factor for latex allergy. The relative importance of pollen sensitivity, a sign of atopy, as a risk factor for food allergy in latex-allergic patients has not, however, been examined. OBJECTIVE: To investigate the relationship between pollen sensitivity and sensitivity to food in latex-allergic patients. METHODS: Forty-four latex-allergic patients (Groups 1 and 2), 24 of whom were also allergic to tree and/or grass pollen (Group 1) and 25 pollinosis patients who were not allergic to latex (Group 3) were studied. We obtained a history of reactions to food and skin tested them with 12 fresh-frozen fruits. RESULTS: All 12 foods induced a skin test reaction in at least one patient in each of the three Groups. There were, however, twice as many positive skin test reactions to food in patients with pollinosis, whether or not they were allergic to latex, as there were in patients allergic to latex but not to pollen. Latex-allergic patients were most likely to have a positive skin test and a history of a reaction to avocado or banana whereas patients with pollinosis only were most likely to have a positive skin test and a history of a reaction to apple, peach or celery. CONCLUSIONS: These results suggest that concomitant allergy to pollen is an important risk factor in determining which plant-derived foods sensitize latex-allergic patients.

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[17] - Gonzalo MA, Moneo I, Ventas P, Polo F, Garcia JM. IgE-mediated hypersensitivity to custard-apple. Allergy 1997;52:597

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[18] - Sanchez-Guerrero IM, Escudero AI, Tortosa JA, Lombardero M. Anaphylaxis to cherimoya. Allergy 2000;55:976-977

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[19] - Gonzalo MA, Moneo I, Ventas P, Polo F, Garcia JM. IgE-mediated hypersensitivity to custard-apple. Allergy 1997;52:597

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[20] - Diaz-Perales A, Collada C, Blanco C, Sanchez-Monge R, Carillo T, Aragoncillo C, et al. Cross-reactions in the latex-fruit syndrome: a relevant role of chitinases but not of complex asparagine-linked glycans. J Allergy Clin Immunol 1999;104:681-687

BACKGROUND: Cross-reactions between latex and plant foods (mainly fruits) have been widely reported. Although the cross-reactive components have not been well identified, class I chitinases seem to be the most credible candidates in chestnut, avocado, and banana . OBJECTIVE: We sought to evaluate the potential role of chitinases and complex glycans as cross-reactive determinants linked to latex-food allergy . METHODS: Extracts from 20 different plant foods and from latex were obtained. These preparations were immunodetected with anticomplex glycans and antichitinase sera raised in rabbits, as well as with sera from patients with latex-fruit allergy and sera from patients allergic to latex without food allergy. Immunoblot inhibition assays were carried out by using a purified class I chitinase from avocado or latex extract as inhibitors . RESULTS: Reactive proteins of approximately 30 to 45 kd (putative class I chitinases) were recognized by both specific polyclonal antibodies to chitinases and sera from patients with latex-fruit allergy in chestnut, cherimoya, passion fruit, kiwi, papaya, mango, tomato, and flour wheat extracts. Prs a 1, the major allergen and class I chitinase from avocado, and the latex extract strongly or fully inhibited IgE binding by these components when tested in immunoblot inhibition assays. Additional bands of 16 to 20 kd, 23 to 28 kd, and 50 to 70 kd were detected by the antichitinase serum but not with the patients' pooled sera. The putative 30- to 45-kd chitinases present in different food extracts did not react with a pool of sera from subjects allergic to latex but not to fruit. Very different immunodetection patterns were produced with the anticomplex glycan serum and the sera from allergic patients . CONCLUSIONS: Putative class I chitinases seem to be relevant cross-reactive components in foods associated with the latex-fruit syndrome, but do not play a specific role in allergy to latex but not to fruit. Cross-reactive carbohydrate determinants are not important structures in the context of latex-fruit cross-sensitization.

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[21] - Sanchez-Morillas L, Moneo I, Sedano E, Iglesias A, Caballero ML, Rodriguez M. Oral allergic syndrome after ingestion of custard apple. Allergy 2003;58:260-261

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[22] - Gamboa PM, Sánchez-Monge R, Díaz-Perales A, Salcedo G, Ansótegui I, Sanz ML. Latex-vegetable syndrome due to custard apple and aubergine: new variations of the hevein symphony. J Investig Allergol Clin Immunol 2005;15:308-311

An increasing number of vegetables with crossreactions to latex are being described in patients with latex-vegetable syndrome. We present two of these vegetables, custard apple linked in two previous cases with latex sensitisation, and aubergine, that had not been described up to now in patients with latex sensitisation. The diagnosis of both cases was based on the clinical history, positive skin prick test (SPT) and specific IgE to the offending vegetables, as well as to positive SPT and specific IgE levels to latex and the major fruits involved in the latex-fruit syndrome (avocado, banana, and chestnut). Further, crude extracts from latex, custard apple and aubergine, as well as the purified allergens Hev b 6.02 and Prs a 1 were used in in vitro and in vivo assays: IgE immunodetection, histamine release (HRT) and basophil activation (BAT) tests and skin prick tests. In case 1, both purified Hev b 6.02 and Prs a 1 induced positive responses in skin prick tests, high levels of basophil activation and histamine release. Specific IgE immunodetection uncovered a reactive band of 45 kd in the crude custard apple extract, which was also recognized by anti-chitinase monospecific antibodies. The serum from patient 1 also detected Prs a 1 in immunodetection. Hev b 6.02 produced positive skin responses and showed high biological activity in HRT and BAT in the case of patient 2. However, Prs a 1 was reactive neither in SPT nor in IgE immunodetection. In fact, no band was detected using the serum of patient 2 in avocado or aubergine extracts. By contrast, Prs a 1 reached high values of basophil activation and over 10% of histamine release in case 2.

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[23] - Santos-Magadán S, Bartolomé-Zavala B, Rodríguez-Jiménez B, Heras-Mendaza F, Conde-Salazar L, Rodríguez-Álvarez M, et al. Custard-apple allergy. Allergy 2007;62(suppl. 83):340

Background: An increasing number of vegetables and fruits which present cross-reactivity with latex have been described. Fruit class I chitinases with an N-terminal hevein-like domain and latex hevein (Hev b 6.02) have been identified as the main allergens (panallergens) responsible for this type of cross-reaction, but in vitro assays suggest that relevant epitopes are also contained in the catalytic domain of these allergens. Case report: A 28-year-old woman, working as a fishmonger for the last 2 years, developed over the last year pruritus, erythema and urticaria in fingers, hands and forearms while working. She wore latex gloves at work and she had no symptoms when touching or eating fish. Her symptoms improved on weekends and holidays. On the other hand, she referred tongue and pharyngeal itching and mouth erythema when eating custard-apple. She had no symptoms with kiwi, chestnut, avocado and other fruits. She also referred rhinoconjunctivitis during grass pollen season (from April to June). Methods: Skin prick tests (SPT) with extracts of latex, common aeroallergens and fruits, date palm pollen profiling, and Pru p 3 were performed. Levels of total and specific IgE were assessed by CAP system; SDS-PAGE immunoblotting and immunoblotting-inhibition assays were carried out. Results: SPT were positive to pollens of Artemisa vulgaris, Platanus acerifolia, Chenopodium album, olive and grass as well as to latex and chestnut. The custard-apple prick-prick test elicited also a positive response. Serum specific IgE was positive (>0,35 kU/L) to pollens from weed, trees, grass and olive, and to avocado, chestnut, banana, papaya, latex, rHev b 6.02 and rBet v 2. Specific IgE to other latex recombinant proteins (rHeb v 1, rHeb v 3, rHeb v 5 and rHeb v 6.01) were negative. Immunobloting with the custard-apple extract showed an IgE-binding band of 14-15 kDa. Inhibition assays revealed cross-reaction between extracts from custard apple and avocado, papaya and latex, whereas latex profilin and Hev b 1 did not inhibit the custard apple immunoblotting. Conclusion: We present a case of IgE-mediated allergy to custard apple linked to latex allergy. A custard apple IgE-binding band of 14 kDa was detected. This allergen exhibited cross-reactivity with proteins from latex, papaya and avocado, but not with latex profilin or with Hev b 1.

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[24] - Sanchez-Guerrero IM, Escudero AI, Tortosa JA, Lombardero M. Anaphylaxis to cherimoya. Allergy 2000;55:976-977

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[25] - Lafosse-Marin S, Aparicio C, Guérin L. Allergie alimentaire à la pomme-cannelle (annona squamosa). Communication: 9èmes Journées Parisiennes d'Allergie - Paris 10-12 janvier 2001

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[26] - Gonzalo MA, Moneo I, Ventas P, Polo F, Garcia JM. Immediate hypersensitivity reaction to date. Allergy 1997;52:598-599

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[27] - Grob M, Reindl J, Vieths S, Wuthrich B, Ballmer-Weber BK. Heterogeneity of banana allergy: characterization of allergens in banana-allergic patients. Ann Allergy Asthma Immunol 2002;89:513-516

BACKGROUND: Banana is a frequent cause of food allergy, particularly in latex-sensitized patients. OBJECTIVE: The aim of the study was to get insights in immunoglobulin (Ig)E antibody responses of patients with a history of allergic reaction to banana but not to latex. METHODS: In four patients who complained about symptoms after banana consumption, skin prick tests (SPTs) with aeroallergens, latex, banana, avocado, and kiwi were performed. Total and specific serum IgE to birch pollen, rBet v 1 and rBet v 2, latex, banana, avocado, and kiwi were determined by the CAP method (Pharmacia Diagnostics, Uppsala, Sweden). Allergens were identified by immunoblotting with banana extract and recombinant banana profilin. Two patients underwent double-blind, placebo-controlled food challenges (DBPCFC) with banana. RESULTS: All patients showed a positive SPT to banana, and three were IgE-CAP positive (> or = class 2). Two patients were also sensitized (SPT and CAP) to latex, avocado, kiwi, and birch pollen. In the immunoblot these two patients' sera reacted to 32- to 34-kDa proteins, which had already been described as major banana allergens. In both patients banana allergy was confirmed by DBPCFC. The third patient also had a sensitization to avocado, but not to latex or pollen. Immunoblot analysis detected a single band at 70 kDa. The fourth patient was sensitized to birch pollen, rBet v 1 and rBet v 2, but not to latex. Immunoblot analysis in this patient's serum was positive with recombinant banana profilin. CONCLUSIONS: The relevance of banana as a source of food allergy was confirmed in two patients by DBPCFC. In 1 of 2 patients, in whom banana allergy was not a consequence of latex sensitization, a 70-kDa protein was identified as a banana allergen, and in the other patient profilin was detected as a putative cross-reactive allergen.

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[28] - Kwaasi AA, Parhar RS, Tipirneni P, Harfi H, al-Sedairy ST. Major allergens of date palm (Phoenix dactylifera L.) pollen Identification of IgE-binding components by ELISA and immunoblot analysis. Allergy 1993;48:511-518

The IgE-binding components of date palm (Phoenix dactylifera L.) pollen were determined by ELISA and Western blotting in atopic patients in order to identify its major allergens. From a pool of previously identified allergenic fractions and sera from 15 skin-test-positive, atopic subjects, four components of 12, 14.4, 57, and 65-67 kDa were found to bind IgE in 80-93% of sera. Two other components of molecular masses 28-30 and 37-40 kDa also bound 60-80% of atopic sera. The immunologic specificity of date-pollen allergen that induced antibody response in sera of atopic patients was confirmed with ELISA. Furthermore, most of the reactivity in pooled positive atopic serum and antiserum raised in rabbits was eliminated after the sera were absorbed with the allergen. IgG immunoblot analyses showed varying degrees of cross-reactivity with common local allergens, notably Bermuda grass, but were generally of low intensity These results indicate that date pollen has six major allergens with the 12, 14.4, 57, and 65-67 kDa bands binding 80-93%, and the 28-30 and 37-40 kDa bands 60-80% of atopic sera. We propose that these major allergens be assigned the notations "Pho d I" to "Pho d VI" in the order listed.

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[29] - Asturias JA, Ibarrola I, Fernandez J, Arilla MC, Gonzalez-Rioja R, Martinez A. Pho d 2, a major allergen from date palm pollen, is a profilin: cloning, sequencing, and immunoglobulin E cross-reactivity with other profilins. Clin Exp Allergy 2005;35:374-381

Summary Background Up to now, some date palm pollen (DPP) allergens have been described but very few data are available about their molecular nature. The aim of this study was to identify and characterize Pho d 2, a major allergen from this pollen. Methods Sera from 25 patients allergic to DPP were analysed by immunoblotting. Purification of DPP profilin was performed by poly-l-proline affinity chromatography. Profilin-encoding cDNA from DPP was cloned by using a RT-PCR strategy and recombinant allergen was expressed as a non-fusion protein in Escherichia coli. Natural and recombinant Pho d 2 were investigated by means of enzyme allergosorbent test to compare the immunologic properties of both allergens and to analyse cross-reactivity with other profilins. Results A 14.4 kDa protein was identified as a major allergen in DPP extract. Purification, cloning, heterologous expression, and inhibition experiments identified it as profilin (Pho d 2). Pho d 2 comprises 131 amino acids and has high sequence identity with other allergenic food and pollen profilins. The prevalence of specific IgE antibody reactivity to natural Pho d 2 by ELISA was 56% and 64% by skin prick test (SPT). Pho d 2 is an important allergen as it is responsible for more than 70% of the IgE reactivity to the pollen extract. IgE directed against Pho d 2 showed a strong cross-reactivity with other profilins such as those from olive tree and grass pollens. Conclusion Pho d 2, a 14.4 kDa protein identified as profilin, is a major and relevant allergen in DPP, as confirmed by SPT and thereby may elicit clinical symptoms in sensitized patients.

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[30] - Gonzalo MA, Moneo I, Ventas P, Polo F, Garcia JM. Immediate hypersensitivity reaction to date. Allergy 1997;52:598-599

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[31] - Grob M, Reindl J, Vieths S, Wuthrich B, Ballmer-Weber BK. Heterogeneity of banana allergy: characterization of allergens in banana-allergic patients. Ann Allergy Asthma Immunol 2002;89:513-516

BACKGROUND: Banana is a frequent cause of food allergy, particularly in latex-sensitized patients. OBJECTIVE: The aim of the study was to get insights in immunoglobulin (Ig)E antibody responses of patients with a history of allergic reaction to banana but not to latex. METHODS: In four patients who complained about symptoms after banana consumption, skin prick tests (SPTs) with aeroallergens, latex, banana, avocado, and kiwi were performed. Total and specific serum IgE to birch pollen, rBet v 1 and rBet v 2, latex, banana, avocado, and kiwi were determined by the CAP method (Pharmacia Diagnostics, Uppsala, Sweden). Allergens were identified by immunoblotting with banana extract and recombinant banana profilin. Two patients underwent double-blind, placebo-controlled food challenges (DBPCFC) with banana. RESULTS: All patients showed a positive SPT to banana, and three were IgE-CAP positive (> or = class 2). Two patients were also sensitized (SPT and CAP) to latex, avocado, kiwi, and birch pollen. In the immunoblot these two patients' sera reacted to 32- to 34-kDa proteins, which had already been described as major banana allergens. In both patients banana allergy was confirmed by DBPCFC. The third patient also had a sensitization to avocado, but not to latex or pollen. Immunoblot analysis detected a single band at 70 kDa. The fourth patient was sensitized to birch pollen, rBet v 1 and rBet v 2, but not to latex. Immunoblot analysis in this patient's serum was positive with recombinant banana profilin. CONCLUSIONS: The relevance of banana as a source of food allergy was confirmed in two patients by DBPCFC. In 1 of 2 patients, in whom banana allergy was not a consequence of latex sensitization, a 70-kDa protein was identified as a banana allergen, and in the other patient profilin was detected as a putative cross-reactive allergen.

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[32] - Kwaasi AA, Harfi HA, Parhar RS, Al-Sedairy ST, Collison KS, Panzani RC, et al. Allergy to date fruits: characterization of antigens and allergens of fruits of the date palm (Phoenix dactylifera L.). Allergy 1999;54:1270-1277

Date-palm (Phoenix dactylifera L.) fruits are eaten daily by most inhabitants of the Middle East and the neighboring countries. Recent reports have indicated that dates are allergenic. This study aimed to investigate the antigenic and allergenic potential of date fruits. METHODS: Date-fruit extracts from eight cultivars were evaluated in skin prick tests (SPT) in an atopic population, used to produce antisera, analyzed by SDS-PAGE, and fractionated by gel-filtration chromatography. Sera from SPT-positive individuals were evaluated by ELISA and RAST, and in anti-igE immunoblot experiments. RESULTS: About 13% of patients were SPT-positive for at least two extracts. SDS-PAGE of whole extracts revealed 15-18 protein bands of 6.5->100 kDa, and Sephacryl S-200 fractions gave distinct peptide bands. RAST and anti-IgE ELISA gave a range of positive results, which could be abrogated when sera were preabsorbed with fruit extracts. IgE immunoblots of different extracts with pooled positive sera revealed different anti-IgE-binding immunoprints. All the positive sera from fruit-allergic and pollen-allergic individuals bound strongly to two anti-IgE reactive bands of 6.5 to 12-14 kDa and 28-33 kDa, respectively, and about 50% of sera bound to a 54-58-kDa band. CONCLUSIONS: These results strongly indicate that 1) date-palm fruit is a potent allergen 2) sera from fruit-allergic as well as pollen-allergic patients recognize common fruit-specific epitopes 3) there is heterogeneity in patient responses to the different extracts.

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[33] - Kwaasi AA, Harfi HA, Parhar RS, Collison KS, Al-Sedairy ST, Al-Mohanna FA. Cultivar-specific IgE-epitopes in date (Phoenix dactylifera L.) fruit allergy. Correlation of skin test reactivity and IgE-binding properties in selecting date cultivars for allergen standardization. Int Arch Allergy Immunol 2000;123:137-144

BACKGROUND: Date fruits are allergenic and standardized extracts are required for diagnosis and therapy of this allergy. Since there are several cultivars of dates, this study was carried out to assess the allergenicity of different cultivars in order to select suitable source material for standardization. METHODS: The protein profiles of 18 of the most commonly sold varieties were compared by SDS-PAGE and their relative allergenicity assessed by SPT and IgE-based ELISA and immunoblotting. Thirty-two date fruit-sensitive patients were skin tested with a pooled extract from all the cultivars. Six of the patients with high SPT results (> or =3+) who volunteered were further tested with the 18 cultivars and their sera used in ELISA and immunoblotting. RESULTS: Six of the cultivars gave high SPT-positive reactions in > or =4 of patients. Five of these high SPT-reactive cultivars gave high IgE ELISA scores (> or =0.58) but individual cultivars varied in their number of IgE immunoblot bands. Cultivar-specific IgE-binding patterns indicated that only certain cultivars bound IgE at molecular weights of < or =14.3 and 27-33 kDa whilst all cultivars bound to a 54-58 kDa doublet. Cultivars that bind to the < or =14.3 and 27-33 kDa bands appeared to form the majority of the high SPT-reactive cultivars. When individual sera of 24 of the 32 SPT-positive patients were used in IgE immunoblots with the pooled cultivar extract, all sera bound IgE at < or =14.3 and 27-33 kDa and about 60% of sera bound to a 54-58 kDa doublet bands. CONCLUSIONS: These results indicate that allergenicity of date fruits is a cultivar-specific phenomenon. Sixty to 100% of sera from date fruit-allergic patients bind IgE to three major allergens of < or =14.3, 27-33 and 54-58 kDa. Five of the cultivars that evoke high SPT reactions, high IgE ELISA scores and bind IgE to the major allergens, can be selected for the preparation of 'in-house' allergen extracts and for allergen standardization.

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[34] - Kwaasi AAA, Harfi HA, Parhar RS, Saleh S, Collison KS, Panzani RC, et al. Cross-reactivities between date palm (Phoenix dactylifera L.) polypeptides and foods implicated in the oral allergy syndrome. Allergy 2002;57:508-518

BACKGROUND: Date fruit and pollen antigens share a number of cross-reactive epitopes. Date pollen has been shown to cross-react with antigens from Artemisia, cultivated rye (Secale cereale), Timothy grass (Phleum pratense), Sydney golden wattle (Acacia longifolia) and Bermuda grass (Cynodon dactylon) pollen. The present study was carried out to examine any cross-reactivities between date palm polypeptides and antigens of some common foods and vegetables that have been implicated in the oral allergy syndrome (OAS). Because most of such cross-reactivities in other allergens are attributable to the presence of carbohydrate chains and profilin, their role was also investigated . METHODS: Fresh extracts of 20 common fruits and vegetables were prepared. Putative date profilins were isolated by affinity chromatography using a poly L-proline column. Date fruit extracts were digested by various endoglycosidases and the immunoglobulin (Ig)E binding of the postdigest products was assessed in immunoblots. Rabbit antisera to whole date fruit extracts, Timothy grass profilin and putative date profilins, as well as human sera from date sensitive individuals were used in immunoblotting, ELISA and in inhibition experiments . RESULTS: IgG, ELISA and immunoblot results with the different rabbit antisera and date-sensitive atopic sera showed several antigenic cross-reactivities and similar cross-reactivities were seen with birch, date and timothy grass profilins. IgE, ELISA and immunoblot experiments with pooled date sensitive human sera showed a range of cross-reactivities with some food extracts. A number of the IgE cross-reactivities could be inhibited after preabsorption of pooled sera with date extracts. Sixty-six percent of individual date hypersensitive human sera bound IgE in putative date fruit profilin and their pooled sera bound IgE in birch pollen profilin. IgE-binding of the endoglycosidase digested date fruit extracts to atopic serum pool was restricted to only a very low molecular weight band of 6.5-8 kDa . CONCLUSION: These results indicate that date palm polypeptides share cross-reactive IgG and IgE epitopes with a number of foods implicated in the oral allergy syndrome, bind to birch and Timothy grass profilins and bind IgE through glycosyl residues. The clinical relevance of these cross-reactivities needs to be further elucidated.

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[35] - Kwaasi AAA. Homology of Pho d 5 to chitinases contributes to cross-reactivities between date palm, banana and avocado allergens. EAACI 23th Congress, Amsterdam, 12-16 June, 2004, Poster n°575

Background: The major date palm (Phoenix dactylifera L.) pollen allergen Pho d 5 and its isoalleRgen in fruits Pho d f3 share sequence homology with class III chitinase and endochitinase precursor (Allergy 2001; 56 (Suppl. 68): 86). Date palm antigens cross-react with polypeptides in several foods including avocado and banana (Allergy, 2002; 57:508-518). Chitinases have been identified as the cross-reacting allergens in the latex-fruit syndrome, which include avocado, banana, kiwi and chestnut. Some of the cross-reactivities observed between date palm antigens, banana and avocado occur in proteins of similar molecular weight range (25-35 kDa) as these major date allergens. In the present study, we investigated whether polysensitised date allergic patients' sera bind IgE to chitinases in banana and avocado. This knowledge would help to assess whether chitinases are yet another group of pan-allergens of date palm that need to be further studied. Methods: Fresh avocado and banana fruits were homogenised and then extracted in 10 mM Phosphate buffered saline containing 2% polyvinylpolypyrrolidone (PPVP), 2mM ethylene-diaminetetracetic acid (EDTA), 10mM diethyldithiocarbamate (DIECA) and 0.02 % thiomersal. Extracts were lyophilized, concentrated, fractionated and the fractions containing the desired proteins were used for these studies. Sera from polysensitised date palm allergic patients including banana and avocado sensitized individuals were investigated using ELISA, immunoblotting and immunoblot inhibition. Results: ELISA results demonstrated a wide range of IgE reactivities to proteins in avocado and banana in about 60% of atopic sera. In immunoblots, 25 and 33 % of date allergic sera bound IgE to distinct bands in avocado and banana extracts respectively. Most of these bands were in the molecular weight ranges of between 23 and 37 kDa, these being the molecular weight range of the chitinase allergens in avocado and banana. Cross inhibition experiments demonstrated that some of the IgE immunostaining bands diminished significantly in intensity in both immunoblots. Conclusions: Chitinases in date pollen and fruits contribute, in part, to the cross-reactivities between date palm, avocado and banana allergens. Chitinases have been described as one of the most important IgE-binding pan-allergens associated with the latex fruit syndrome and date allergens should be investigated for their possible involvement in this syndrome.

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[36] - Olivieri J, Quiliquini-Chambard AM, Hauser C. Allergy to durian. Allergy 2002;57:263

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[37] - Garcia-Menaya JM, Cordobés-Duran C, Bobadilla P, Ledesma A, Pérez-Rangel I. Hypersensitivity systemic reaction to cactus fruit (Opuntia ficus-indica). Allergy 2009;64:1689-1690

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[38] - Diaz-Perales A, Collada C, Blanco C, Sanchez-Monge R, Carillo T, Aragoncillo C, et al. Cross-reactions in the latex-fruit syndrome: a relevant role of chitinases but not of complex asparagine-linked glycans. J Allergy Clin Immunol 1999;104:681-687

BACKGROUND: Cross-reactions between latex and plant foods (mainly fruits) have been widely reported. Although the cross-reactive components have not been well identified, class I chitinases seem to be the most credible candidates in chestnut, avocado, and banana . OBJECTIVE: We sought to evaluate the potential role of chitinases and complex glycans as cross-reactive determinants linked to latex-food allergy . METHODS: Extracts from 20 different plant foods and from latex were obtained. These preparations were immunodetected with anticomplex glycans and antichitinase sera raised in rabbits, as well as with sera from patients with latex-fruit allergy and sera from patients allergic to latex without food allergy. Immunoblot inhibition assays were carried out by using a purified class I chitinase from avocado or latex extract as inhibitors . RESULTS: Reactive proteins of approximately 30 to 45 kd (putative class I chitinases) were recognized by both specific polyclonal antibodies to chitinases and sera from patients with latex-fruit allergy in chestnut, cherimoya, passion fruit, kiwi, papaya, mango, tomato, and flour wheat extracts. Prs a 1, the major allergen and class I chitinase from avocado, and the latex extract strongly or fully inhibited IgE binding by these components when tested in immunoblot inhibition assays. Additional bands of 16 to 20 kd, 23 to 28 kd, and 50 to 70 kd were detected by the antichitinase serum but not with the patients' pooled sera. The putative 30- to 45-kd chitinases present in different food extracts did not react with a pool of sera from subjects allergic to latex but not to fruit. Very different immunodetection patterns were produced with the anticomplex glycan serum and the sera from allergic patients . CONCLUSIONS: Putative class I chitinases seem to be relevant cross-reactive components in foods associated with the latex-fruit syndrome, but do not play a specific role in allergy to latex but not to fruit. Cross-reactive carbohydrate determinants are not important structures in the context of latex-fruit cross-sensitization.

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[39] - Gaspar A, Raulf-Heimsoth M, Pires G, Rihs HP, Yeang HY, Matos V, et al. Latex allergen sensitization patterns in different risk groups and latex-fruit syndrome patients from Portugal. EAACI 23th Congress, Amsterdam, 12-16 June, 2004, Poster n°1188

Background: Latex allergy has been recognized as a clinically important health problem, mainly in some risk groups: spina bifida (SB), other congenital malformations submitted to multiple surgeries (MS) and health care workers (HCW). Purpose: To study IgE-binding reactivity to latex allergens, by using recombinant and natural allergens, in latex-allergic patients from different risk groups including patients with latex-fruit syndrome (LFS). Material and Methods: We selected sera of 51 latex-allergic patients within different risk groups: 20 with SB, 10 MS and 21 HCW; all these patients had positive skin prick tests with commercial latex extract (ALK-Abelló) and serum latex-specific IgE determined by UniCAP®(Pharmacia Diagnostics). Sixteen out of the 51 patients had LFS. A panel of single recombinant latex allergens was coupled to ImmunoCAPs (CAP system®) and the isolated natural allergen nHev b 2 was coupled on paper disks (EAST testing). This panel comprised rHev b 1, nHev b 2, rHev b 3, rHev b 5, rHev b 6.01, rHev b 7, rHev b 8, rHev b 9, rHev b 10 and rHev b 11. The recombinant allergens were produced as fusion protein with maltose-binding protein (MBP) in E. coli. MBP coupled on ImmunoCAPs served as control. Specific IgE values of >0.35kU/l were considered positive. Major allergen is defined if produces a positive IgE response in more than 50% of the tested group. Results: Recombinant Hev b 1 specific IgE antibodies were detected in 70% sera from SB, 30% from MS, 5% from HCW, and in 13% sera from LFS patients. For nHev b 2: SB-69%, MS-71%, HCW-71% and LFS-75%. For rHev b 3: SB-50%, MS-20%, HCW-10% and LFS-13%. For rHev b 5: SB-55%, MS-40%, HCW-62% and LFS-75%. For rHev b 6.01: SB-45%, MS-30%, HCW-76% and LFS-81%. For rHev b 7: SB-33%, MS-0%, HCW-16% and LFS-27%. For rHev b 8: SB-10%, MS-0%, HCW-5% and LFS-6%. For rHev b 9 and rHev b 10: SB-0%, MS-0%, HCW-5% and LFS-7%. For rHev b 11: SB-7%, MS-0%, HCW-5% and LFS-7%. Conclusions: The different routes of exposure influence the IgE antibody pattern. The major latex allergens identified in SB were Hev b 1, Hev b 2, Hev b 3 and Hev b 5, being Hev b 1 the most important one. The major allergen identified in MS was Hev b 2. For occupational exposure route, the major latex allergens identified in HCW were Hev b 2, Hev b 5 and Hev b 6.01, being prohevein the most important one. Regarding cross-reactivity with foods, the major allergens identified in LFS were Hev b 2, Hev b 5 and Hev b 6.01.

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[40] - Gaspar A, Neto-Braga C, Pires G, Murta R, Morais-Almeida M, Rosado-Pinto J. Anaphylactic reaction to manioc: cross-reactivity to latex. Allergy 2003;58:683-684

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[41] - Branco Ferreira M, Pedro E, Meneses Santos J, Pereira dos Santos MC, Palma Carlos ML, Bartolome B, et al. Latex and chickpea (Cicer arietinum) allergy: first description of a new association. Eur Ann Allergy Clin Immunol 2004;36:366-371

In this paper we describe the existence of cross-reactivity between allergens from latex and chickpea, a food from the Leguminosae family, which is common in the Mediterranean diet. We present the case report of a spina bifida boy with a clinical relevant food allergy to chickpea (oral syndrome + dysphonia), developing after the appearance of latex allergy symptoms (lip angioedema + intraoperative anaphylaxis). Specific IgE to latex and chickpea was demonstrated by skin prick tests, measurement of patient's serum specific IgE and IgE-immunoblotting. Cross-reactivity was studied by means of EAST-inhibition and western blotting-inhibition. A strong inhibition was observed in several IgE-binding bands when latex extract was used in solid phase and patient serum was preincubated with chickpea extract (chickpea extract as inhibitor phase). As far as we know, this is the first report of cross-reactivity between latex and chickpea, a food which should therefore be added to the extensive list of latex cross-reactive foods.

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[42] - Brehler R, Theissen U, Mohr C, Luger T. 'Latex-fruit syndrome': frequency of cross-reacting IgE antibodies. Allergy 1997;52:404-410

An association between allergies to latex proteins and to various foods has been reported and confirmed by RAST and immunoblotting inhibition. However, no significant data had been collected on the frequency of specific IgE antibodies to fruits in these patients and the frequency of a history of fruit intolerance. Serum samples of 136 patients with well-documented, clinically relevant, immediate-type hypersensitivity against latex proteins were analyzed for IgE antibodies against a panel of different fruits. Patient history of food intolerance was documented by a standardized questionnaire. Fruit-specific IgE antibodies were detected in 69.1% of serum samples. Cross-reacting IgE antibodies recognizing latex and fruit allergens (papaya. avocado, banana, chestnut, passion fruit, fig. melon, mango, kiwi, pineapple, peach, and tomato) were demonstrated by RAST-inhibition tests. Of our patients 42.6% reported allergic symptoms after ingestion of these fruits and a total of 112 intolerance reactions were recorded. However, fruit-specific IgE antibodies were detected only in serum samples from 32.1% of the patients who perceived symptoms due to these fruits. Thus, serologic tests seem to be of low significance for prediction of food allergy in latex-allergic patients.

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[43] - Puente Y, Bartolome B, Daza JC, Almeda E, Roviralta C, Garcia-Arevalo J. Anaphylaxis due to pomegranate. Allergy 2007;62(suppl. 83):336

Background: The pomegranate is the fruit of Punica granatum tree and is cultivated over the whole Mediterranean region since ancient times. We report the case of a 20-year-old woman suffered from anaphylaxis (urticaria, angioedema, hypotension, bronchial obstruction) moments after ingesting pomegranate (Punica granatum). She needed emergency treatment with parenteral epinephrine, beta-agonists, steroids and antihistamines. She also had seasonal rhinitis that had not been studied. Methods: Specific IgE (Enzyme Allergo Sorbent Test), SDS-PAGE immunoblotting, and skin prick tests were carried out. RESULTS: Cutaneous prick tests with a lot of inhalant allergens were positive with Olea europaea, Platanus acerifolia, Cupressus arizonica, Plantago lanceolata Artemisia vulgaris and Hellianthus annus. Patch-tests with the European standard set of contact allergens were negative. Prick tests with commercial food extracts were positive with almond, hazelnut, peanut, chestnut, nut, pistachio, soya and corn. Prick by prick were positive with grape, melon, cherry. Prick tests with latex were negative. Cutaneous tests using the prick by prick technique with the pomegranate fruit were positive. Prick extracts were made by Bial-Aristegui®. By immunoblotting with pomegranate a pulp extract band of 16 kDa was obtained. We thought it could be LTP. On the other hand, we studied cross reactivities between pollens and pomegranate by SDS PAGE immunoblotting of inhibition. Allergen Pomegranate Chestnut Platanus acerifolia Olea europaea Peach LTP Artemisia vulgaris IgE (kU/l) 1.2 6.4 6.1 88.8 12.4 2.2 Conclusions: Only few cases have been reported about this kind of sensitization. We show a case of anaphylaxis due to IgE mediated hypersensitivity to pomegranate with positive in vivo and in vitro tests. Cross reactivity between LTP of pomegranate pulp extract and Pla a 3 of Platanus acerifolia was found.

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[44] - San Miguel-Moncín M, Lombardero M, Alonso R, Tella R, Bartra J, Barber D, et al. Anaphylaxis to pomegranate: Detection of IgE reactivity to a 13 kDa protein. EAACI 23th Congress, Amsterdam, 12-16 June, 2004, Poster n°1005

Rationale: Pomegranate is the fruit of the Punica granatum tree. The fruit pulp is made of a cluster of red-violet seeds. Hypersensitivity to pomegranate has been rarely reported, although systemic reactions are frequently implicated. Nevertheless, allergens involved have not been identified so far, and only IgE reactivity to a 29 kDa protein has been reported. Case Report: A 31-years-old female suffered an acute episode of red itchy palms and soles, abdominal pain, cough, generalized urticaria and shortness of breath after ingesting a pomegranate. She had a past history of oropharyngeal pruritus when eating peach peel, and seasonal allergic rhinoconjunctivitis to Platanus acerifolia since last 6 years. An allergic study was carried out. In vitro immunoassays were performed in order to determine the pattern of IgE reactivity and cross reactivity. Results: Skin prick tests to commercial extracts of common inhalants and foods (ALK-Abelló, Madrid, Spain) were positive to Platanus acerifolia pollen, peach peel and nuts. Prick-by-prick with fresh pomegranate fruit pulp showed an immediate positive wheal (12 x 6 mm). Common blood parameters were within normal limits, being total serum IgE 228 kU/L. Patient serum showed high levels of specific IgE (Pharmacia, CAP system) to Platanus acerifolia (48.4 kU/L), peach (13.4 kU/L) and to walnut (0.85 kU/L). Determination of specific IgE by ELISA to purified Pru p 3 gave >27 kU/L. SDS-PAGE immunoblotting of pomegranate and peach extracts showed a strong IgE-binding band of 13 kDa and another weak one of 27-29 kDa. Conclusions: Pomegranate is an uncommon but potential allergen of severe systemic reactions. To our knowledge, this is the first report of a low-molecular-weight allergen of 13 kDa (possibly a nsLTP) involved in pomegranate allergy.

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[45] - Zoccatelli G, Olivieri M, Peruffo A. Allergy to pomegranate: a case report. Allergy Clin Immunol Int 2005;17(Suppl. 1):580

Background. Pomegranate (Punica granatum) fruits have rarely been reported to cause immediate hypersensitivity after ingestion. The first case of adverse reactions to pomegranate was described in 1991, but it did not appear to be IgE-mediated. Allergy to pomegranate was subsequently documented by means of positive prick-by-prick test and RAST, and thereafter a 29-kDa protein allergen causing systemic reactions after fruit ingestion was described. Recently, the presence of mannitol-specific human IgE in a sensitised allergic subject has been demonstrated and a mannitol-mediated mechanism to explain sensitisation and onset of anaphylactic reactions has been proposed. Here we report a case of a 24 years old atopic woman who suffers of Oral Allergy Syndrome (OAS) upon ingestion of pomegranate fruits. A new protein allergen has been detected. Method. Total serum IgE and specific IgE levels were measured with UniCAP and RAST respectively. Prick-by-prick was performed with fresh fruit, while skin prick test (SPT) with commercial extracts were performed for a panel food and pollen allergens. D-mannitol (1%) was also tested by SPT. Using IgE blotting technique we investigated the presence of serum IgE-specific antibodies to pomegranate juice proteins. Pomegranate juice proteins were fractionated by cation exchange FPLC. Results. Total serum IgE levels were 285 kU/I. SPT were positive for Compositae, Graminaceae and Artemisia. Prick-by-prick with fresh pomegranate was also positive. SPT with mannitol was instead negative. Patient‚s IgE revealed a major 12-KDa protein band together with 2 faint bands with a higher molecular weight (38 and 60 KDa). To verify whether the nature of the 12-kDa IgE binding protein belonged to Lipid Transfer Protein (LTP) family, whose members are known to be major allergens in many fruits, pomegranate LTP was purified and subjected to western blotting with anti-peach LTP antibody (a kind gift of professor A. Curioni, University of Padova, Italy). The purified LTP was not labelled by the patient‚s IgE antibodies. Conclusion. In the reported case, OAS due to ingestion of pomegranate is not caused by a mannitol-mediated mechanism nor involves pomegranate LTP. Characterization of the 12-KDa IgE binding protein is in progress.

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[46] - Pineda F, Utz M, Enrique E, De Mateo J, Castello J, Palacios R, et al. Allergy to pomegranate: immunologic study and identification of a lipid transfer protein responsible for cross-reactivity. EAACI 25th Congress, Vienna, 10-14 June, 2006, Poster n°1523

Objectives: Lipids transfer proteins (LTP) are the most important pan-allergens of the food allergy in the Mediterranean area. The aim of this study was to investigate if the food allergy due to pomegranate was associated to other foods contained LTP. Materials and methods: we illustrate a clinical case of a 21 years-old patient who described an anaphylactic reaction (urticaria, facial angioedema, and hypotension) after intake of pomegranate fruit. Three months later, he presented with a comparable systemic reaction after hazelnut and peanut eating. He had asthma and rhinoconjuntivitis as a child and was treated with specific immunotherapy with mite dust and mould extract. SPTs were performed with fresh fruit, and SPTs with commercial extracts were performed for a group of plant food and pollen allergens (DIATER laboratories, Madrid, Spain). The existence of IgE specific serum antibodies to pomegranate, hazelnut, and peanut extract was investigated with an Western blot assay. Crossreactivity studies were performed by means of IgE inhibition with rCor a 8 (recombinant hazelnut LTP) (Paul-Earlich-Institute, Langen, Germany) as a inhibitor. Results: The results of SPTs were positive for grass, olive, planetree, cypress, and chenopodium pollen extracts and for hazelnut, peanut, peach, apple, maize, and rice food extracts. The results of SPTs with fresh pomegranate were also positive. IgE immunoblotting of pomegranate extract exposed that known 29-kDa binding band protein together with another new one with a molecular mass of approximately 9 kDa. This 9 kDa IgE-binding band protein was also obtainable in other food extracts studied and in plane tree pollen extract and completely inhibited with rCor a 8 as the inhibitor agent. Conclusions: We described a case of allergy to pomegranate where the cross-reactivity between this fruit and other foods (hazelnuts and peanut) is principally due to the presence of a LTP.

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[47] - Ben M'rad S, Dridi A, Doggui MH, Khouani H, Tritar F, Merai S, et al. L'allergie alimentaire à la pêche. Rev Fr Allergol Immunol Clin 2005;45:385-388

La pêche est un fruit répandu en région méditerranéenne. Il appartient à la famille des Rosacées qui comprend outre les pêches, les pommes, les cerises, les poires, les abricots, les framboises, les fraises, les noisettes et les amandes. Bien que la fréquence réelle de l'allergie à la pêche soit méconnue, cette dernière semble en augmentation. L'allergène majeur est une protéine de transfert lipidique très répandue dans le règne végétal et intervient dans la défense des plantes contre les agressions extérieures. Une allergie croisée avec les autres fruits de la famille des Rosacées et avec les pollens de bouleau et de graminées est fréquente. Nous faisons le point sur cette pathologie à travers l'étude de cinq observations de patients présentant une allergie alimentaire à la pêche ainsi qu'une revue de la littérature.

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[48] - 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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[49] - Zoccatelli G, Dalla Pellegrina C, Consolini M, Fusi M, Sforza S, Aquino G, et al. Isolation and Identification of Two Lipid Transfer Proteins in Pomegranate (Punica granatum). J Agric Food Chem 2007;55:11057-11062

Lipid transfer proteins (LTPs) are a family of low molecular mass (7-9 kDa) polypeptides, the members of which share 35-95% sequence homology. These proteins are widely distributed throughout the plant kingdom and are receiving attention for their biochemical characteristics and biological activity. LTPs are indeed studied in different research fields varying from allergy to food technology, and numerous molecules belonging to this class are progressively being identified and investigated. Proteins from pomegranate juice were fractioned by cation exchange chromatography and analyzed by SDS-PAGE. Two proteins were identified as putative LTPs on the basis of their molecular weights and their electrophoretic behaviors under reducing and nonreducing conditions. Finally, proteins were purified and characterized by mass spectrometry. This analysis confirmed that the two polypeptides are LTPs on the basis of an amino acid sequence common to LTPs from other plant sources and cysteine content. The two proteins, named LTP1a and LTP1b, showed similar molecular masses but different immunological profiles when immunodetected with rabbit antibodies specific for Pru p 3 and human IgE from a patient suffering from pomegranate allergy. The demonstration of the existence of two immunologically unrelated LTPs in pomegranate confirms the variability and the complexity of the plant LTP family. This should be taken into account when the role of these proteins as elicitors of allergies to fruits is investigated and could help to explain the contradictory literature data on pomegranate allergy.

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[50] - Gangemi S, Mistrello G, Roncarolo D, Amato S, Minciullo PL. Pomegranate-dependent exercise-induced anaphylaxis. J Investig Allergol Clin Immunol 2008;18:491-492

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[51] - Eriksson NE, Werner S, Foucard T, Möller C, Berg T, Kiviloog J, et al. Self-reported hypersensitivity to exotic fruit in birch pollen-allergic patients. Allergol Int 2003;52:199-206

Background: The majority of Swedish birch pollen (BP)-allergic patients report hypersensitivity to some fruits, nuts and vegetables. Some BP-allergic patients complain 'I can't tolerate any fruit'. The main aim of the present study was to answer the question, 'can BP-allergic patients tolerate some of the exotic fruit, not at present common in Sweden?' Methods: Consecutive patients (n = 397) visiting the participating Allergy Clinics, who had a BP allergy and reported a food hypersensitivity, were asked to fill out questionnaires regarding 66 different fruits and vegetables. Subjects had three alternatives as an answer to each of the food questions: (i) 'I tolerate it'; (ii) 'I get symptoms from it'; or (iii) 'I have not tried this food'. Skin prick tests were performed with pollen allergens. Results: Most patients had experienced reactions to several foods; only 31 patients (8%) reported hypersensitivity to one food only. Some of the fruit had been tried by only a few patients. In addition to earlier well-known BP-related foods, more than 40% of patients who had knowingly eaten Japanese pear and pomegranate said that they had experienced symptoms after eating the fruit. Most patients tolerated pineapple, melon, grapes and citrus fruits, as well as zucchini, lychee, rambutan, mangosteen, ugli, melon pear and cherimoya. Conclusions: Although an allergy to fruit is common among BP-allergic patients, there are several widely available fruits that most patients tolerate; for instance, pineapple, melon, grapes and citrus fruit. Furthermore, there are many exotic fruits that most patients have not yet tried.

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[52] - Polosa R. The interaction between particulate air pollution and allergens in enhancing allergic and airway responses. Curr Allergy Asthma Rep 2001;1:102-107

Although the detrimental effects of air pollution on human health have been brought widely to public notice, it appears that less attention has been given to the potential role of toxic air pollutants in the induction of allergic conditions such as asthma, rhinoconjunctivitis, and atopic eczema. A number of large epidemiologic studies have shown that people exposed to intense motor vehicle traffic and its associated emissions are at major risk for allergic symptoms, reduced lung function, and increased sensitization to common airborne allergens. Several laboratory-based studies have demonstrated that particulate air pollutants emitted from motor vehicles can induce allergic inflammation, enhance IgE responses, and increase airway hyperresponsiveness, which could provide an underlying mechanism for the increasing prevalence of allergic diseases. This article reviews the evidence that supports the causative link between particulate air pollution and the sharp increase in the prevalence of type I allergies in developed countries.

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[53] - Venkatesh YP, Venkatesh LH. Immediate hypersensitivity to mannitol found in pomegranate and mushroom. Allergol Int 2003;52:165-170

Immediate hypersensitivity reactions to mannitol present naturally in pomegranate (Punica granatum) and cultivated mushroom (Agaricus bisporus) have appeared in the medical literature recently. Mannitol, being inert, cannot react with proteins to form a haptencarrier conjugate and elicit an immune response. The proposed mechanism for sensitization involves the reaction of d-mannose with exposed amino groups of proteins in vivo to form Schiff base intermediates bearing a d-mannitoyl moiety, which closely resembles d-mannitol. This intermediate appears to be responsible for eliciting the formation of mannitol-specific IgE in susceptible individuals. Once an individual is sensitized with the formation of mannitol-specific IgE, mannitol can cause anaphylactic reactions by acting either as a univalent anaphylactogen or a bivalent hapten. The Schiff base intermediate bearing the mannitoyl moiety appears to act as a true sensitizer, whereas d-mannose appears to act as prosensitizer and d-mannitol acts as a non-sensitizing elicitor. This hypothesis can also explain the mechanism of sensitization and IgE-mediated hypersensitivity to any sugar alcohol. A hypothesis for the mechanism of immediate hypersensitivity to mannitol.

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[54] - Igea JM, Cuesta J, Cuevas M, Elias LM, Marcos C, Lazaro M, et al. Adverse reaction to pomegranate ingestion. Allergy 1991;46:472-474

We present a non-atopic 85-year-old woman, with a late-onset recidivant tongue angio-edema due to pomegranate intake, as proven by a double blind oral challenge test. This is the first case ever reported about adverse reaction to pomegranate. We have been unable to demonstrate an IgE-mediated mechanism (prick test, histamine release test and RAST with pomegranate were all negative). We emphasize the importance of clinical history and oral challenge test in the diagnosis of food allergy.

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[55] - Lee MF, Chen YH, Lan JL, Tseng CY, Wu CH. Allergenic Components of Indian Jujube (Zizyphus mauritiana) Show IgE Cross-Reactivity with Latex Allergen. Int Arch Allergy Immunol 2004;133:211-216

BACKGROUND: 'Latex-fruit syndrome' has been well documented. A prevalence of latex allergy among medical workers of 6.8-8.6% had been reported in Taiwan. However, there has been no study to determine the importance and type of fruit hypersensitivity in latex-allergic patients in Taiwan. This study aimed to identify the allergenic components of Indian jujube (Zizyphus mauritiana) and characterize the cross-reactivity of specific IgE antibodies to latex allergen . METHODS: Crude extracts were prepared from Indian jujube and from ammoniated natural rubber latex, and six medical workers and one patient with a history of fruit allergy underwent skin testing with routine allergens, latex, Indian jujube and other fruits. Sera from two Indian jujube skin test-positive latex-allergic subjects were used for allergen-specific IgE, immunoblotting, immunoblot inhibition and enzyme-linked immunosorbent assay (ELISA) inhibition studies . RESULTS: Both patients had positive skin test responses and specific IgE assays to Indian jujube and latex extracts. Immunoblotting revealed that IgE from both subjects bound to a 42-kD latex protein and a 42-kD Indian jujube protein. In addition, IgE from one subject bound to a 30-kD Indian jujube protein. Preincubation of atopic sera with Indian jujube or latex extract demonstrated absent and/or marked inhibition of IgE binding. Moreover, anti-Indian jujube protein antibody-based ELISA was able to detect latex extracts . CONCLUSIONS: Our results add to findings regarding the 'latex-fruit syndrome' described in the literature, and further study of the cross-reacting allergens identified in Indian jujube may help to elucidate the mechanisms underlying this syndrome.

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[56] - Lombardi C, Mistrello G, Roncarolo D, Senna G, Passalacqua G. Latex-jujube cross-reactivity: case report and immunological study. Allergy 2005;60:971-972

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[57] - Marco F, Ferrer A, Andreu C. Allergic reaction to jujube fruits. EAACI 25th Congress, Vienna, 10-14 June, 2006, Poster n°1556

Jujube (Ziziphus jujuba) is a tree originated in China belonging to the Rhamnaceae family. Jujube fruits are drupes with a sweet taste, of varying sizes depending on the cultivar. Allergic reactions to jujube fruits have been rarely reported, generally associated to latex allergy. We report a case of immediate allergic reaction to jujube fruits in a polysensitized patient. Case Report: a 23 years-old woman reported throat and oesophageal itching related to the ingestion of jujube fruits. These symptoms sometimes were associated to epigastric discomfort and were also triggered by the ingestion of nuts. On anamnesis no other food intolerances or symptoms related to latex exposure were reported. The study included prick tests to a battery of common pneumoallergens and foods, specific IgE determination and immunoblot. Results: prick tests were positive to dust mites, chenopodiaceae pollen, cat and dog and cockroaches. Positive reactions were obtained with peanut and chufa (Cyperus esculentus), a tuber used in Spain to prepare a cold drink named horchata. Specific IgE to jujube fruit was strongly positive, equivalent to 9 kU/l. Protein content in jujube was studied by SDS-PAGE and allergen profile by immunoblot. Conclusion: a case of allergic sensitivity to jujube is reported with no clinical association to latex allergy.

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[58] - Alvarado MI, Moneo I, Gonzalo MA, Alvarez-Eire M, Diaz-Perales A. Allergy to azufaifa fruit and latex. Allergy 2002;57:460-461

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[59] - Lee MF, Tsai JJ, Hwang GY, Lin SJ, Chen YH. Identification of immunoglobulin E (IgE)-binding epitopes and recombinant IgE reactivities of a latex cross-reacting Indian jujube Ziz m 1 allergen. Clin Exp Immunol 2008;152:464-471

Ziz m 1 is a major Indian jujube (Zizyphus mauritiana) allergen involved in latex-fruit syndrome, and cDNA of the allergen has been cloned, sequenced and expressed in yeast by our laboratory previously. In this study, we performed an immunoglobulin E (IgE)-binding epitope analysis of Ziz m 1 using overlapping recombinant fragments. Eight overlapping recombinant fragments were generated from the recombinant Ziz m 1 allergen. The fragments were expressed in Escherichia coli and IgE-binding activities were evaluated by sera of latexˆIndian jujube-allergic subjects and normal subjects using immunoblotting. Human allergic sera are not able to recognize fragments consisting of amino acid sequences 26ˆ71, 119ˆ280 and 119ˆ291. However, residues at positions 26ˆ199, 26ˆ105, 26ˆ86, 119ˆ320 and 238ˆ330 were found relevant in the IgE-binding. Our results indicate that 72NISGHCSDCTFLGEE86 and 292VWNRYYDLKTNYSSSIILEYVNSGTKYLP320 of Ziz m 1 are the sequences required for human IgE binding. Four corresponding peptides, 72NISGHCSDCTE86, 292VWNRYYDLKT301, 300KTNYSSSIILEY311 and 309LEYVNSGTKYLP320, were synthesized, and these peptides reacted with 70%, 100%, 70% and 70% of 10 allergic sera tested, as revealed by enzyme-linked immunosorbent assay. Sensitization to 292VWNRYYDLKT301 correlated significantly with the presence of allergic symptoms (P < 0·001). These findings will be useful in designing diagnostic and therapeutic approaches, thereby contributing to the development of specific immunotherapy for subjects with latexˆfruit syndrome.

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[60] - Lee MF, Hwang GY, Chen YH, Lin HC, Wu CH. Molecular cloning of Indian jujube (Zizyphus mauritiana) allergen Ziz m 1 with sequence similarity to plant class III chitinases. Mol Immunol 2006;43:1144-1151

Indian jujube (Zizyphus mauritiana) is a sweet fruit that is abundantly cultivated in Taiwan. We have previously identified 42 and 30kDa allergens that are cross-reactive with latex allergen from crude Indian jujube extract. This study aimed to clone the 30kDa Ziz m 1 Z. mauritiana allergen. The Ziz m 1 encoding cDNA was isolated from a ZAPII cDNA library constructed from Z. mauritiana mRNA, sequenced and expressed in Pichia pastoris. The protein predicted from the cDNA sequence has 330 amino acids, the first 25 of which constituted a putative signal peptide. The deduced molecular mass of the mature protein is 33.86kDa, while its isoelectric point is estimated at 4.36. The recombinant Ziz m 1 showed chitinase activity, possessed IgE binding capacity, and had IgE cross-reactivity with the latex allergen. Moreover, anti-recombinant Ziz m 1 antibody-based ELISA was able to detect commercial skin testing latex reagent, laboratory prepared latex and Indian jujube extracts. Recombinant Ziz m 1 showed 87.5% skin reactivities on eight latex- and Indian jujube-sensitive subjects. Although no sequence similarity was found to other known allergens, Ziz m 1 was found to have amino acid sequence identity (39-45.3%) to many plant chitinases including chitinase (45.2%) of Hevea brasiliensis (hevamine), class III chitinases of Vigna angularis (45.3%), Capsicum annuum (44.7%) and Oryza sativa (41.2%). A conserved domain search revealed that Ziz m 1 belongs to the family 18 glycosyl hydrolases. The recombinant allergen may therefore be of value for diagnosis and therapeutic purposes, and the further characterization of Indian jujube allergen may help to elucidate the mechanism underlying latex-fruit syndrome.

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[61] - Anliker MD, Reindl J, Vieths S, Wüthrich B. Allergy caused by ingestion of persimmon (Diospyros kaki): detection of specific IgE and cross-reactivity to profilin and carbohydrate determinants. J Allergy Clin Immunol 2001;107:718-723

BACKGROUND: Allergy to persimmon (Diospyros kaki) is very rare and not yet confirmed by means of double-blind, placebo-controlled, food-challenge (DBPCFC). Thus far, specific IgE to this fruit and cross-reactivity to pollen and other foods has not been determined. OBJECTIVE: The objective was to confirm allergy to persimmon in 3 patients with an according personal history and to characterize allergens and cross-reactivity of specific IgE antibodies to pollen and food allergens. One patient reacted with pruritus, penis edema, urticaria, and asthma; the second reacted with nausea and vomitus; and the third reacted with rhinoconjunctivitis, asthma, and stomachache after ingestion of persimmon. METHODS: Patients underwent skin prick testing with routine allergens, latex, persimmon, and other foods. Allergy to persimmon was confirmed by means of a DBPCFC. Specific serum IgE levels were measured with CAP-FEIA and the enzyme allergosorbent test (EAST) method. EAST and immunoblot inhibitions were carried out with persimmon; birch, grass, and ragweed pollen; latex; and N-glycans as inhibitors. RESULTS: All patients had positive skin test responses, DBPCFC and specific IgE assays to persimmon. Blot and EAST inhibition assays revealed IgE to cross-reactive profilin in one patient and IgE to cross-reacting carbohydrate determinants in all patients. CONCLUSIONS: This is the first report on 3 cases of allergy to persimmon verified by means of DBPCFC and detection of specific IgE. The sensitization is due to cross-reactive profilin and carbohydrate

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[62] - Prandini M, Marchesi S. Anaphylaxis to persimmon. Allergy 1999;54:897

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[63] - Bolhaar STHP, van Ree R, Bruijnzeel-Koomen CAFM, Vieths S, Hoffmann-Sommergruber K, Knulst AC, et al. Severe Allergy to Sharon Fruit Caused by Birch Pollen. Int Arch Allergy Immunol 2005;136:45-52

BACKGROUND: Allergy to sharon fruit (persimmon) has been only rarely reported. Cross-reactivity with pollen (profilin and Bet v 6) appeared to be involved, but Bet v 1 has not been implicated previously . OBJECTIVE: It is our aim to identify whether Bet v 1 sensitization is linked to sharon fruit allergy . METHODS: Two patients with a reaction upon first exposure to sharon fruit were included in the study, as well as 7 patients with birch-pollen-related apple allergy. Sensitivity was assessed by skin prick testing (SPT), a radio-allergosorbent test (RAST) and immunoblotting. RAST analysis was performed for Bet v 1, Bet v 2 and Bet v 6. Cross-reactivity was evaluated by RAST and immunoblot inhibitions. Biological activity of IgE was measured by basophil histamine release. Sharon fruit allergy was evaluated by double-blind placebo-controlled food challenge (DBPCFC) or open challenge (OC) . RESULTS: Both sharon-fruit-allergic patients demonstrated positive reactions in the RAST (8.6 and 6.2 IU/ml, respectively) and SPT (wheal area 37 and 36 mm2). Sharon fruit allergy was confirmed by DBPCFC in 1 patient. The second patient refused a challenge because of the severe initial reaction. Sera from both patients were reactive to Bet v 1 and Bet v 6, which was cross-reactive with sharon fruit by inhibition assays. The patient with the severest reactions was reactive to profilin on immunoblotting. However, profilin did not induce significant histamine release, nor did Bet v 6. Bet v 1 induce approximately 60% histamine release. An OC with sharon fruit in 7 patients allergic to birch pollen and apple, who had not eaten sharon fruit previously, was positive in 6/7 cases . CONCLUSIONS: Birch-pollen-related allergy to sharon fruit is mediated by the known cross-reactive pollen allergens including Bet v 1 and may become more of a problem should sharon fruit consumption increase.

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[64] - Martinez JC, Armentia A, Bartolome B, Callejo A, Fuentes MJ, Fernandez A. Anaphylaxis after ingestion of sharon fruit. Allergol Immunopathol (Madr) 2001;29:69-71

The sharon fruit is the edible fruit of the persimmon tree (Diospyros kaki) which belongs to the Ebenaceae family. There are few references of allergic reaction to this fruit. We introduce a case of a 33-years old man with a anaphylactic reaction immediately after ingestion of sharon fruit. METHODS: Skin prick test (SPT) were performed by prick by prick with sharon fruit, legumes, vegetables, and fresh fruit. The test was considered positive when the average diameter of the wheal was > 3 mm. Serum-specific IgE was identified with use of the EIA, and SDS-PAGE Immunoblotting. RESULTS: The skin by prick test with sharon fruit was positive in our case, and negative in five controls patients. Specific IgE in patient serum, assayed by EIA was positive for sharon fruit, but the results of immunoblotting were non-specific. CONCLUSION: We have introduced a cause of anaphylaxis by sharon fruit that suggest an IgE mediated hypersensitivity reaction.

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[65] - Kitano A, Miyazaki T, Yoshioka K, Kurono T, Kurono S, Matsumoto T. Facial rash and palmoplantar pruritus in an infant after first contact with kaki. J Investig Allergol Clin Immunol 2009;19:237-238

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[66] - Ciardiello MA, Tamburrini M, Tuppo L, Carratore V, Giovane A, Mattei B, et al. Pectin methylesterase from kiwi and kaki fruits: purification, characterization, and role of pH in the enzyme regulation and interaction with the kiwi proteinaceous inhibitor. J Agric Food Chem 2004;52:7700-7703

Pectin methylesterase was purified from kiwi (Actinidia chinensis) and kaki fruit (Diospyros kaki). The pH values of the fruit homogenates were 3.5 and 6.2, respectively. The kiwi enzyme is localized in the cell wall and has a neutral-alkaline pI, whereas the kaki enzyme is localized in the soluble fraction and has a neutral-acidic pI. The molecular weights of the kiwi and kaki enzymes were 50 and 37 kDa, respectively. The two enzymes showed a similar salt and pH dependence of activity, and a different pH dependence of the inhibition by the kiwi proteinaceous inhibitor.

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[67] - Anliker MD, Reindl J, Vieths S, Wüthrich B. Allergy caused by ingestion of persimmon (Diospyros kaki): detection of specific IgE and cross-reactivity to profilin and carbohydrate determinants. J Allergy Clin Immunol 2001;107:718-723

BACKGROUND: Allergy to persimmon (Diospyros kaki) is very rare and not yet confirmed by means of double-blind, placebo-controlled, food-challenge (DBPCFC). Thus far, specific IgE to this fruit and cross-reactivity to pollen and other foods has not been determined. OBJECTIVE: The objective was to confirm allergy to persimmon in 3 patients with an according personal history and to characterize allergens and cross-reactivity of specific IgE antibodies to pollen and food allergens. One patient reacted with pruritus, penis edema, urticaria, and asthma; the second reacted with nausea and vomitus; and the third reacted with rhinoconjunctivitis, asthma, and stomachache after ingestion of persimmon. METHODS: Patients underwent skin prick testing with routine allergens, latex, persimmon, and other foods. Allergy to persimmon was confirmed by means of a DBPCFC. Specific serum IgE levels were measured with CAP-FEIA and the enzyme allergosorbent test (EAST) method. EAST and immunoblot inhibitions were carried out with persimmon; birch, grass, and ragweed pollen; latex; and N-glycans as inhibitors. RESULTS: All patients had positive skin test responses, DBPCFC and specific IgE assays to persimmon. Blot and EAST inhibition assays revealed IgE to cross-reactive profilin in one patient and IgE to cross-reacting carbohydrate determinants in all patients. CONCLUSIONS: This is the first report on 3 cases of allergy to persimmon verified by means of DBPCFC and detection of specific IgE. The sensitization is due to cross-reactive profilin and carbohydrate

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[68] - Thomas WR, Smith W. How good are carbohydrates as allergens ? Clin Exp Allergy 2002;32:658-661

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[69] - Anliker MD, Reindl J, Vieths S, Wüthrich B. Allergy caused by ingestion of persimmon (Diospyros kaki): detection of specific IgE and cross-reactivity to profilin and carbohydrate determinants. J Allergy Clin Immunol 2001;107:718-723

BACKGROUND: Allergy to persimmon (Diospyros kaki) is very rare and not yet confirmed by means of double-blind, placebo-controlled, food-challenge (DBPCFC). Thus far, specific IgE to this fruit and cross-reactivity to pollen and other foods has not been determined. OBJECTIVE: The objective was to confirm allergy to persimmon in 3 patients with an according personal history and to characterize allergens and cross-reactivity of specific IgE antibodies to pollen and food allergens. One patient reacted with pruritus, penis edema, urticaria, and asthma; the second reacted with nausea and vomitus; and the third reacted with rhinoconjunctivitis, asthma, and stomachache after ingestion of persimmon. METHODS: Patients underwent skin prick testing with routine allergens, latex, persimmon, and other foods. Allergy to persimmon was confirmed by means of a DBPCFC. Specific serum IgE levels were measured with CAP-FEIA and the enzyme allergosorbent test (EAST) method. EAST and immunoblot inhibitions were carried out with persimmon; birch, grass, and ragweed pollen; latex; and N-glycans as inhibitors. RESULTS: All patients had positive skin test responses, DBPCFC and specific IgE assays to persimmon. Blot and EAST inhibition assays revealed IgE to cross-reactive profilin in one patient and IgE to cross-reacting carbohydrate determinants in all patients. CONCLUSIONS: This is the first report on 3 cases of allergy to persimmon verified by means of DBPCFC and detection of specific IgE. The sensitization is due to cross-reactive profilin and carbohydrate

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[70] - Bolhaar STHP, van Ree R, Bruijnzeel-Koomen CAFM, Vieths S, Hoffmann-Sommergruber K, Knulst AC, et al. Severe Allergy to Sharon Fruit Caused by Birch Pollen. Int Arch Allergy Immunol 2005;136:45-52

BACKGROUND: Allergy to sharon fruit (persimmon) has been only rarely reported. Cross-reactivity with pollen (profilin and Bet v 6) appeared to be involved, but Bet v 1 has not been implicated previously . OBJECTIVE: It is our aim to identify whether Bet v 1 sensitization is linked to sharon fruit allergy . METHODS: Two patients with a reaction upon first exposure to sharon fruit were included in the study, as well as 7 patients with birch-pollen-related apple allergy. Sensitivity was assessed by skin prick testing (SPT), a radio-allergosorbent test (RAST) and immunoblotting. RAST analysis was performed for Bet v 1, Bet v 2 and Bet v 6. Cross-reactivity was evaluated by RAST and immunoblot inhibitions. Biological activity of IgE was measured by basophil histamine release. Sharon fruit allergy was evaluated by double-blind placebo-controlled food challenge (DBPCFC) or open challenge (OC) . RESULTS: Both sharon-fruit-allergic patients demonstrated positive reactions in the RAST (8.6 and 6.2 IU/ml, respectively) and SPT (wheal area 37 and 36 mm2). Sharon fruit allergy was confirmed by DBPCFC in 1 patient. The second patient refused a challenge because of the severe initial reaction. Sera from both patients were reactive to Bet v 1 and Bet v 6, which was cross-reactive with sharon fruit by inhibition assays. The patient with the severest reactions was reactive to profilin on immunoblotting. However, profilin did not induce significant histamine release, nor did Bet v 6. Bet v 1 induce approximately 60% histamine release. An OC with sharon fruit in 7 patients allergic to birch pollen and apple, who had not eaten sharon fruit previously, was positive in 6/7 cases . CONCLUSIONS: Birch-pollen-related allergy to sharon fruit is mediated by the known cross-reactive pollen allergens including Bet v 1 and may become more of a problem should sharon fruit consumption increase.

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[71] - Karamloo F, Wangorsch A, Kasahara H, Davin LB, Haustein D, Lewis NG, et al. Phenylcoumaran benzylic ether and isoflavonoid reductases are a new class of cross-reactive allergens in birch pollen, fruits and vegetables. Eur J Biochem 2001;268:5310-5320

We investigated the biochemical function of the birch pollen allergen Bet v 6 and its role in the IgE-cross-reactivity between birch pollen and plant foods, and characterized Pyr c 5, a Bet v 6-related food allergen, from pear; the proteins were expressed as His-Tag fusion proteins in Eschershia coli and purified by Ni-chelate affinity chromatography under native conditions. Nonfusion proteins were obtained by factor Xa protease treatment. The highest degree of amino-acid sequence identity of Pyr c 5 and Bet v 6 was found with a plant protein related to a defense mechanism, which we have named phenylcoumaran benzylic ether reductase (PCBER) based on its ability to catalyze the NADPH-dependent reduction of 8-5' linked lignans such as dehydrodiconiferyl alcohol to give isodihydrodehydrodiconiferyl alcohol. Enzymatic assays with recombinant Pyr c 5 and Bet v 6 showed PCBER catalytic activity for both recombinant allergens. Both Pyr c 5 and Bet v 6 allergens had similar IgE binding characteristics in immunoblotting and enzyme allergosorbent tests (EAST), and bound IgE from 10 sera of birch-pollen-allergic patients including six pear-allergic subjects. EAST inhibition experiments with Pyr c 5 as the solid phase antigen suggested that homologous allergens may be present in many vegetable foods such as apple, peach, orange, lychee fruit, strawberry, persimmon, zucchini (courgette), and carrot. In extracts of pear, apple, orange, and persimmon, the presence of proteins of approximately 30-35 kDa containing Bet v 6 cross-reactive epitopes was demonstrated with two Bet v 6-specific monoclonal antibodies. Recombinant Pyr c 5 triggered a strong, dose-dependent mediator release from basophils of a pear-allergic subject, suggesting that Pyr c 5 has the potential to elicit type I allergic reactions.

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[72] - Sokolova A, Martins P, Prates S, Loureiro V, Bartolomé B, Leiria Pinto P. Anaphylaxis caused by ingestion of persimmon (Diospyros kaki). Allergy 2009;64(Suppl. 90):483

Background: Diospyros kaki, originally cultivated in China and Japan, was introduced in Europe in the mid of 19th century. Allergy to this fruit is extremely rare and to date there are only 6 published cases with documented IgE- mediated reactions. Clinical case: We describe a case of a 24-year-old woman who suffered of hay fever, without any previous food allergy. Persimmon fruit was frequently a part of her diet. In October of 2007 the patient experienced lip pruritus and oedema immediately after eating raw persimmon. Some minutes later she felt dizzy, vomited and started abdominal pain. The symptoms responded promptly to endovenous corticosteroid and anti-H1. The patient suffered a similar episode one month later also immediately after ingestion of raw persimmon. Since then she eliminated this fruit from her diet. Skin prick tests were positive for Dermatophagoides and Grass pollen. Skin prickto- prick tests performed with raw persimmon pulp and peel were both positive (12 and 9 mm respectively). Serum specific IgE for Dyospiros kaki was 0.7 kU/l and for Lolium perenne 6.7 kU/l. SDS PAGE immunoblotting revealed binding bands with the following molecular weights: 1)incubation with extract of Lolium perenne pollen without 2-mercaptoethanol - 97, 60, 32 and 28 kDa; with 2-mercaptoethanol - 68, 32, 30 kDa 2)incubation with extract from Diospyros kaki without 2-mercaptoethanol - no IgE bands to mention; with 2-mercaptoethanol 40 kDa and 28- 30 kDa (a very faint band). Study performed with Immuno Solid-phase Allergen Chip (ISAC®) identified the presence of specific IgE for rDer f 1, rLol p 1 e rPhl p1.0102 and was negative for other allergens, rBet v 2 included. Discussion: This is the report of a case of anaphylaxis to ingestion of persimmon fruit. In 5 of 6 previously reported cases of allergy to Diospyros kaki there was sensitisation to birch pollen and in 4 to grass pollen. In our patient there was no evidence of sensitization to birch pollen allergens. The immunoblotting study of serum of our patient incubated with Diospyros kaki extract in reducing condition permitted to identify a protein with molecular weight of 40 kDa. There was no similar protein when serum was incubated with Lolium perenne extract. To our knowledge, this protein was not previously documented in persimmon fruit allergic patients.

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[73] - Kitano A, Miyazaki T, Yoshioka K, Kurono T, Kurono S, Matsumoto T. Facial rash and palmoplantar pruritus in an infant after first contact with kaki. J Investig Allergol Clin Immunol 2009;19:237-238

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[74] - Torre J, Ibañez M, Escudero C, Bartolomé B. Oral Allergy Syndrome (OAS) and contact urticaria due to sharoni fruit. Allergy 2008;63(suppl. 88):324

Background: The increase in the consumption of exotic fruits is leading to develop new allergies in atopic patients either caused by cross-reactivity or by primary sensitisation. Sharon fruit is a variety of kaki (Diospyros kaki) that is mainly cultivated in Israel. A 13-year-old girl complained of episodes of contact urticaria while peeling a sharon fruit and oral ichting, swelling and erythema on her lips after its intake when she was 8-yearold. Also she referred once fingers ichting when she was manipulating a kaki. Since then she has not eaten Rosaceae fruits such as apple, plum, peach and apricot due to her fear to have new allergic reactions. She has rhinoconjuctivitis and asthma due to pollens exposition. Methods: Skin prick tests (SPT) were carried out with a battery of common inhalants allergens and pollen profilin from palm (Phoenix dactylifera). Skin prick-to-prick (SPPT) were performed with apple, peach, plum, kaki and sharon fruit. Serum specific IgE against these fruits were measured by CAP method and against kaki and Sharon fruit by EAST technique. SDS-PAGE and IgE-inmunoblotting with kaki and sharon fruit was carried out. Results: SPT resulted positive to extracts from grasses pollen, olive pollens and to palm profilin. SPPT were positive (43 mm2) against all fruits tested. SPPT (mm2) to sharon (peel: 4x4; pulp: 5x5) and kaki (peel: 4x3; pulp: 4x4). Serum specific IgE to apple, peach and plum were positive (40.35 kU/L). Serum specific IgE to sharon (peel: 0.4 kU/L; pulp: 1.4 kU/L), kaki (peel:<0.35 kU/L; pulp: 1.2 kU/L). Several IgE-binding bands with molecular mass ranging from 18 to 66 kDa were found; the three most IgE-reactive ones (18, 38 and 50 kDa) appeared in both kaki and sharon fruit extracts. Conclusions: we present a girl with contact urticaria and OAS after sharon fruit consumption. Several IgE-binding bands were detected in both kaki and sharon fruit; Two of the most IgE-reactive ones showed molecular mass of 18-kDa and 38-kDa; IgE binding bands of these sizes have been described as Sharon proteins which showed cross-reactivity with Bet v 1 and Bet v 6 respectively.

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[75] - Bolhaar STHP, van Ree R, Bruijnzeel-Koomen CAFM, Vieths S, Hoffmann-Sommergruber K, Knulst AC, et al. Severe Allergy to Sharon Fruit Caused by Birch Pollen. Int Arch Allergy Immunol 2005;136:45-52

BACKGROUND: Allergy to sharon fruit (persimmon) has been only rarely reported. Cross-reactivity with pollen (profilin and Bet v 6) appeared to be involved, but Bet v 1 has not been implicated previously . OBJECTIVE: It is our aim to identify whether Bet v 1 sensitization is linked to sharon fruit allergy . METHODS: Two patients with a reaction upon first exposure to sharon fruit were included in the study, as well as 7 patients with birch-pollen-related apple allergy. Sensitivity was assessed by skin prick testing (SPT), a radio-allergosorbent test (RAST) and immunoblotting. RAST analysis was performed for Bet v 1, Bet v 2 and Bet v 6. Cross-reactivity was evaluated by RAST and immunoblot inhibitions. Biological activity of IgE was measured by basophil histamine release. Sharon fruit allergy was evaluated by double-blind placebo-controlled food challenge (DBPCFC) or open challenge (OC) . RESULTS: Both sharon-fruit-allergic patients demonstrated positive reactions in the RAST (8.6 and 6.2 IU/ml, respectively) and SPT (wheal area 37 and 36 mm2). Sharon fruit allergy was confirmed by DBPCFC in 1 patient. The second patient refused a challenge because of the severe initial reaction. Sera from both patients were reactive to Bet v 1 and Bet v 6, which was cross-reactive with sharon fruit by inhibition assays. The patient with the severest reactions was reactive to profilin on immunoblotting. However, profilin did not induce significant histamine release, nor did Bet v 6. Bet v 1 induce approximately 60% histamine release. An OC with sharon fruit in 7 patients allergic to birch pollen and apple, who had not eaten sharon fruit previously, was positive in 6/7 cases . CONCLUSIONS: Birch-pollen-related allergy to sharon fruit is mediated by the known cross-reactive pollen allergens including Bet v 1 and may become more of a problem should sharon fruit consumption increase.

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[76] - Fiocchi A, Isoardi P, Pastori P, Martelli A, Sarratud T. Litchi sinensis allergy in a boy. ACAAI Annual Meeting, New Orleans, 7-12 Nov. 2003, Poster n° 69

The description of allergy to Litchi chinensis is confined to adults. In December 2002 a 15-year-old boy presented after labial oedema, hives, pruritus, and general malaise which developed soon after eating litchis. Antihistamine had been administered without success. Soon after admission to our PICU, the boy developed extensive urticaria and went into shock with diaphoresis, hypotension and vomiting. Therapy with epinephrine, chlorpheniramine and hydrocortisone sodium succinate administered via a percutaneous catheter achieved symptomatic control within 30 minutes. Hives disappeared after two days‚ cetirizine therapy. After discharge the boy was referred for allergy workup to our paediatric allergy unit. The boy had a history of seasonal pollen rhinitis. Lung obstruction with MEF50 81% and MEF25 78% of normal value was found (amenable to bronchodilator therapy). Prior to onset of symptoms, the patient had eaten pasta, beef and vegetables followed by three litchis obtained from a local outlet. Total serum IgE levels were 51.2 IU/mL. Specific IgE determinations using CAP system technology tested positive for Artemisia (17.80 IU/mL), birch (11.28 IU/mL), hazelnut (35.87 IU/mL), and grass (6.50 IU/mL). SPTs with fresh kiwi, orange, mandarin, celery, carrot and tomato induced positive wheals (>3 mm diameter) with reactions to litchi and cucumber being the strongest (>10 mm diameter), although cucumber was tolerated by the patient. Strict avoidance of litchi was advised and instructions regarding injectable epinephrine use were given. This is the second report of anaphylaxis following ingestion of litchis. As this was the first time the boy was tasting this fruit, we speculate that cross-sensitization with pollens was pre-existent. We present this case as cautionary evidence against introducing novel foods of relatively unknown allergenic potential in children with multiple pollen sensitisations without performing at least a labial provocation test.

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[77] - Niggemann B, Reibel S, Hipler C, Wahn U. Anaphylactic reaction to lychee in a 12-year-old girl: cross-reactivity to latex? Pediatr Allergy Immunol 2002;13:64-67

There are very few case reports on allergic reactions to lychee in the literature - so far only in adults. We report on a 12-year-old girl who developed swelling of lips, pruritus, generalized urticaria and dyspnea 30 min after eating a raw lychee. A second event occurred after eating a piece of cake covered with a fruit cocktail. All other foods were well tolerated. In infancy the girl had suffered from atopic dermatitis, which disappeared in childhood; for the previous 2 yr she had presented with seasonal allergic rhinoconjunctivitis. Upon oral provocation, she developed restlessness, flush, generalized urticaria and inspiratory stridor 50 min after eating half a lychee. The diagnostic work up showed a clear positive skin prick test to raw lychee and specific immunoglobulin E (IgE) in serum to latex but not to lychee. In the cellular antigen stimulation test (CAST) carried out with lychee extracts in several concentrations, the same positive results could be found confirming an allergic reaction. Cross-reactivity of lychee to latex was shown by inhibition experiments using the UniCAP 100-system. In conclusion, it seems worthwhile considering the rare allergy to lychee in the case of unclear food-allergic reactions and lychee should be added to the list of foods cross-reacting with latex.

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[78] - Raap U, Schaefer T, Kapp A, Wedi B. Exotic Food Allergy: Anaphylactic Reaction to Lychee. J Investig Allergol Clin Immunol 2007;17:199-201

There are very few reports on allergic reactions to lychee fruit in the literature. We describe the case of a 26-year-old man who developed pruritus, generalized urticaria, and severe angioedema of his lips and tongue with dyspnea within 15 minutes after lychee fruit intake. Although we found no lychee-specific immunoglobulin E antibodies, a basophil activation test (BAT) and a cellular antigen stimulation test (CAST) to lychee were both positive, as was a prick-to-prick test with fresh lychee fruit. The patient also suffered from an oral food allergy syndrome to parsley and was sensitized to mugwort but not to latex or profilin. BAT and CAST are helpful tools in the diagnostic workup for exotic food allergy. Mugwort is suggested as the allergen responsible for,the cross-reactivity presented by this patient, as he had no sensitization to latex or profilin.

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[79] - Fäh J, Wüthrich B, Vieths S. Anaphylactic reaction to lychee fruit: evidence for sensitization to profilin. Clin Exp Allergy 1995;25(10):1018-1023

Due to the increasing popularity of exotic fruits in the Western diet, allergologists are confronted with allergic reactions to substances in these plants. The present report describes an anaphylactic reaction after the consumption of lychee fruit (Litchi sinensis). The atopic patient also suffers from rhinoconjunctivitis due to a sensitization against pollen of the Compositae family, as well as from dyspnoea after eating sunflower seeds. Our goals were to determine crossreactivity between antibodies against lychee fruit and other plants and to characterize the allergen. METHODS AND RESULTS: Specific IgE against lychee fruits were detected by an EAST assay. The allergen was characterized by immunoblot, immunoblot inhibition and EAST inhibition assays. Broad crossreactivity between lychee fruit and other plants was found and profilin identified as the protein responsible for the patient's complex allergy syndrome. CONCLUSION: Lychee fruit contains a significant amount of profilin. Consumption of this exotic fruit can cause severe anaphylactic reactions in patients being sensitized against the plant pan-allergen profilin.

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[80] - Garrido S, García BE, Goienetxe E, Rodriguez A, Sanz ML, Tabar AI. Allergy due to lychee. EAACI 23th Congress, Amsterdam, 12-16 June, 2004, Poster n°985

Introduction Lychee is a tropical fruit from South-East Asia with an increasing consumption in Western diet in the last few years. It belongs to the family of Sapindaceae. Few cases of allergy to this fruit have been described in literature. We report a 25 year-old female who presented rhinoconjunctivitis, facial swelling, generalized itching and diffuse erythema a few minutes after ingestion of two fresh lychees, progressively she started to suffer from high breathing difficulty and dysphonia. One mild similar episode had appeared after eating a fruit cake in childhood. She suffered from erythema and general itching when eating sunflower seeds. Furthermore she reported rhinitis and conjunctivitis in spring and after exposing to daisies. Methods Skin prick tests (SPTs) were carried out with fresh lychee fruit, other fruits, nuts, condiments, vegetables, other foods and common airborne allergens. We measured total and specific Ig E against those allergens that were positive in SPTs (CAP-System, Pharmacia). The percentage of basophil activated by the basophil activation test (BAT) was measured in control subjects and in the patient blood with lychee, sunflower seed, celery and mugwort at different dilutions. A histamine release test (HRT) and a cellular antigen stimulation test (CAST) were also performed. Allergens characterization of lychee, sunflower seeds and celery and Ig E binding proteins with patient‚s serum were identified by SDS-PAGE and Immunoblotting respectively. Results SPTs were positive for lychee fruit, sunflower seed, pistachio, aniseed, parsley, celery and to Phleum pratense and mugwort pollen. Specific Ig E to lychee fruit, Phleum pratense and mugwort pollen were positive and negative to sunflower seeds, pistachio, birch and both birch and Phleum pratense profilin. BAT was positive to sunflower seed, celery and mugwort and negative to lychee. HRT was positive to sunflower seeds and mugwort. The CAST showed a positive response to sunflower seed, celery and mugwort. In Immunoblotting with patient serum we found three Ig E binding bands in lychee of 80 Kda, 70 Kda and 21 Kda, and two Ig E binding bands in sunflower seeds of 70 Kda and 26 Kda. Conclusion We report on a woman with anaphylaxis after eating two lychee fruit, prick test, the Ig E-mediated mechanism and immunoblotting results confirm it. Crossreactivity between Compositae family and lychee fruit is consider.

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[81] - Song JJ, Zhang HY, Liu ZG, Ran PX. Cloning of the panallergen profilin from lychee fruit and its cross-reactivity with birch pollen profilin Bet v 2. Food Agric Immunol 2007;18:129-138

Lychee fruits can cause severe anaphylactic reactions and has cross-reactivity with other allergens. Panallergen profilin is partly responsible for the cross-reactivity between allergens. In the present study, the cDNA of lychee profilin was performed by RT-PCR and 3'RACE from total RNA. The lychee profilin cDNA includes an open reading frame coding for 131 amino acids. The deduced amino acid sequence of the corresponding protein show high identity with other allergenic profilins. Expression of the recombinant lychee profilin was carried out in Escherichia coli BL21 (DE3) using vector PET-28a, and the purification of the recombinant protein was performed via affinity chromatography with Ni+ coupled to sepharose. IgE reactivity of recombinant lychee profilin was investigated by immunoblot, and five of 15 lychee-allergic patients tested presented specific IgE antibodies to recombinant lychee profilin. IgE inhibition and ELISA inhibition experiments were performed to analyze lychee profilin cross-reactivity with profilins from birch pollen, and a high cross-reactivity between lychee profilin and birch profilin has been found in sera from lychee allergic patients.

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[82] - Hoppe S, Steinhart H, Paschke A. Identification of a 28 kDa lychee allergen as a triose-phosphate isomerase. Food Agric Immunol 2006;17:9-19

The aim of this study was to investigate the allergenic potency of the exotic fruit lychee (Litchi chinensis SONN.). For this purpose the lychee protein extract was separated by ion exchange chromatography and a purified allergen with a molecular weight of 28 kDa was identified by N-terminal sequencing and peptide mass fingerprinting. Both methods determined the lychee allergen as a triose-phosphate isomerase. To this protein 67% of patients showed allergic reactions respectively IgE binding of their sera. Similar enzymes from other plants were also recognized as allergens.

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[83] - Wellhausen A, Schöning B, Petersen A, Vieths S. IgE binding to a new cross-reactive structure: a 35 kDa protein in birch pollen, exotic fruit and other plant foods. Z Ernahrungswiss 1996;35:348-355

Food allergies in birch pollen allergic patients have been shown to be due to cross-reactivities of specific IgE antibodies which are directed against birch pollen allergens with related proteins in fruit, nuts and vegetables. We identified a new cross-reactive structure of 35 kDa in birch pollen and some plant food extracts by Enzyme Allergosorbent Test (EAST) and immunoblot inhibition studies. The 35 kDa birch pollen protein is a minor allergen to which approximately 10-15% of birch pollen allergic individuals have specific IgE. Our data demonstrate that there is cross-reactivity of this protein with proteins of comparable size from lychee, mango, banana, orange, apple, pear and carrot. While the 35 kDa protein is immunologically independent of the major birch pollen allergen Bet v 1, we also observed IgE binding to a 34 kDa structure which appears to be a Bet v 1 dimer.

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[84] - Vieths S, Frank E, Scheurer S, Meyer HE, Hrazdina G, Haustein D. Characterization of a new IgE-binding 35-kDa protein from birch pollen with cross-reacting homologues in various plant foods. Scand J Immunol 1998;47:263-272

The present investigation was undertaken to obtain molecular data of a new immunoglobulin (Ig)E-binding birch pollen protein with a mass of 35 kDa. In a previous study, this protein showed IgE cross-reactivity with 34- and 35-kDa proteins in apples, pears, carrots, bananas and other exotic fruits. Since the protein was N-terminally blocked, it was purified by preparative SDS-PAGE, and multiple proteolytic fragments were subsequently generated by in-gel digestion with the endoproteinases Glu C, Lys C and Clostripain. After electrophoretic separation and blotting onto polyvinylidene difluoride (PVDF), the resulting polypeptides were subjected to N-terminal amino acid microsequencing. The internal sequences obtained showed a high degree of sequence identity to isoflavone reductases (IFR) and isoflavone reductase-like proteins (IRL) from several plants which also had a similar size. For a stretch of 25 consecutive residues this identity ranged from 56% for IFR from peas and chick peas and an IRL from maize, to 80% for a tobacco IRL. A 453 bp fragment was amplified from total birch pollen RNA by polymerase chain reaction (PCR) using primers derived from the nucleotide sequence of the tobacco IRL. The deduced 151 amino acid sequence represented approximately 50% of the protein and confirmed the sequence identities obtained by Edman degradation. Moreover, the 25 amino acid sequence was included in the cloned fragment. Deduced and determined amino acids showed only one mismatch, which was due to a single nucleotide exchange. At the antibody level, the immunological relationship of the birch pollen protein to IRL and IFR was demonstrated by immunoblotting with a rabbit antiserum against a pea IFR which recognized the same birch protein as patients' IgE. The rabbit antiserum also reproduced the cross-reactivity pattern previously observed with patients' IgE by recognizing related proteins in specific plant foods, including some exotic fruits. We therefore suggest that the 35-kDa birch pollen protein belongs to the IFR/IRL family and represents a minor allergen, possibly being responsible for less common pollen-related food allergies in patients allergic to birch pollen.

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[85] - Karamloo F, Schmitz N, Scheurer S, Foetisch K, Hoffmann A, Haustein D, et al. Molecular cloning and characterization of a birch pollen minor allergen, Bet v 5, belonging to a family of isoflavone reductase-related proteins. J Allergy Clin Immunol 1999;104:991-999

Birch pollen is a major cause of pollinosis and is responsible for cross-reactive oral allergies to fruits, nuts, and vegetables. The major allergen, Bet v 1, has been extensively characterized, and 3 minor allergens, Bet v 2, Bet v 3, and Bet v 4, have been cloned and sequenced. Recently, another birch pollen protein with an apparent mass of 35 kd was described as a new IgE-binding protein in birch pollen with cross-reacting homologues in plant foods. OBJECTIVE: The aim of this study was to determine the primary structure of the 35-kd birch pollen allergen and to investigate its immunologic properties. METHODS: On the basis of a known complementary DNA fragment, a PCR strategy was applied to obtain the full-length nucleotide sequence of the coding region. The protein was expressed as His-Tag fusion protein in Escherichia coli and purified by Ni-chelate affinity chromatography. Nonfusion protein was obtained by cyanogen bromide treatment of the fusion protein. IgE-binding characteristics and potential allergenicity were investigated by immunoblot, immunoblot inhibition analysis, rat basophil leukemia-cell mediator release assay, and basophil histamine release and compared with those of natural (n) Bet v 5, recombinant (r)Bet v 1, and rBet v 2. RESULTS: Recombinant Bet v 5 has a mass of 33 kd, an isoelectric point of 9.0, and sequence identity of 60% to 80% to isoflavone reductase homologue proteins from various plants. On immunoblots the recombinant Bet v 5 bound IgE from 9 (32%) of 28 sera from patients allergic to birch pollen with a CAP class of at least 3; Bet v 1 was detected by 89% of these patients. IgE immunoblot and inhibition experiments showed that nBet v 5 and rBet v 5 shared identical epitopes. A rabbit antiserum raised against pea isoflavone reductase and patients' IgE reacted with Bet v 5 and proteins of similar size in several vegetable foods, including exotic fruits. A similar reaction pattern was obtained with 2 Bet v 5-specific mAbs. Furthermore, Bet v 5 triggered a dose-dependent mediator release from rat basophil leukemia 2H3 cells passively sensitized with murine anti-birch pollen IgE and from basophils of a Bet v 5-reactive subject with birch pollen allergy. In contrast, no mediator release could be induced from basophils of a subject who was monosensitized to Bet v 1. CONCLUSIONS: This 33-kd protein, designated as Bet v 5, is a new minor allergen in birch pollen and may be responsible for pollen-related oral allergy to specific foods in a minority of patients with birch pollen allergy. Amino acid sequence comparison and immunoreactivity to anti-isoflavone reductase serum indicate that Bet v 5 is related to isoflavone reductase, a protein family that is involved in plant defense reactions.

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[86] - Lüttkopf D, Ballmer-Weber BK, Wüthrich B, Vieths S. Celery allergens in patients with positive double-blind placebo-controlled challenge. J Allergy Clin Immunol 2000;106:390-399

BACKGROUND: Recently, for the first time, allergy to celery was confirmed by double-blind placebo-controlled food challenge (DBPCFC). Api g 1, Api g 4, cross-reactive carbohydrate determinants (CCD), and a 60 kDa allergen have been described as celery allergens . OBJECTIVE: To get insights in IgE responses of patients with a positive DBPCFC to celery tuber (celeriac) compared with patients with a negative challenge test . METHODS: Specific IgE to native and heated celery tuber and to recombinant Api g 1, the major celery allergen, were determined by enzyme allergosorbent test and immunoblotting. IgE binding to Api g 1, Api g 4, and CCD was confirmed by inhibition experiments that used recombinant Api g 1, recombinant Api g 4, pure N-glycans, and extracts of celeriac, lychee fruit, and pollens of birch, mugwort, and timothy grass as inhibitors . RESULTS: Immunoblotting with sera from 22 patients with a positive DBPCFC to celeriac confirmed the presence of known allergenic structures: The major allergen Api g 1 (16 kDa) was recognized by IgE from 13 of 22 patients (59%). Another major allergen was CCD, determined by IgE reactivity in 12 of 22 patients (55%). Celery profilin, Api g 4, was recognized by IgE from 5 of 22 patients (23%) . CONCLUSION: Our DBPCFC-positive patients exclusively presented IgE to known celery allergens, although the prevalences were slightly different than were previously reported. No obvious differences were found in patients with positive IgE antibody but negative challenge test. IgE binding to all 3 structures in celeriac extract was inhibited by birch pollen extract, whereas mugwort pollen extract could only inhibit IgE reactivity to Api g 4 and CCD. Inhibition experiments with a purified carbohydrate moiety clearly showed that the IgE epitope mannose-xylose-fucose-glycan (Manalpha1-6[Xylbeta1-2]Manbeta1-4GlcNAcbeta1-4[ Fucalpha1-3]GlcNAc) or a closely related structure is present in celeriac extract and is important in patients with clinical allergy to celery.

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[87] - Niggemann B, Reibel S, Hipler C, Wahn U. Anaphylactic reaction to lychee in a 12-year-old girl: cross-reactivity to latex? Pediatr Allergy Immunol 2002;13:64-67

There are very few case reports on allergic reactions to lychee in the literature - so far only in adults. We report on a 12-year-old girl who developed swelling of lips, pruritus, generalized urticaria and dyspnea 30 min after eating a raw lychee. A second event occurred after eating a piece of cake covered with a fruit cocktail. All other foods were well tolerated. In infancy the girl had suffered from atopic dermatitis, which disappeared in childhood; for the previous 2 yr she had presented with seasonal allergic rhinoconjunctivitis. Upon oral provocation, she developed restlessness, flush, generalized urticaria and inspiratory stridor 50 min after eating half a lychee. The diagnostic work up showed a clear positive skin prick test to raw lychee and specific immunoglobulin E (IgE) in serum to latex but not to lychee. In the cellular antigen stimulation test (CAST) carried out with lychee extracts in several concentrations, the same positive results could be found confirming an allergic reaction. Cross-reactivity of lychee to latex was shown by inhibition experiments using the UniCAP 100-system. In conclusion, it seems worthwhile considering the rare allergy to lychee in the case of unclear food-allergic reactions and lychee should be added to the list of foods cross-reacting with latex.

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[88] - Fiocchi A, Isoardi P, Pastori P, Martelli A, Sarratud T. Litchi sinensis allergy in a boy. ACAAI Annual Meeting, New Orleans, 7-12 Nov. 2003, Poster n° 69

The description of allergy to Litchi chinensis is confined to adults. In December 2002 a 15-year-old boy presented after labial oedema, hives, pruritus, and general malaise which developed soon after eating litchis. Antihistamine had been administered without success. Soon after admission to our PICU, the boy developed extensive urticaria and went into shock with diaphoresis, hypotension and vomiting. Therapy with epinephrine, chlorpheniramine and hydrocortisone sodium succinate administered via a percutaneous catheter achieved symptomatic control within 30 minutes. Hives disappeared after two days‚ cetirizine therapy. After discharge the boy was referred for allergy workup to our paediatric allergy unit. The boy had a history of seasonal pollen rhinitis. Lung obstruction with MEF50 81% and MEF25 78% of normal value was found (amenable to bronchodilator therapy). Prior to onset of symptoms, the patient had eaten pasta, beef and vegetables followed by three litchis obtained from a local outlet. Total serum IgE levels were 51.2 IU/mL. Specific IgE determinations using CAP system technology tested positive for Artemisia (17.80 IU/mL), birch (11.28 IU/mL), hazelnut (35.87 IU/mL), and grass (6.50 IU/mL). SPTs with fresh kiwi, orange, mandarin, celery, carrot and tomato induced positive wheals (>3 mm diameter) with reactions to litchi and cucumber being the strongest (>10 mm diameter), although cucumber was tolerated by the patient. Strict avoidance of litchi was advised and instructions regarding injectable epinephrine use were given. This is the second report of anaphylaxis following ingestion of litchis. As this was the first time the boy was tasting this fruit, we speculate that cross-sensitization with pollens was pre-existent. We present this case as cautionary evidence against introducing novel foods of relatively unknown allergenic potential in children with multiple pollen sensitisations without performing at least a labial provocation test.

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[89] - Garrido S, García BE, Goienetxe E, Rodriguez A, Sanz ML, Tabar AI. Allergy due to lychee. EAACI 23th Congress, Amsterdam, 12-16 June, 2004, Poster n°985

Introduction Lychee is a tropical fruit from South-East Asia with an increasing consumption in Western diet in the last few years. It belongs to the family of Sapindaceae. Few cases of allergy to this fruit have been described in literature. We report a 25 year-old female who presented rhinoconjunctivitis, facial swelling, generalized itching and diffuse erythema a few minutes after ingestion of two fresh lychees, progressively she started to suffer from high breathing difficulty and dysphonia. One mild similar episode had appeared after eating a fruit cake in childhood. She suffered from erythema and general itching when eating sunflower seeds. Furthermore she reported rhinitis and conjunctivitis in spring and after exposing to daisies. Methods Skin prick tests (SPTs) were carried out with fresh lychee fruit, other fruits, nuts, condiments, vegetables, other foods and common airborne allergens. We measured total and specific Ig E against those allergens that were positive in SPTs (CAP-System, Pharmacia). The percentage of basophil activated by the basophil activation test (BAT) was measured in control subjects and in the patient blood with lychee, sunflower seed, celery and mugwort at different dilutions. A histamine release test (HRT) and a cellular antigen stimulation test (CAST) were also performed. Allergens characterization of lychee, sunflower seeds and celery and Ig E binding proteins with patient‚s serum were identified by SDS-PAGE and Immunoblotting respectively. Results SPTs were positive for lychee fruit, sunflower seed, pistachio, aniseed, parsley, celery and to Phleum pratense and mugwort pollen. Specific Ig E to lychee fruit, Phleum pratense and mugwort pollen were positive and negative to sunflower seeds, pistachio, birch and both birch and Phleum pratense profilin. BAT was positive to sunflower seed, celery and mugwort and negative to lychee. HRT was positive to sunflower seeds and mugwort. The CAST showed a positive response to sunflower seed, celery and mugwort. In Immunoblotting with patient serum we found three Ig E binding bands in lychee of 80 Kda, 70 Kda and 21 Kda, and two Ig E binding bands in sunflower seeds of 70 Kda and 26 Kda. Conclusion We report on a woman with anaphylaxis after eating two lychee fruit, prick test, the Ig E-mediated mechanism and immunoblotting results confirm it. Crossreactivity between Compositae family and lychee fruit is consider.

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[90] - Fäh J, Wüthrich B, Vieths S. Anaphylactic reaction to lychee fruit: evidence for sensitization to profilin. Clin Exp Allergy 1995;25(10):1018-1023

Due to the increasing popularity of exotic fruits in the Western diet, allergologists are confronted with allergic reactions to substances in these plants. The present report describes an anaphylactic reaction after the consumption of lychee fruit (Litchi sinensis). The atopic patient also suffers from rhinoconjunctivitis due to a sensitization against pollen of the Compositae family, as well as from dyspnoea after eating sunflower seeds. Our goals were to determine crossreactivity between antibodies against lychee fruit and other plants and to characterize the allergen. METHODS AND RESULTS: Specific IgE against lychee fruits were detected by an EAST assay. The allergen was characterized by immunoblot, immunoblot inhibition and EAST inhibition assays. Broad crossreactivity between lychee fruit and other plants was found and profilin identified as the protein responsible for the patient's complex allergy syndrome. CONCLUSION: Lychee fruit contains a significant amount of profilin. Consumption of this exotic fruit can cause severe anaphylactic reactions in patients being sensitized against the plant pan-allergen profilin.

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[91] - Moneret-Vautrin DA, Lemerdy P, Morisset M, Croizier A, Kanny G. Allergie alimentaire et sensibilisation IgE dépendantes aux épices: données du CICBAA (sur 589 cas d'allergie alimentaire). Alim'Inter 2002;7:53-62

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[92] - Moneret-Vautrin DA, Lemerdy P, Morisset M, Croizier A, Kanny G. Allergie alimentaire et sensibilisation IgE dépendantes aux épices: données du CICBAA (sur 589 cas d'allergie alimentaire). Alim'Inter 2002;7:53-62

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[93] - Fiocchi A, Isoardi P, Pastori P, Martelli A, Sarratud T. Litchi sinensis allergy in a boy. ACAAI Annual Meeting, New Orleans, 7-12 Nov. 2003, Poster n° 69

The description of allergy to Litchi chinensis is confined to adults. In December 2002 a 15-year-old boy presented after labial oedema, hives, pruritus, and general malaise which developed soon after eating litchis. Antihistamine had been administered without success. Soon after admission to our PICU, the boy developed extensive urticaria and went into shock with diaphoresis, hypotension and vomiting. Therapy with epinephrine, chlorpheniramine and hydrocortisone sodium succinate administered via a percutaneous catheter achieved symptomatic control within 30 minutes. Hives disappeared after two days‚ cetirizine therapy. After discharge the boy was referred for allergy workup to our paediatric allergy unit. The boy had a history of seasonal pollen rhinitis. Lung obstruction with MEF50 81% and MEF25 78% of normal value was found (amenable to bronchodilator therapy). Prior to onset of symptoms, the patient had eaten pasta, beef and vegetables followed by three litchis obtained from a local outlet. Total serum IgE levels were 51.2 IU/mL. Specific IgE determinations using CAP system technology tested positive for Artemisia (17.80 IU/mL), birch (11.28 IU/mL), hazelnut (35.87 IU/mL), and grass (6.50 IU/mL). SPTs with fresh kiwi, orange, mandarin, celery, carrot and tomato induced positive wheals (>3 mm diameter) with reactions to litchi and cucumber being the strongest (>10 mm diameter), although cucumber was tolerated by the patient. Strict avoidance of litchi was advised and instructions regarding injectable epinephrine use were given. This is the second report of anaphylaxis following ingestion of litchis. As this was the first time the boy was tasting this fruit, we speculate that cross-sensitization with pollens was pre-existent. We present this case as cautionary evidence against introducing novel foods of relatively unknown allergenic potential in children with multiple pollen sensitisations without performing at least a labial provocation test.

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[94] - Panadero P, Pineda F, Sanchez I, Jimenez M, Moral A, Senent C. Anaphylaxis to exotic fruits. Allergy Clin Immunol Int 2005;17(Suppl. 1):346

Background: Due to the increasing popularity fruit or vegetables in the western diet, is not rare to expect cases relationed to these delicacies. Lychee fruit belongs to the family of sapindaceae. The association between this kind of fruits and allergic reactions to fruits, and vegetables are well established and anaphylactic reactions against mango, avocado and kiwi fruit have been described Case report: A 53 years old man with personal history of allergy to pollens presented after the intake of milk with several lychee fruits, fresh date, cherry and mandarins, conjunctival hyperemia, arterial hypotension, palpebral and glottis oedema, without lost consciousness and he required emergency services Skin prick test (SPT) performed with profilins containing extracts were positive and grapes, cherry, kiwi, and avocado extracts were negative. Prick by prick with the lychee fruit (Litchi sinensis) and date (Phoenix dactylifera) were positive in patient. SDS PAGEˆimmunoblotting using the patient´s serum revealed different IgE-binding protein bands between transferred extracts, but two major bands of 22, and 70 kDa in the lychee fruit, Artemisia vulgaris, and date extracts were commonly revealed between them (fig 1.) Conclusions: This case illustrates anaphylaxis and IgE-mediated sensitization to lychee fruit (Litchi sinensis) and date (Phoenix dactylifera) and their supposed cross-reactivity with profilins containing fonts but other proteins were suspected as being responsible of these reactions.

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[95] - Raap U, Schaefer T, Kapp A, Wedi B. Exotic Food Allergy: Anaphylactic Reaction to Lychee. J Investig Allergol Clin Immunol 2007;17:199-201

There are very few reports on allergic reactions to lychee fruit in the literature. We describe the case of a 26-year-old man who developed pruritus, generalized urticaria, and severe angioedema of his lips and tongue with dyspnea within 15 minutes after lychee fruit intake. Although we found no lychee-specific immunoglobulin E antibodies, a basophil activation test (BAT) and a cellular antigen stimulation test (CAST) to lychee were both positive, as was a prick-to-prick test with fresh lychee fruit. The patient also suffered from an oral food allergy syndrome to parsley and was sensitized to mugwort but not to latex or profilin. BAT and CAST are helpful tools in the diagnostic workup for exotic food allergy. Mugwort is suggested as the allergen responsible for,the cross-reactivity presented by this patient, as he had no sensitization to latex or profilin.

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[96] - Garrido S, García BE, Goienetxe E, Rodriguez A, Sanz ML, Tabar AI. Allergy due to lychee. EAACI 23th Congress, Amsterdam, 12-16 June, 2004, Poster n°985

Introduction Lychee is a tropical fruit from South-East Asia with an increasing consumption in Western diet in the last few years. It belongs to the family of Sapindaceae. Few cases of allergy to this fruit have been described in literature. We report a 25 year-old female who presented rhinoconjunctivitis, facial swelling, generalized itching and diffuse erythema a few minutes after ingestion of two fresh lychees, progressively she started to suffer from high breathing difficulty and dysphonia. One mild similar episode had appeared after eating a fruit cake in childhood. She suffered from erythema and general itching when eating sunflower seeds. Furthermore she reported rhinitis and conjunctivitis in spring and after exposing to daisies. Methods Skin prick tests (SPTs) were carried out with fresh lychee fruit, other fruits, nuts, condiments, vegetables, other foods and common airborne allergens. We measured total and specific Ig E against those allergens that were positive in SPTs (CAP-System, Pharmacia). The percentage of basophil activated by the basophil activation test (BAT) was measured in control subjects and in the patient blood with lychee, sunflower seed, celery and mugwort at different dilutions. A histamine release test (HRT) and a cellular antigen stimulation test (CAST) were also performed. Allergens characterization of lychee, sunflower seeds and celery and Ig E binding proteins with patient‚s serum were identified by SDS-PAGE and Immunoblotting respectively. Results SPTs were positive for lychee fruit, sunflower seed, pistachio, aniseed, parsley, celery and to Phleum pratense and mugwort pollen. Specific Ig E to lychee fruit, Phleum pratense and mugwort pollen were positive and negative to sunflower seeds, pistachio, birch and both birch and Phleum pratense profilin. BAT was positive to sunflower seed, celery and mugwort and negative to lychee. HRT was positive to sunflower seeds and mugwort. The CAST showed a positive response to sunflower seed, celery and mugwort. In Immunoblotting with patient serum we found three Ig E binding bands in lychee of 80 Kda, 70 Kda and 21 Kda, and two Ig E binding bands in sunflower seeds of 70 Kda and 26 Kda. Conclusion We report on a woman with anaphylaxis after eating two lychee fruit, prick test, the Ig E-mediated mechanism and immunoblotting results confirm it. Crossreactivity between Compositae family and lychee fruit is consider.

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[97] - Fäh J, Wüthrich B, Vieths S. Anaphylactic reaction to lychee fruit: evidence for sensitization to profilin. Clin Exp Allergy 1995;25(10):1018-1023

Due to the increasing popularity of exotic fruits in the Western diet, allergologists are confronted with allergic reactions to substances in these plants. The present report describes an anaphylactic reaction after the consumption of lychee fruit (Litchi sinensis). The atopic patient also suffers from rhinoconjunctivitis due to a sensitization against pollen of the Compositae family, as well as from dyspnoea after eating sunflower seeds. Our goals were to determine crossreactivity between antibodies against lychee fruit and other plants and to characterize the allergen. METHODS AND RESULTS: Specific IgE against lychee fruits were detected by an EAST assay. The allergen was characterized by immunoblot, immunoblot inhibition and EAST inhibition assays. Broad crossreactivity between lychee fruit and other plants was found and profilin identified as the protein responsible for the patient's complex allergy syndrome. CONCLUSION: Lychee fruit contains a significant amount of profilin. Consumption of this exotic fruit can cause severe anaphylactic reactions in patients being sensitized against the plant pan-allergen profilin.

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[98] - Garrido S, García BE, Goienetxe E, Rodriguez A, Sanz ML, Tabar AI. Allergy due to lychee. EAACI 23th Congress, Amsterdam, 12-16 June, 2004, Poster n°985

Introduction Lychee is a tropical fruit from South-East Asia with an increasing consumption in Western diet in the last few years. It belongs to the family of Sapindaceae. Few cases of allergy to this fruit have been described in literature. We report a 25 year-old female who presented rhinoconjunctivitis, facial swelling, generalized itching and diffuse erythema a few minutes after ingestion of two fresh lychees, progressively she started to suffer from high breathing difficulty and dysphonia. One mild similar episode had appeared after eating a fruit cake in childhood. She suffered from erythema and general itching when eating sunflower seeds. Furthermore she reported rhinitis and conjunctivitis in spring and after exposing to daisies. Methods Skin prick tests (SPTs) were carried out with fresh lychee fruit, other fruits, nuts, condiments, vegetables, other foods and common airborne allergens. We measured total and specific Ig E against those allergens that were positive in SPTs (CAP-System, Pharmacia). The percentage of basophil activated by the basophil activation test (BAT) was measured in control subjects and in the patient blood with lychee, sunflower seed, celery and mugwort at different dilutions. A histamine release test (HRT) and a cellular antigen stimulation test (CAST) were also performed. Allergens characterization of lychee, sunflower seeds and celery and Ig E binding proteins with patient‚s serum were identified by SDS-PAGE and Immunoblotting respectively. Results SPTs were positive for lychee fruit, sunflower seed, pistachio, aniseed, parsley, celery and to Phleum pratense and mugwort pollen. Specific Ig E to lychee fruit, Phleum pratense and mugwort pollen were positive and negative to sunflower seeds, pistachio, birch and both birch and Phleum pratense profilin. BAT was positive to sunflower seed, celery and mugwort and negative to lychee. HRT was positive to sunflower seeds and mugwort. The CAST showed a positive response to sunflower seed, celery and mugwort. In Immunoblotting with patient serum we found three Ig E binding bands in lychee of 80 Kda, 70 Kda and 21 Kda, and two Ig E binding bands in sunflower seeds of 70 Kda and 26 Kda. Conclusion We report on a woman with anaphylaxis after eating two lychee fruit, prick test, the Ig E-mediated mechanism and immunoblotting results confirm it. Crossreactivity between Compositae family and lychee fruit is consider.

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[99] - Panadero P, Pineda F, Sanchez I, Jimenez M, Moral A, Senent C. Anaphylaxis to exotic fruits. Allergy Clin Immunol Int 2005;17(Suppl. 1):346

Background: Due to the increasing popularity fruit or vegetables in the western diet, is not rare to expect cases relationed to these delicacies. Lychee fruit belongs to the family of sapindaceae. The association between this kind of fruits and allergic reactions to fruits, and vegetables are well established and anaphylactic reactions against mango, avocado and kiwi fruit have been described Case report: A 53 years old man with personal history of allergy to pollens presented after the intake of milk with several lychee fruits, fresh date, cherry and mandarins, conjunctival hyperemia, arterial hypotension, palpebral and glottis oedema, without lost consciousness and he required emergency services Skin prick test (SPT) performed with profilins containing extracts were positive and grapes, cherry, kiwi, and avocado extracts were negative. Prick by prick with the lychee fruit (Litchi sinensis) and date (Phoenix dactylifera) were positive in patient. SDS PAGEˆimmunoblotting using the patient´s serum revealed different IgE-binding protein bands between transferred extracts, but two major bands of 22, and 70 kDa in the lychee fruit, Artemisia vulgaris, and date extracts were commonly revealed between them (fig 1.) Conclusions: This case illustrates anaphylaxis and IgE-mediated sensitization to lychee fruit (Litchi sinensis) and date (Phoenix dactylifera) and their supposed cross-reactivity with profilins containing fonts but other proteins were suspected as being responsible of these reactions.

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[100] - Moneret-Vautrin DA, Lemerdy P, Morisset M, Croizier A, Kanny G. Allergie alimentaire et sensibilisation IgE dépendantes aux épices: données du CICBAA (sur 589 cas d'allergie alimentaire). Alim'Inter 2002;7:53-62

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[101] - Kelso JM, Jones RT, Yunginger JW. Anaphylaxis after initial ingestion of rambutan, a tropical fruit. J Allergy Clin Immunol 1998;102:145-146

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[102] - Rank MA, Li JT. A case of food allergy due to longan fruit. Ann Allergy Asthma Immunol 2007;98:402

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[103] - Lebo DB, Ditto AM, Boxer MB, Grammer LC, Bonagura VR, Roberts M. Anaphylaxis to ackee fruit. J Allergy Clin Immunol 1996;98:997-998

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[104] - Paschke A, Kinder H, Zunker K, Wigotzki M, Wessbecher R, Vieluf D, et al. Characterization of allergens in mango fruit and ripening dependence of the allergenic potency. Food Agric Immunol 2001;13:51-61

Characterization of IgE-related mango allergens in human sera, and the occurrence of allergens during ripening of mangoes were investigated. Mol. wt. of IgE-binding allergens were determined by SDS-PAGE/immunoblotting. Of 52 sera from patients with IgE-mediated sensitization to mangoes, 46 contained 2 allergens with mol. wt. of approx. 40 and 30 kDa; these were described as the major allergens. Other IgE-binding patterns were detected in <50% of assigned sera. 2D-electrophoresis proved that the 40 kDa major allergen exists as an isoallergen with isoelectric points of 4.6 and 4.8. The 30 kDa allergen has an isoelectric point of 4.9. According to international rules, the 40 kDa allergen was named Mangifera indica 1 (Man i 1) and the 30 kDa allergen, Mangifera indica 2 (Man i 2). SDS-PAGE/immunoblotting, immunoblot inhibition and EAST-inhibition analyses showed that there was no significant difference in allergenic potency during fruit ripening

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[105] - Dube M, Zunker K, Neidhart S, Carle R, Steinhart H, Paschke A. Effect of technological processing on the allergenicity of mangoes (Mangifera indica L.). J Agric Food Chem 2004;52:3938-3945

In parallel with the rising popularity of exotic fruits in Europe, allergy against mango is of increasing importance. Because mangoes are also consumed as processed products such as chutneys or beverages, the influences of different process conditions on their allergenicity were investigated. Mango purees and nectars were manufactured at small pilot-plant scale, and the allergenic potencies of the resulting intermediate and final products were determined by means of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), immunoblotting and inhibitive enzyme allergosorbent tests (EAST-inhibition), using a pool serum of 9 individuals with manifest mango allergy. The mango allergens were shown to be very stable during technological processing. Irrespective of enzymatic matrix decomposition, mechanical tissue disintegration and heating during peeling, mash treatment, and pasteurization, significant loss of allergenicity could not be observed in the extracts of mango purees and nectars derived thereof. These results were confirmed by analogous investigation of commercial mango drinks and nectars. Hence, conventional mango processing into pulp-containing products typical for this species obviously does not allow complete elimination of the allergenic potency.

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[106] - Hegde VL, Venkatesh YP. Anaphylaxis following ingestion of mango fruit. J Investig Allergol Clin Immunol 2007;17:341-344

Allergic reactions to fresh fruits and nuts have become increasingly common. Mango (Mangifera indica) is a popular fruit eaten all over the world. We report the case of a 43-year-old woman who experienced oropharyngeal itching, swelling of the face and other parts of the body, and difficulty breathing within a few minutes of eating ripe mango fruit. The woman had no history of pollen or latex allergy. However, she reported instances of milder food allergic reactions to Indian dill and cashew apple. Skin prick tests using mango fruit pulp, Indian dill, and cashew apple extracts were positive. Prick tests with a panel of common grass and weed pollen extracts were negative. Enzyme-linked immunosorbent assay for mango-specific serum immunoglobulin (Ig) E was positive. A specific protein allergen in mango could not be detected by immunoblotting. Based on the strongly positive clinical history and results of allergy testing, it was concluded that the woman had IgE-mediated anaphylactic reactions to mango fruit.

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[107] - Song J, Zhang H, Liu Z, Ran P. Mango profilin: cloning, expression and cross-reactivity with birch pollen profilin Bet v 2. Mol Biol Rep 2008;35:231-237

Mango can cause severe anaphylactic reactions. Profilin has been assumed partly responsible for the cross-reactivity between mango fruit and other allergens but has not been finally clarified. In this study, two isoforms of mango fruits profilin were amplified by RT-PCR and 3'RACE from total RNA. Each mango profilin cDNA includes an open reading frame coding for 131 amino acids. The deduced amino acid sequence of the corresponding protein show high identity with other allergenic profilins. Expression of the recombinant mango profilin was carried out in Escherichia coli BL21(DE3) using vector PET28a and the purification of the recombinant protein was performed via affinity chromatography with Ni(+) coupled to sepharose. IgE reactivity of recombinant mango profilin was investigated by immunoblot and 8 of 18 mango-allergic patients tested presented specific IgE-antibodies to recombinant mango profilin. IgE-inhibition and ELISA inhibition experiments were performed to analyze mango profilin cross-reactivity with profilins from birch pollen and high cross-reactivities have been found

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[108] - Paschke A, Kinder H, Zunker K, Wigotzki M, Wessbecher R, Vieluf D, et al. Characterization of allergens in mango fruit and ripening dependence of the allergenic potency. Food Agric Immunol 2001;13:51-61

Characterization of IgE-related mango allergens in human sera, and the occurrence of allergens during ripening of mangoes were investigated. Mol. wt. of IgE-binding allergens were determined by SDS-PAGE/immunoblotting. Of 52 sera from patients with IgE-mediated sensitization to mangoes, 46 contained 2 allergens with mol. wt. of approx. 40 and 30 kDa; these were described as the major allergens. Other IgE-binding patterns were detected in <50% of assigned sera. 2D-electrophoresis proved that the 40 kDa major allergen exists as an isoallergen with isoelectric points of 4.6 and 4.8. The 30 kDa allergen has an isoelectric point of 4.9. According to international rules, the 40 kDa allergen was named Mangifera indica 1 (Man i 1) and the 30 kDa allergen, Mangifera indica 2 (Man i 2). SDS-PAGE/immunoblotting, immunoblot inhibition and EAST-inhibition analyses showed that there was no significant difference in allergenic potency during fruit ripening

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[109] - Diaz-Perales A, Collada C, Blanco C, Sanchez-Monge R, Carillo T, Aragoncillo C, et al. Cross-reactions in the latex-fruit syndrome: a relevant role of chitinases but not of complex asparagine-linked glycans. J Allergy Clin Immunol 1999;104:681-687

BACKGROUND: Cross-reactions between latex and plant foods (mainly fruits) have been widely reported. Although the cross-reactive components have not been well identified, class I chitinases seem to be the most credible candidates in chestnut, avocado, and banana . OBJECTIVE: We sought to evaluate the potential role of chitinases and complex glycans as cross-reactive determinants linked to latex-food allergy . METHODS: Extracts from 20 different plant foods and from latex were obtained. These preparations were immunodetected with anticomplex glycans and antichitinase sera raised in rabbits, as well as with sera from patients with latex-fruit allergy and sera from patients allergic to latex without food allergy. Immunoblot inhibition assays were carried out by using a purified class I chitinase from avocado or latex extract as inhibitors . RESULTS: Reactive proteins of approximately 30 to 45 kd (putative class I chitinases) were recognized by both specific polyclonal antibodies to chitinases and sera from patients with latex-fruit allergy in chestnut, cherimoya, passion fruit, kiwi, papaya, mango, tomato, and flour wheat extracts. Prs a 1, the major allergen and class I chitinase from avocado, and the latex extract strongly or fully inhibited IgE binding by these components when tested in immunoblot inhibition assays. Additional bands of 16 to 20 kd, 23 to 28 kd, and 50 to 70 kd were detected by the antichitinase serum but not with the patients' pooled sera. The putative 30- to 45-kd chitinases present in different food extracts did not react with a pool of sera from subjects allergic to latex but not to fruit. Very different immunodetection patterns were produced with the anticomplex glycan serum and the sera from allergic patients . CONCLUSIONS: Putative class I chitinases seem to be relevant cross-reactive components in foods associated with the latex-fruit syndrome, but do not play a specific role in allergy to latex but not to fruit. Cross-reactive carbohydrate determinants are not important structures in the context of latex-fruit cross-sensitization.

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[110] - Brehler R, Theissen U, Mohr C, Luger T. 'Latex-fruit syndrome': frequency of cross-reacting IgE antibodies. Allergy 1997;52:404-410

An association between allergies to latex proteins and to various foods has been reported and confirmed by RAST and immunoblotting inhibition. However, no significant data had been collected on the frequency of specific IgE antibodies to fruits in these patients and the frequency of a history of fruit intolerance. Serum samples of 136 patients with well-documented, clinically relevant, immediate-type hypersensitivity against latex proteins were analyzed for IgE antibodies against a panel of different fruits. Patient history of food intolerance was documented by a standardized questionnaire. Fruit-specific IgE antibodies were detected in 69.1% of serum samples. Cross-reacting IgE antibodies recognizing latex and fruit allergens (papaya. avocado, banana, chestnut, passion fruit, fig. melon, mango, kiwi, pineapple, peach, and tomato) were demonstrated by RAST-inhibition tests. Of our patients 42.6% reported allergic symptoms after ingestion of these fruits and a total of 112 intolerance reactions were recorded. However, fruit-specific IgE antibodies were detected only in serum samples from 32.1% of the patients who perceived symptoms due to these fruits. Thus, serologic tests seem to be of low significance for prediction of food allergy in latex-allergic patients.

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[111] - Wellhausen A, Schöning B, Petersen A, Vieths S. IgE binding to a new cross-reactive structure: a 35 kDa protein in birch pollen, exotic fruit and other plant foods. Z Ernahrungswiss 1996;35:348-355

Food allergies in birch pollen allergic patients have been shown to be due to cross-reactivities of specific IgE antibodies which are directed against birch pollen allergens with related proteins in fruit, nuts and vegetables. We identified a new cross-reactive structure of 35 kDa in birch pollen and some plant food extracts by Enzyme Allergosorbent Test (EAST) and immunoblot inhibition studies. The 35 kDa birch pollen protein is a minor allergen to which approximately 10-15% of birch pollen allergic individuals have specific IgE. Our data demonstrate that there is cross-reactivity of this protein with proteins of comparable size from lychee, mango, banana, orange, apple, pear and carrot. While the 35 kDa protein is immunologically independent of the major birch pollen allergen Bet v 1, we also observed IgE binding to a 34 kDa structure which appears to be a Bet v 1 dimer.

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[112] - Karamloo F, Wangorsch A, Kasahara H, Davin LB, Haustein D, Lewis NG, et al. Phenylcoumaran benzylic ether and isoflavonoid reductases are a new class of cross-reactive allergens in birch pollen, fruits and vegetables. Eur J Biochem 2001;268:5310-5320

We investigated the biochemical function of the birch pollen allergen Bet v 6 and its role in the IgE-cross-reactivity between birch pollen and plant foods, and characterized Pyr c 5, a Bet v 6-related food allergen, from pear; the proteins were expressed as His-Tag fusion proteins in Eschershia coli and purified by Ni-chelate affinity chromatography under native conditions. Nonfusion proteins were obtained by factor Xa protease treatment. The highest degree of amino-acid sequence identity of Pyr c 5 and Bet v 6 was found with a plant protein related to a defense mechanism, which we have named phenylcoumaran benzylic ether reductase (PCBER) based on its ability to catalyze the NADPH-dependent reduction of 8-5' linked lignans such as dehydrodiconiferyl alcohol to give isodihydrodehydrodiconiferyl alcohol. Enzymatic assays with recombinant Pyr c 5 and Bet v 6 showed PCBER catalytic activity for both recombinant allergens. Both Pyr c 5 and Bet v 6 allergens had similar IgE binding characteristics in immunoblotting and enzyme allergosorbent tests (EAST), and bound IgE from 10 sera of birch-pollen-allergic patients including six pear-allergic subjects. EAST inhibition experiments with Pyr c 5 as the solid phase antigen suggested that homologous allergens may be present in many vegetable foods such as apple, peach, orange, lychee fruit, strawberry, persimmon, zucchini (courgette), and carrot. In extracts of pear, apple, orange, and persimmon, the presence of proteins of approximately 30-35 kDa containing Bet v 6 cross-reactive epitopes was demonstrated with two Bet v 6-specific monoclonal antibodies. Recombinant Pyr c 5 triggered a strong, dose-dependent mediator release from basophils of a pear-allergic subject, suggesting that Pyr c 5 has the potential to elicit type I allergic reactions.

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[113] - Kinder H, Scharf B, Steinhart H, Paschke A. Investigation of IgE-binding patterns and allergenicity of mango fruit allergens in different varieties. Internet Symp Food Allergens 1999;1(2):43-49

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[114] - Besler M, Paschke A, Rodriguez J. Allergen data collection: mango. Internet Symp Food Allergens 2001;3(3):135-141

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[115] - Brehler R, Theissen U, Mohr C, Luger T. 'Latex-fruit syndrome': frequency of cross-reacting IgE antibodies. Allergy 1997;52:404-410

An association between allergies to latex proteins and to various foods has been reported and confirmed by RAST and immunoblotting inhibition. However, no significant data had been collected on the frequency of specific IgE antibodies to fruits in these patients and the frequency of a history of fruit intolerance. Serum samples of 136 patients with well-documented, clinically relevant, immediate-type hypersensitivity against latex proteins were analyzed for IgE antibodies against a panel of different fruits. Patient history of food intolerance was documented by a standardized questionnaire. Fruit-specific IgE antibodies were detected in 69.1% of serum samples. Cross-reacting IgE antibodies recognizing latex and fruit allergens (papaya. avocado, banana, chestnut, passion fruit, fig. melon, mango, kiwi, pineapple, peach, and tomato) were demonstrated by RAST-inhibition tests. Of our patients 42.6% reported allergic symptoms after ingestion of these fruits and a total of 112 intolerance reactions were recorded. However, fruit-specific IgE antibodies were detected only in serum samples from 32.1% of the patients who perceived symptoms due to these fruits. Thus, serologic tests seem to be of low significance for prediction of food allergy in latex-allergic patients.

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[116] - Gaspar A, Raulf-Heimsoth M, Pires G, Rihs HP, Yeang HY, Matos V, et al. Latex allergen sensitization patterns in different risk groups and latex-fruit syndrome patients from Portugal. EAACI 23th Congress, Amsterdam, 12-16 June, 2004, Poster n°1188

Background: Latex allergy has been recognized as a clinically important health problem, mainly in some risk groups: spina bifida (SB), other congenital malformations submitted to multiple surgeries (MS) and health care workers (HCW). Purpose: To study IgE-binding reactivity to latex allergens, by using recombinant and natural allergens, in latex-allergic patients from different risk groups including patients with latex-fruit syndrome (LFS). Material and Methods: We selected sera of 51 latex-allergic patients within different risk groups: 20 with SB, 10 MS and 21 HCW; all these patients had positive skin prick tests with commercial latex extract (ALK-Abelló) and serum latex-specific IgE determined by UniCAP®(Pharmacia Diagnostics). Sixteen out of the 51 patients had LFS. A panel of single recombinant latex allergens was coupled to ImmunoCAPs (CAP system®) and the isolated natural allergen nHev b 2 was coupled on paper disks (EAST testing). This panel comprised rHev b 1, nHev b 2, rHev b 3, rHev b 5, rHev b 6.01, rHev b 7, rHev b 8, rHev b 9, rHev b 10 and rHev b 11. The recombinant allergens were produced as fusion protein with maltose-binding protein (MBP) in E. coli. MBP coupled on ImmunoCAPs served as control. Specific IgE values of >0.35kU/l were considered positive. Major allergen is defined if produces a positive IgE response in more than 50% of the tested group. Results: Recombinant Hev b 1 specific IgE antibodies were detected in 70% sera from SB, 30% from MS, 5% from HCW, and in 13% sera from LFS patients. For nHev b 2: SB-69%, MS-71%, HCW-71% and LFS-75%. For rHev b 3: SB-50%, MS-20%, HCW-10% and LFS-13%. For rHev b 5: SB-55%, MS-40%, HCW-62% and LFS-75%. For rHev b 6.01: SB-45%, MS-30%, HCW-76% and LFS-81%. For rHev b 7: SB-33%, MS-0%, HCW-16% and LFS-27%. For rHev b 8: SB-10%, MS-0%, HCW-5% and LFS-6%. For rHev b 9 and rHev b 10: SB-0%, MS-0%, HCW-5% and LFS-7%. For rHev b 11: SB-7%, MS-0%, HCW-5% and LFS-7%. Conclusions: The different routes of exposure influence the IgE antibody pattern. The major latex allergens identified in SB were Hev b 1, Hev b 2, Hev b 3 and Hev b 5, being Hev b 1 the most important one. The major allergen identified in MS was Hev b 2. For occupational exposure route, the major latex allergens identified in HCW were Hev b 2, Hev b 5 and Hev b 6.01, being prohevein the most important one. Regarding cross-reactivity with foods, the major allergens identified in LFS were Hev b 2, Hev b 5 and Hev b 6.01.

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[117] - Scheurer S, Pastorello EA, Wangorsch A, Kästner M, Haustein D, Vieths S. Recombinant allergens Pru av 1 and Pru av 4 and a newly identified lipid transfer protein in the in vitro diagnosis of cherry allergy. J Allergy Clin Immunol 2001;107:724-731

BACKGROUND: In central and northern Europe food allergy to fruits of the Rosaceae family is strongly associated with birch pollinosis because of the existence of IgE cross-reactive homologous allergens in birch pollen and food. By contrast, in the Mediterranean population allergic reactions to these fruits frequently are not related to birch pollen allergy and are predominantly elicited by lipid transfer proteins (LTPs). OBJECTIVE: We sought to determine the prevalence of IgE sensitization to the recombinant cherry allergens Pru av 1 and Pru av 4 in comparison with cherry extract within a representative group of patients who were allergic to cherries recruited in Germany and to compare the relevance of IgE to cherry LTPs in Italian patients. METHODS: Recombinant Pru av 1 and rPru av 4 were available from earlier studies. The cDNA of the cherry LTPs was obtained by using a PCR-cloning strategy. The protein was expressed in Escherichia coli and purified by means of metal chelate affinity chromatography. Sera from 101 German patients with birch pollinosis and oral allergy syndrome to cherry and sera from 7 Italian patients with cherry allergy were investigated by using enzyme allergosorbent tests for IgE reactivity with cherry extract, rPru av 1, rPru av 4, and the recombinant cherry LTP. Inhibition experiments were performed to compare the IgE reactivity of natural and recombinant cherry LTPs and to investigate potential cross-reactivity with birch pollen allergens. RESULTS: The LTP from cherry comprises 91 amino acids and a 26 amino acid signal peptide. The mature cherry LTP shows high amino acid sequence identity with allergenic LTPs from peach (Pru p 3, 88%), apricot (Pru ar 3, 86%), and maize (Zea m 14, 59%) and displays no IgE cross-reactivity with birch pollen. The IgE prevalences in the German patients were as follows: LTP, 3 of 101 (3%); rPru av 1, 97 of 101 (96.0%); rPru av 4, 16 of 101 (16.2%); and cherry extract, 98 of 101 (97%). All 7 Italian patients had IgE against the cherry LTP. CONCLUSIONS: Recombinant allergens are useful tools for a more accurate in vitro IgE-based diagnosis of cherry allergy. Taken together, they mimic the allergenic activity of cherry extract, having slightly higher biologic activity. Sensitization to the cherry LTP is relevant for a minority of patients recruited in Germany, but our data indicate that it may be a major allergen in Italy.

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[118] - Rodriguez J, Mielgo R, Gonzalez A, Crespo JF. Allergic Reactions to Fresh Fruits: Beyond Oral Symptoms. AAAAI 62nd Annual Meeting, Miami, 3-7 March 2006, Poster n°1163

RATIONALE: Fruit allergy is frequently considered to be associated with mild oral symptoms in the context of the pollen-food allergy syndrome, while few studies have focused on fruits as a cause of severe allergic reactions METHODS: Three hundred forty-six allergic reactions to fruits were diagnosed in 194 patients (135 female), aged from 14 to 72 yrs. (median = 27 yrs). The diagnostic procedure followed the guidelines for the evaluation of the adverse reactions to foods from the EAACI, including a clinical questionnaire, skin testing, fruit-specific serum IgE (CAP-FEIA) and open challenges, followed if positive by DBPCFC, unless a convincing history of severe anaphylaxis RESULTS: One hundred-eighty (52%) reactions consisted exclusively of isolated oral symptoms. The most frequent offenders were: melon, 42(23%); kiwi, 28(15.5%) and avocado, 24 (13%). One hundred twentyeight (37%) systemic reactions were accompanied with oral symptoms The most frequent foods were peach, 29 (23%); kiwi, 21 (16%), and melon, 18 (14%). Thirty-eight (11%) systemic reactions did not show any oral symptoms. Peach, 10 reactions (26%); banana, 8 (21%); and kiwi, 4(10.5%), were the most frequent causal foods. Grades of severity were: mild, 15 reactions; moderate, 5 reactions; severe, 13 reactions; life-threatening, 5 reactions. Three patients reported having isolated oral symptoms months before their systemic reactions took place (2 peach, 1 banana) CONCLUSIONS: Half of the fresh-fruit allergic reactions consist of isolated oral symptoms, with melon being the most frequent culprit However, systemic reactions are relevant, being peach the most frequent causative agent in our area Funding: Mº Sanidad (Grant G03-094)

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[119] - Levy DA, Mounedji N, Noirot C, Leynadier F. Allergic sensitization and clinical reactions to latex, food and pollen in adult patients. Clin Exp Allergy 2000;30:270-275

Many latex-allergic patients are sensitized to one or more foods. Patients allergic to tree and/or grass pollens are also often sensitized to plant-derived foods. Atopy, defined in most studies as sensitivity to an aeroallergen, is a risk factor for latex allergy. The relative importance of pollen sensitivity, a sign of atopy, as a risk factor for food allergy in latex-allergic patients has not, however, been examined. OBJECTIVE: To investigate the relationship between pollen sensitivity and sensitivity to food in latex-allergic patients. METHODS: Forty-four latex-allergic patients (Groups 1 and 2), 24 of whom were also allergic to tree and/or grass pollen (Group 1) and 25 pollinosis patients who were not allergic to latex (Group 3) were studied. We obtained a history of reactions to food and skin tested them with 12 fresh-frozen fruits. RESULTS: All 12 foods induced a skin test reaction in at least one patient in each of the three Groups. There were, however, twice as many positive skin test reactions to food in patients with pollinosis, whether or not they were allergic to latex, as there were in patients allergic to latex but not to pollen. Latex-allergic patients were most likely to have a positive skin test and a history of a reaction to avocado or banana whereas patients with pollinosis only were most likely to have a positive skin test and a history of a reaction to apple, peach or celery. CONCLUSIONS: These results suggest that concomitant allergy to pollen is an important risk factor in determining which plant-derived foods sensitize latex-allergic patients.

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[120] - Duque S, Fernandez-Pello L, Rodriguez F. Mango allergy in a latex-sensitized patient. Allergy 1999;54:1004-1005

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[121] - Gaspar A, Neto-Braga C, Pires G, Murta R, Morais-Almeida M, Rosado-Pinto J. Anaphylactic reaction to manioc: cross-reactivity to latex. Allergy 2003;58:683-684

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[122] - Oliveira S, Câmara R, Câmara I, Carvalho M, Borges F. Latex allergy - cross reactivity to food - Funchal Hospital Immunoallergy. EAACI 22th Congress, Paris, 7-11 June, 2003, Poster n°1239

Background: A considerable increase in latex allergy has become apparent since the early 1980s. It's known that some groups of persons are especially likely to suffer from latex allergy. On these patients the cross reactivity syndrome seems to be more prevalent and must to be studied. Purpose: The aim of this study is to calculate the incidence of latex allergy in outpatients Immunoallergy Clinic, of Funchal Hospital, during the year of 2001 and characterize the "latex-fruit syndrome" in this population. Material and methods: Clinical characterization of patients group with latex allergy and evaluation of sensitization to different allergens through skin prick tests (SPT), with standard commercial extracts, and oral open challenge. Results: Studied population: n=14. Gender distribution: female (71%), male (29%). Population mean age: 33.6 years old and mean age for appearance of first symptoms- 30.5 years old. Clinical presentation: muco-cutaneous and respiratory-71%, and anaphylaxis-28.5 %. The interval between the first contact and first symptoms was on average-13 years. Personal and family histories of atopy were present in 50% of cases. Associated allergic disease-36% of cases; all of them had rhinitis. Associated bronchial asthma was present in one case and food allergy in another. In all cases, there was daily/professional use of latex articles. "Latex-fruit syndrome" was present in 71% of the patients. SPT positive to: latex -100%; fruits - 85%. Fruit sensitisation distribution: hazelnut, chestnut and maize - 8%, banana and avocado - 17%, peach - 25%, kiwi - 42%, mango - 58%. Pollens sensitization was present in 90% of cases, 55% of whom had rhinitis. In this population we observed high total IgE and latex specific IgE positive in 86% of the patients, on average higher than 8.1 UI/mL. Conclusions: The prevalence of sensitization to latex remains unknown in general population, but it is supposed to be less than 1%. Distinct groups at risk for latex allergy include children with spina bifida (18 - 73%), and health care workers (3 - 17%). Our outpatient prevalence was 10%. It's remarkable the existence of cross reactivity to phylogenetically distant plants - "latex-fruit syndrome"- what could be explained by preview sensitisation to other allergens like pollens.

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[123] - Silva R, Lopes C, Castro E, Ferraz de Oliveira J, Castel-Branco G. Anaphylaxis due to Mango fruit: a case report. Allergy 2008;63(suppl. 88):261

Background: Severe allergic reactions to fresh fruits are rising in incidence. Mango fruit (Mangifera indica) however, is still a very rare cause, despite its important consumption in many parts of the world (second most cultivated tropical fruit worldwide). In a review of the literature, only 6 cases of anaphylaxis due to this fruit were found, 2 of which were published more than 40 years ago. An allergy to mango as a result of crossreactivity to latex has been more frequently reported than an allergy to mango alone. Case description: We report the case of a 39 year-old woman who developed anaphylaxis less than 5 min after the ingestion of a fruit salad containing fresh mango, strawberry, kiwi, orange and pineapple, with the presence of oral allergy syndrome, pruritus of the palms of the hands, angioedema, hoarseness, nausea, vomiting and edema of the glottis. She was admitted to the Emergency Room and treated with adrenalin and corticosteroids, with clinical improvement. She had history of allergic rhinitis to house dust mites, but no previous history of food or latex allergy, nor skin diseases such as contact dermatitis or urticaria. After the episode, she has eaten all culprit fruits with exception of mango, without any reaction. Skin prick tests (SPT) with commercial extracts for a panel of 38 food allergens (not including mango) were performed, with negative results for all. The sensitisation to mango and the other fruits was investigated using skin prick-to-prick tests (SPPT) with fresh fruit (pulp and peel), with positive results to mango fruit and negative to all others. Specific IgE measured by fluorenzymeimmunoassay (UniCAPs-FEIA, Phadia, Uppsala, Sweden) was also positive to mango (5.96 KU/L) and negative to all others. SPT for latex and most common cross-reactive foods were also performed, with negative results. Conclusions: Based on the very suggestive clinical history, SPPT with fresh fruit results and specific IgE value, the definitive diagnosis of IgE-mediated anaphylatic reaction to mango fruit was made. Provocation test is neither indicated nor advisable due to the severity of the clinical manifestations. In all cases of severe food allergy, the patient needs to be informed about dietary restrictions - the implicated food itself, possible cross-reacting foods belonging to the same family and the possibility of its presence as a ŒŒhidden allergen‚‚ (such as meat tenderizers and some oriental dishes, in this case).

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[124] - Hegde VL, Venkatesh YP. Anaphylaxis following ingestion of mango fruit. J Investig Allergol Clin Immunol 2007;17:341-344

Allergic reactions to fresh fruits and nuts have become increasingly common. Mango (Mangifera indica) is a popular fruit eaten all over the world. We report the case of a 43-year-old woman who experienced oropharyngeal itching, swelling of the face and other parts of the body, and difficulty breathing within a few minutes of eating ripe mango fruit. The woman had no history of pollen or latex allergy. However, she reported instances of milder food allergic reactions to Indian dill and cashew apple. Skin prick tests using mango fruit pulp, Indian dill, and cashew apple extracts were positive. Prick tests with a panel of common grass and weed pollen extracts were negative. Enzyme-linked immunosorbent assay for mango-specific serum immunoglobulin (Ig) E was positive. A specific protein allergen in mango could not be detected by immunoblotting. Based on the strongly positive clinical history and results of allergy testing, it was concluded that the woman had IgE-mediated anaphylactic reactions to mango fruit.

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[125] - Wüthrich B, Hofer T. [Food allergy: the celery-mugwort-spice syndrome. Association with mango allergy ?]. Dtsch Med Wochenschr 1984;109:981-986

Celery allergies are commonly observed in mugwort pollen-allergic patients. This situation is frequently associated with an allergy to spices of the umbelliferous family. Thus a "celery-mugwort-spice syndrome" has been established. In 31 patients (27 females, 4 males) allergy to celery was diagnosed between 1978 and 1982. They were followed up in 1983 and complementary tests (skin and RAST) with various raw vegetables, spices and mugwort pollen were done. For specific diagnosis of allergy to celery skin testing (scratch or prick) with fresh celery bulb was reliable. In contrast, RAST was not sufficiently sensitive, 87% of patients allergic to celery had pollinosis in the form of mugwort pollen sensitisation established by skin testing and RAST. Allergy to carrots was clinically and by testing currently associated in 52%. In contrast, a clinically relevant hypersensitivity to caraway (26%), parsley (16%), fennel (13%), green pepper (10%) and aniseed (3%) was found less frequently although these allergens showed a much larger positivity in skin testing. This signifies group sensitisation within the umbelliferous plants. The association of celery-mugwort allergy with allergy to mango fruit described here for the first time cannot be explained as group sensitisation within a botanic relation, as mango, and pistachio-nut, belong to the family of anacardiaceae.

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[126] - Renner R, Hipler C, Treudler R, Harth W, Süss A, Simon JC. Identification of a 27 kDa protein in patients with anaphylactic reactions to mango. J Investig Allergol Clin Immunol 2008;18:476-481

Mango fruit has become increasingly popular in recent years. We report on 2 patients who developed anaphylactic reactions after the ingestion of fresh mango. Allergy to mango was confirmed by a positive skin prick test result and positive cellular allergen stimulation test results. Neither of the patients had detectable mango-specific immunoglobulin (Ig) E levels. Results were validated by sodium dodecyl sulfate polyacrylamide gel electrophoresis immunoblotting and analyzed using Quantiscan.We identified 2 major allergens with a molecular weight of 27 kDa in both patients, in addition to a 15 kDa allergen in 1 patient and a 32 kDa allergen in the other. Currently available IgE systems seem to be lacking these mango allergens and as such are probably unsuitable for diagnosing type 1 sensitization to mango. Skin prick testing with fresh mango fruit therefore seems to be a much more reliable test method for clinical practice.

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[127] - Paschke A, Kinder H, Zunker K, Wigotzki M, Steinhart H, Wessbecher R, et al. Characterization of cross-reacting allergens in mango fruit. Allergy 2001;56:237-242

BACKGROUND: Allergic reactions to mango fruit have become increasingly important. A cross-reaction between mango fruit, various other foods, and respiratory allergens has been assumed but not investigated until now. METHODS: The sera of nine patients were used to characterize cross-reacting allergens in mango fruits by EAST inhibition and immunoblot inhibition. RESULTS AND CONCLUSIONS: EAST inhibition and immunoblot inhibition demonstrated that cross-reactions between mango fruits, mugwort pollen, birch pollen, celery, and carrot are based on allergens related to Bet v 1 and Art v 1, the major allergens of birch and mugwort pollen, respectively.

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[128] - Paschke A, Kinder H, Zunker K, Wigotzki M, Wessbecher R, Vieluf D, et al. Characterization of allergens in mango fruit and ripening dependence of the allergenic potency. Food Agric Immunol 2001;13:51-61

Characterization of IgE-related mango allergens in human sera, and the occurrence of allergens during ripening of mangoes were investigated. Mol. wt. of IgE-binding allergens were determined by SDS-PAGE/immunoblotting. Of 52 sera from patients with IgE-mediated sensitization to mangoes, 46 contained 2 allergens with mol. wt. of approx. 40 and 30 kDa; these were described as the major allergens. Other IgE-binding patterns were detected in <50% of assigned sera. 2D-electrophoresis proved that the 40 kDa major allergen exists as an isoallergen with isoelectric points of 4.6 and 4.8. The 30 kDa allergen has an isoelectric point of 4.9. According to international rules, the 40 kDa allergen was named Mangifera indica 1 (Man i 1) and the 30 kDa allergen, Mangifera indica 2 (Man i 2). SDS-PAGE/immunoblotting, immunoblot inhibition and EAST-inhibition analyses showed that there was no significant difference in allergenic potency during fruit ripening

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[129] - Renner R, Hipler C, Treudler R, Harth W, Süss A, Simon JC. Identification of a 27 kDa protein in patients with anaphylactic reactions to mango. J Investig Allergol Clin Immunol 2008;18:476-481

Mango fruit has become increasingly popular in recent years. We report on 2 patients who developed anaphylactic reactions after the ingestion of fresh mango. Allergy to mango was confirmed by a positive skin prick test result and positive cellular allergen stimulation test results. Neither of the patients had detectable mango-specific immunoglobulin (Ig) E levels. Results were validated by sodium dodecyl sulfate polyacrylamide gel electrophoresis immunoblotting and analyzed using Quantiscan.We identified 2 major allergens with a molecular weight of 27 kDa in both patients, in addition to a 15 kDa allergen in 1 patient and a 32 kDa allergen in the other. Currently available IgE systems seem to be lacking these mango allergens and as such are probably unsuitable for diagnosing type 1 sensitization to mango. Skin prick testing with fresh mango fruit therefore seems to be a much more reliable test method for clinical practice.

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[130] - Garcia-Menaya JM, González-Galán I, Rosendo R, González-Mateos G, Jiménez G, Cordobés C. Anaphylactic reaction to mango. EAACI 22th Congress, Paris, 7-11 June, 2003, Poster n°694

Introduction: Mangoes belong to the family Anacardiaceae, which includes cashew nuts, pistachio nuts, hog plum, sumac and poison ivy. Few cases of anaphylactic reaction after eating this fruit have been previously reported. Case report: A 29-year-old woman with a previous history of seasonal rhinoconjunctivitis experienced a generalized reaction with pruritus, nasal congestion, edema of eyelids, lips and tongue, generalized erythema, dizziness and difficulty in breathing and swallowing few minutes after eating a mango. In the emergency room she was treated with methylprednisolone and oxygen improving 2-3 hours later. Previously she did not remember ingestion of mango. After the reaction the patient avoided mango. Methods and results: Routine skin prick tests with aereoallergens and fruits were positive for olea europea pollen and negative for all other allergens tested. Skin prick tests (prick by prick) with mango (pulp and peel) and cashew nuts were positive, but it proved negative for pistachio nuts. Prick by prick tests with mango were negative in 5 healthy volunteers. Total IgE was normal (47 UI/ml). Specific IgE against mango was weakly positive (0.45 kU/l) and was negative against cashew nuts. Conclusion: We present a case of anaphylaxis from mango. IgE-mediated hypersensitivity has been demonstrated by in vivo and in vitro tests. Skin test for cashew nuts has been also positive. Anacardiaceae family are well-known contact sensitizers because they contain the allergen urushiol but allergic immediate reactions to this botanical family have been described and in the future they may become more common.

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[131] - Renner R, Hipler C, Treudler R, Harth W, Süss A, Simon JC. Identification of a 27 kDa protein in patients with anaphylactic reactions to mango. J Investig Allergol Clin Immunol 2008;18:476-481

Mango fruit has become increasingly popular in recent years. We report on 2 patients who developed anaphylactic reactions after the ingestion of fresh mango. Allergy to mango was confirmed by a positive skin prick test result and positive cellular allergen stimulation test results. Neither of the patients had detectable mango-specific immunoglobulin (Ig) E levels. Results were validated by sodium dodecyl sulfate polyacrylamide gel electrophoresis immunoblotting and analyzed using Quantiscan.We identified 2 major allergens with a molecular weight of 27 kDa in both patients, in addition to a 15 kDa allergen in 1 patient and a 32 kDa allergen in the other. Currently available IgE systems seem to be lacking these mango allergens and as such are probably unsuitable for diagnosing type 1 sensitization to mango. Skin prick testing with fresh mango fruit therefore seems to be a much more reliable test method for clinical practice.

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[132] - Hegde VL, Venkatesh YP. Anaphylaxis following ingestion of mango fruit. J Investig Allergol Clin Immunol 2007;17:341-344

Allergic reactions to fresh fruits and nuts have become increasingly common. Mango (Mangifera indica) is a popular fruit eaten all over the world. We report the case of a 43-year-old woman who experienced oropharyngeal itching, swelling of the face and other parts of the body, and difficulty breathing within a few minutes of eating ripe mango fruit. The woman had no history of pollen or latex allergy. However, she reported instances of milder food allergic reactions to Indian dill and cashew apple. Skin prick tests using mango fruit pulp, Indian dill, and cashew apple extracts were positive. Prick tests with a panel of common grass and weed pollen extracts were negative. Enzyme-linked immunosorbent assay for mango-specific serum immunoglobulin (Ig) E was positive. A specific protein allergen in mango could not be detected by immunoblotting. Based on the strongly positive clinical history and results of allergy testing, it was concluded that the woman had IgE-mediated anaphylactic reactions to mango fruit.

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[133] - Rodriguez J, Mielgo R, Gonzalez A, Crespo JF. Allergic Reactions to Fresh Fruits: Beyond Oral Symptoms. AAAAI 62nd Annual Meeting, Miami, 3-7 March 2006, Poster n°1163

RATIONALE: Fruit allergy is frequently considered to be associated with mild oral symptoms in the context of the pollen-food allergy syndrome, while few studies have focused on fruits as a cause of severe allergic reactions METHODS: Three hundred forty-six allergic reactions to fruits were diagnosed in 194 patients (135 female), aged from 14 to 72 yrs. (median = 27 yrs). The diagnostic procedure followed the guidelines for the evaluation of the adverse reactions to foods from the EAACI, including a clinical questionnaire, skin testing, fruit-specific serum IgE (CAP-FEIA) and open challenges, followed if positive by DBPCFC, unless a convincing history of severe anaphylaxis RESULTS: One hundred-eighty (52%) reactions consisted exclusively of isolated oral symptoms. The most frequent offenders were: melon, 42(23%); kiwi, 28(15.5%) and avocado, 24 (13%). One hundred twentyeight (37%) systemic reactions were accompanied with oral symptoms The most frequent foods were peach, 29 (23%); kiwi, 21 (16%), and melon, 18 (14%). Thirty-eight (11%) systemic reactions did not show any oral symptoms. Peach, 10 reactions (26%); banana, 8 (21%); and kiwi, 4(10.5%), were the most frequent causal foods. Grades of severity were: mild, 15 reactions; moderate, 5 reactions; severe, 13 reactions; life-threatening, 5 reactions. Three patients reported having isolated oral symptoms months before their systemic reactions took place (2 peach, 1 banana) CONCLUSIONS: Half of the fresh-fruit allergic reactions consist of isolated oral symptoms, with melon being the most frequent culprit However, systemic reactions are relevant, being peach the most frequent causative agent in our area Funding: Mº Sanidad (Grant G03-094)

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[134] - Gaspar A, Raulf-Heimsoth M, Pires G, Rihs HP, Yeang HY, Matos V, et al. Latex allergen sensitization patterns in different risk groups and latex-fruit syndrome patients from Portugal. EAACI 23th Congress, Amsterdam, 12-16 June, 2004, Poster n°1188

Background: Latex allergy has been recognized as a clinically important health problem, mainly in some risk groups: spina bifida (SB), other congenital malformations submitted to multiple surgeries (MS) and health care workers (HCW). Purpose: To study IgE-binding reactivity to latex allergens, by using recombinant and natural allergens, in latex-allergic patients from different risk groups including patients with latex-fruit syndrome (LFS). Material and Methods: We selected sera of 51 latex-allergic patients within different risk groups: 20 with SB, 10 MS and 21 HCW; all these patients had positive skin prick tests with commercial latex extract (ALK-Abelló) and serum latex-specific IgE determined by UniCAP®(Pharmacia Diagnostics). Sixteen out of the 51 patients had LFS. A panel of single recombinant latex allergens was coupled to ImmunoCAPs (CAP system®) and the isolated natural allergen nHev b 2 was coupled on paper disks (EAST testing). This panel comprised rHev b 1, nHev b 2, rHev b 3, rHev b 5, rHev b 6.01, rHev b 7, rHev b 8, rHev b 9, rHev b 10 and rHev b 11. The recombinant allergens were produced as fusion protein with maltose-binding protein (MBP) in E. coli. MBP coupled on ImmunoCAPs served as control. Specific IgE values of >0.35kU/l were considered positive. Major allergen is defined if produces a positive IgE response in more than 50% of the tested group. Results: Recombinant Hev b 1 specific IgE antibodies were detected in 70% sera from SB, 30% from MS, 5% from HCW, and in 13% sera from LFS patients. For nHev b 2: SB-69%, MS-71%, HCW-71% and LFS-75%. For rHev b 3: SB-50%, MS-20%, HCW-10% and LFS-13%. For rHev b 5: SB-55%, MS-40%, HCW-62% and LFS-75%. For rHev b 6.01: SB-45%, MS-30%, HCW-76% and LFS-81%. For rHev b 7: SB-33%, MS-0%, HCW-16% and LFS-27%. For rHev b 8: SB-10%, MS-0%, HCW-5% and LFS-6%. For rHev b 9 and rHev b 10: SB-0%, MS-0%, HCW-5% and LFS-7%. For rHev b 11: SB-7%, MS-0%, HCW-5% and LFS-7%. Conclusions: The different routes of exposure influence the IgE antibody pattern. The major latex allergens identified in SB were Hev b 1, Hev b 2, Hev b 3 and Hev b 5, being Hev b 1 the most important one. The major allergen identified in MS was Hev b 2. For occupational exposure route, the major latex allergens identified in HCW were Hev b 2, Hev b 5 and Hev b 6.01, being prohevein the most important one. Regarding cross-reactivity with foods, the major allergens identified in LFS were Hev b 2, Hev b 5 and Hev b 6.01.

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[135] - Hemmer W, Focke M, Gotz M, Jarisch R. Sensitization to Ficus benjamina: relationship to natural rubber latex allergy and identification of foods implicated in the Ficus-fruit syndrome. Clin Exp Allergy 2004;34:1251-1258

BACKGROUND: Ornamental Ficus benjamina (FB) has been recognized as a new indoor allergen. Little is known about the prevalence in moderately exposed subjects and the proposed association with fruit and Hevea latex hypersensitivity. OBJECTIVE: To study the prevalence of FB sensitization and the relationship with Hevea latex allergy, to identify cross-reacting fruits, and to characterize the responsible allergens. METHODS: A skin prick test solution prepared from FB latex (200 microg/mL) was included in our routine screening programme for suspect inhalant allergy. Patients reacting with the FB extract were further skin tested with exotic fruits by the prick-to-prick method. Inhibition of fig and FB CAP by FB latex, fig (Ficus carica), kiwi, the thiolproteases ficin and papain, Hevea latex and rHev b 6.02 (hevein) was performed in selected patients. RESULTS: Of 2662 patients with a positive skin test to any aeroallergen, 66 (2.5%) reacted with FB. Ten patients showed isolated sensitization to FB. Although FB-positive subjects were more often co-sensitized to Hevea latex than FB-negative (10.6% vs 3.8%, P< 0.01), nearly 90% tested negative for Hevea latex. Sensitization to FB was specifically associated with positive skin tests to fresh fig (83%), dried fig (37%), kiwi fruit (28%), papaya (22%), avocado (19%), banana (15%), and pineapple (10%) (n = 54). Clinical reactions were reported mainly from fresh and dried fig and kiwi (47%, 60%, and 64%, respectively, of skin test-positive patients), including seven patients with systemic reactions (urticaria, angiooedema, asthma). CAP to fig in 11 patients with clinical fruit allergy was inhibited on average by 87% by FB latex, 89% by fresh fig, 80% by dried fig, 38% by kiwi (100 microg/mL each), and by 59% and 44% by ficin and papain (50 microg/mL), respectively. No inhibition was obtained with Hevea latex and rHev b 6.02. CAP to FB was inhibited on average by 95% by FB, 60% by fresh fig, 41% by ficin, 29% by papain, and less than 7% by rubber latex allergens. CONCLUSIONS: Sensitization to FB latex is found in 2.5% of atopic individuals and mostly occurs independently of Hevea latex allergy. Sensitization is commonly associated with allergic reactions to figs and other tropical fruits ('Ficus-fruit syndrome'). This cross-reactivity is mediated at least in part by thiolproteases.

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[136] - Isola S, Ricciardi L, Saitta S, Fedele R, Mazzeo L, Fogliani O, et al. Latex Allergy and Fruit Cross-Reaction in Subjects Who Are Nonatopic. Allergy Asthma Proc 2003;24:193-197

Abstract: Since the first case reported in 1927, latex allergy has attracted the attention of allergists including its capacity to cross-react with fruits. To evaluate the frequency of sensitivity to some fruit allergens shown to cross-react with latex, we evaluated 82 patients (43 men and 39 women, aged between 18 and 45 years) with latex allergy. All patients underwent skin tests with various fruit extracts that potentially cross-react with latex. Only patients with negative prick tests successively underwent prick-by-prick tests with fresh fruits. Thirty-nine of 82 patients (47.5%) were found to have positive skin tests. Prick tests with fruit extracts were positive in 28 patients (kiwi, 21 patients; banana, 17 patients; avocado, 8 patients; and papaya, 3 patients), and the prick-by-prick test had positive results in 11 patients (kiwi, 7 patients; banana, 4 patients; and avocado, 3 patients). In our experience patients with latex allergy are at a high risk of sensitization to some fruits and they often develop allergic reactions, even severe ones, after eating them; for this reason fruit sensitization should be taken into consideration when investigating patients allergic to natural rubber latex.

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[137] - Guerin B, Leynadier F, Baligadoo S, Dry J. Relation entre la consommation de papaye et la présence d'immunoglobulines E spécifiques à la chymopapaïne. Presse Med 1990;19:429

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[138] - Levy DA, Mounedji N, Noirot C, Leynadier F. Allergic sensitization and clinical reactions to latex, food and pollen in adult patients. Clin Exp Allergy 2000;30:270-275

Many latex-allergic patients are sensitized to one or more foods. Patients allergic to tree and/or grass pollens are also often sensitized to plant-derived foods. Atopy, defined in most studies as sensitivity to an aeroallergen, is a risk factor for latex allergy. The relative importance of pollen sensitivity, a sign of atopy, as a risk factor for food allergy in latex-allergic patients has not, however, been examined. OBJECTIVE: To investigate the relationship between pollen sensitivity and sensitivity to food in latex-allergic patients. METHODS: Forty-four latex-allergic patients (Groups 1 and 2), 24 of whom were also allergic to tree and/or grass pollen (Group 1) and 25 pollinosis patients who were not allergic to latex (Group 3) were studied. We obtained a history of reactions to food and skin tested them with 12 fresh-frozen fruits. RESULTS: All 12 foods induced a skin test reaction in at least one patient in each of the three Groups. There were, however, twice as many positive skin test reactions to food in patients with pollinosis, whether or not they were allergic to latex, as there were in patients allergic to latex but not to pollen. Latex-allergic patients were most likely to have a positive skin test and a history of a reaction to avocado or banana whereas patients with pollinosis only were most likely to have a positive skin test and a history of a reaction to apple, peach or celery. CONCLUSIONS: These results suggest that concomitant allergy to pollen is an important risk factor in determining which plant-derived foods sensitize latex-allergic patients.

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[139] - Levy DA, Mounedji N, Noirot C, Leynadier F. Allergic sensitization and clinical reactions to latex, food and pollen in adult patients. Clin Exp Allergy 2000;30:270-275

Many latex-allergic patients are sensitized to one or more foods. Patients allergic to tree and/or grass pollens are also often sensitized to plant-derived foods. Atopy, defined in most studies as sensitivity to an aeroallergen, is a risk factor for latex allergy. The relative importance of pollen sensitivity, a sign of atopy, as a risk factor for food allergy in latex-allergic patients has not, however, been examined. OBJECTIVE: To investigate the relationship between pollen sensitivity and sensitivity to food in latex-allergic patients. METHODS: Forty-four latex-allergic patients (Groups 1 and 2), 24 of whom were also allergic to tree and/or grass pollen (Group 1) and 25 pollinosis patients who were not allergic to latex (Group 3) were studied. We obtained a history of reactions to food and skin tested them with 12 fresh-frozen fruits. RESULTS: All 12 foods induced a skin test reaction in at least one patient in each of the three Groups. There were, however, twice as many positive skin test reactions to food in patients with pollinosis, whether or not they were allergic to latex, as there were in patients allergic to latex but not to pollen. Latex-allergic patients were most likely to have a positive skin test and a history of a reaction to avocado or banana whereas patients with pollinosis only were most likely to have a positive skin test and a history of a reaction to apple, peach or celery. CONCLUSIONS: These results suggest that concomitant allergy to pollen is an important risk factor in determining which plant-derived foods sensitize latex-allergic patients.

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[140] - Vandenplas O, Vandezande LM, Halloy JL, Delwiche JP, Jamart J, Looze Y. Association between sensitization to natural rubber latex and papain. J Allergy Clin Immunol 1996;97:1421-1424

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[141] - Brehler R, Theissen U, Mohr C, Luger T. 'Latex-fruit syndrome': frequency of cross-reacting IgE antibodies. Allergy 1997;52:404-410

An association between allergies to latex proteins and to various foods has been reported and confirmed by RAST and immunoblotting inhibition. However, no significant data had been collected on the frequency of specific IgE antibodies to fruits in these patients and the frequency of a history of fruit intolerance. Serum samples of 136 patients with well-documented, clinically relevant, immediate-type hypersensitivity against latex proteins were analyzed for IgE antibodies against a panel of different fruits. Patient history of food intolerance was documented by a standardized questionnaire. Fruit-specific IgE antibodies were detected in 69.1% of serum samples. Cross-reacting IgE antibodies recognizing latex and fruit allergens (papaya. avocado, banana, chestnut, passion fruit, fig. melon, mango, kiwi, pineapple, peach, and tomato) were demonstrated by RAST-inhibition tests. Of our patients 42.6% reported allergic symptoms after ingestion of these fruits and a total of 112 intolerance reactions were recorded. However, fruit-specific IgE antibodies were detected only in serum samples from 32.1% of the patients who perceived symptoms due to these fruits. Thus, serologic tests seem to be of low significance for prediction of food allergy in latex-allergic patients.

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[142] - Hemmer W, Focke M, Gotz M, Jarisch R. Sensitization to Ficus benjamina: relationship to natural rubber latex allergy and identification of foods implicated in the Ficus-fruit syndrome. Clin Exp Allergy 2004;34:1251-1258

BACKGROUND: Ornamental Ficus benjamina (FB) has been recognized as a new indoor allergen. Little is known about the prevalence in moderately exposed subjects and the proposed association with fruit and Hevea latex hypersensitivity. OBJECTIVE: To study the prevalence of FB sensitization and the relationship with Hevea latex allergy, to identify cross-reacting fruits, and to characterize the responsible allergens. METHODS: A skin prick test solution prepared from FB latex (200 microg/mL) was included in our routine screening programme for suspect inhalant allergy. Patients reacting with the FB extract were further skin tested with exotic fruits by the prick-to-prick method. Inhibition of fig and FB CAP by FB latex, fig (Ficus carica), kiwi, the thiolproteases ficin and papain, Hevea latex and rHev b 6.02 (hevein) was performed in selected patients. RESULTS: Of 2662 patients with a positive skin test to any aeroallergen, 66 (2.5%) reacted with FB. Ten patients showed isolated sensitization to FB. Although FB-positive subjects were more often co-sensitized to Hevea latex than FB-negative (10.6% vs 3.8%, P< 0.01), nearly 90% tested negative for Hevea latex. Sensitization to FB was specifically associated with positive skin tests to fresh fig (83%), dried fig (37%), kiwi fruit (28%), papaya (22%), avocado (19%), banana (15%), and pineapple (10%) (n = 54). Clinical reactions were reported mainly from fresh and dried fig and kiwi (47%, 60%, and 64%, respectively, of skin test-positive patients), including seven patients with systemic reactions (urticaria, angiooedema, asthma). CAP to fig in 11 patients with clinical fruit allergy was inhibited on average by 87% by FB latex, 89% by fresh fig, 80% by dried fig, 38% by kiwi (100 microg/mL each), and by 59% and 44% by ficin and papain (50 microg/mL), respectively. No inhibition was obtained with Hevea latex and rHev b 6.02. CAP to FB was inhibited on average by 95% by FB, 60% by fresh fig, 41% by ficin, 29% by papain, and less than 7% by rubber latex allergens. CONCLUSIONS: Sensitization to FB latex is found in 2.5% of atopic individuals and mostly occurs independently of Hevea latex allergy. Sensitization is commonly associated with allergic reactions to figs and other tropical fruits ('Ficus-fruit syndrome'). This cross-reactivity is mediated at least in part by thiolproteases.

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[143] - Castillo R, Delgado J, Quiralte J, Blanco C, Carrillo T. Food hypersensitivity among adult patients: epidemiological and clinical aspects. Allergol Immunopathol (Madr) 1996;24:93-97

Food hypersensitivity (FH) is lesser frequent among adult patients than in childhood. Foods implicated in hypersensitivity reactions vary with sociocultural and diet habits from a geographic place to other. We studied 142 adult patients sensitized to foods, among 7698 patients visited at our Outpatient Clinic. Hundred and twenty patients referred clinical symptoms after consumption of one or more foods consistently. From the latest, 107 patients (89.2%) were atopics (92 of them sensitizes to dust mites) and 54 (45%) referred atopic familiar background. Most frequent recorded symptoms were: urticaria/angioedema 84 cases (70%), oral syndrome 65 (54%), asthma 48 (37%) and anaphylaxis 33 patients (27.5%). Shellfish sensitization occurred in 50 patients, fresh fruits in 33 and nuts in 29 cases. Shrimp (48 patients), squid (33), kiwi (14), papaya (14), avocado (13) and banana (12 cases) were the most frequent causes of FH. Significant statistical association between foods and inhalants was observed for fresh fruits and latex (p < 0.001), fresh fruits and pollens (p < 0.01), and shellfish and Blatta germanica (p < 0.001). Prevalence of FH among patients at our Area is around 1.6%. Tropical fruits, as other kind of fruits, seem to share common IgE-epitopes to pollens. High prevalence of shellfish and cockroach hypersensitivity could be more easily developed by previous domestic mites sensitization.

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[144] - Blanco C, Carillo T, Castillo R, Quiralte J, Cuevas M. Avocado hypersensivity. Allergy 1994;49:454-459

The avocado (Av) is a fruit that belongs to the Lauraceae family. We report 17 patients with immediate hypersensitivity to avocado. Clinical manifestations in relation to avocado ingestion were as follows: systemic anaphylaxis in seven patients, angioedema/urticaria in six, vomiting in two, bronchial asthma in one, and rhinoconjunctivitis in one. Skin prick test (SPT) with fresh avocado was positive in all patients with the Strong avocado variety (SAv) and in 14 patients with the Hass avocado variety (HAv). Our patient-associated sensitizations were as follows: 10 to latex, eight to chestnut, eight to banana, four to kiwi, and four to walnut. Avocado-sensitized patients with latex allergy were typically middle-aged women, professionally exposed to latex, who also exhibited frequent associated sensitizations to chestnut, banana, and other fruits. Specific IgE against avocado was demonstrated in 11 of our patients, by both commercial CAP and RAST with avocado extract coupled to nitrocellulose disks. Despite its lower protein content, SAv seems to be more allergenic than HAv, both in vivo and in vitro. On incubating a pool of sera from our patients with avocado, latex, chestnut, and banana extracts, a progressive RAST inhibition was obtained, with SAv- and chestnut-marked disks. This suggests the existence of common antigenic determinants among these allergens.

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[145] - Diaz-Perales A, Collada C, Blanco C, Sanchez-Monge R, Carillo T, Aragoncillo C, et al. Cross-reactions in the latex-fruit syndrome: a relevant role of chitinases but not of complex asparagine-linked glycans. J Allergy Clin Immunol 1999;104:681-687

BACKGROUND: Cross-reactions between latex and plant foods (mainly fruits) have been widely reported. Although the cross-reactive components have not been well identified, class I chitinases seem to be the most credible candidates in chestnut, avocado, and banana . OBJECTIVE: We sought to evaluate the potential role of chitinases and complex glycans as cross-reactive determinants linked to latex-food allergy . METHODS: Extracts from 20 different plant foods and from latex were obtained. These preparations were immunodetected with anticomplex glycans and antichitinase sera raised in rabbits, as well as with sera from patients with latex-fruit allergy and sera from patients allergic to latex without food allergy. Immunoblot inhibition assays were carried out by using a purified class I chitinase from avocado or latex extract as inhibitors . RESULTS: Reactive proteins of approximately 30 to 45 kd (putative class I chitinases) were recognized by both specific polyclonal antibodies to chitinases and sera from patients with latex-fruit allergy in chestnut, cherimoya, passion fruit, kiwi, papaya, mango, tomato, and flour wheat extracts. Prs a 1, the major allergen and class I chitinase from avocado, and the latex extract strongly or fully inhibited IgE binding by these components when tested in immunoblot inhibition assays. Additional bands of 16 to 20 kd, 23 to 28 kd, and 50 to 70 kd were detected by the antichitinase serum but not with the patients' pooled sera. The putative 30- to 45-kd chitinases present in different food extracts did not react with a pool of sera from subjects allergic to latex but not to fruit. Very different immunodetection patterns were produced with the anticomplex glycan serum and the sera from allergic patients . CONCLUSIONS: Putative class I chitinases seem to be relevant cross-reactive components in foods associated with the latex-fruit syndrome, but do not play a specific role in allergy to latex but not to fruit. Cross-reactive carbohydrate determinants are not important structures in the context of latex-fruit cross-sensitization.

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[146] - Vlaicu P, Rusu L, Ledesma A, Zamorano M, Antolin-Amerigo D, Alvarez-Cuesta E et al. Cucumber allergy: a new plant-derived food with cross-reactivity to latex. Allergy 2009;64(Suppl. 90):481

Background: The allergy to plants-derived food is a frequent cause of food allergy and represents a growing clinical problem. The cucumber (Cucumis sativus) is a fruit belonging to Cucurbitaceas family. Methods: We report the case of a 76-years-old woman who experienced dizziness, malaise, vomiting, difficulty breathing, submammary erythema and pruritus, vaginal itching, within 5 min of eating half peeled cucumber. The patient presented approx 3 months before an episode of acute urticaria after eating papaya, and she was diagnosed as having latex allergy. The patient had no history of allergic rhinitis, asthma or atopic eczema. She reported only one previous knee surgical intervention as a risk factor to latex sensitization. Skin prick tests with commercial battery of inhalant and food allergens, including cucumber, watermelon, melon, papaya and profilin were performed. The investigation comprised quantification of total IgE and specific IgE (ImmunoCAP, Phadia) for cucumber and latex. We also performed, sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting with cucumber, papaya, melon and latex extracts, in order to analyze the protein bands and their molecular weights, and identify IgE- binding bands. Immunoblot inhibition was performed with latex in order to investigate cross-reactivity. Results: Skin prick tests for cucumber, watermelon, papaya and latex extracts were positive, and negative for melon and profilin extracts. ImmunoCAP for latex specific serum IgE was positive. Specific serum IgE for latex allergens were positive for rubber elongation factor (Hev b1), rubber acidic protein (Hev b5), prohevein (Hev b6), and negative for rubber profilin (Hev b8), avocado and chestnut chitinase (Prs a 1 and Cas s 5), apple profilin (Mal d 4) and peach LTP (Pru p 3). Cucumber specific serum IgE was negative. Immunoblot analysis using patient serum detected a 30-32-kD protein band in the cucumber and papaya extract. Immunoblot inhibition with latex extract demonstrated inhibition of the band in each of the two vegetable extract. Conclusion: We present a case of allergy IgE mediated to cucumber (anaphylaxis) and papaya (urticaria). Our results strongly suggest that the allergen/s implicated are associated with latex sensitization. In our knowledge is the first report of the association between cucumber and latex allergy, and our results confirm cucumber as another food with clinical cross-reactivity in latex allergy patients.

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[147] - Quarre JP, Lecomte J, Lauwers D, Gilbert P, Thiriaux J. Allergy to latex and papain. J Allergy Clin Immunol 1995;95:922

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[148] - Vandenplas O, Vandezande LM, Halloy JL, Delwiche JP, Jamart J, Looze Y. Association between sensitization to natural rubber latex and papain. J Allergy Clin Immunol 1996;97:1421-1424

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[149] - Baur X, Chen Z, Rozynek P, Duser M, Raulf-Heimsoth M. Cross-reacting IgE antibodies recognizing latex allergens, including Hev b 1, as well as papain. Allergy 1995;50:604-609

The cross-reactivity of IgE antibodies recognizing epitopes of latex allergens and papain was studied in sera of 36 latex-exposed subjects and 22 papain workers. Eight out of 24 latex-sensitized persons also showed a positive reaction to papain in the CAP assay (mostly of low or moderate degree). On the other hand, six out of the 12 sensitized papain workers also revealed IgE binding to latex allergen(s). Reciprocal inhibition experiments confirmed that groups monosensitized to one of the two allergens can be separated from a group showing partial or nearly complete immunologic cross-reactivity. Papain inhibited IgE binding by 20-33% in these subjects, whereas IgE binding to papain was strongly blocked in most cases. Comparison between the primary sequences of Hev b 1, a major latex allergen, and papain suggests that the cross-reactivity may be due to several identical trimers and tetramers.

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[150] - Diez-Gomez ML, Quirce S, Cuevas M, Sanchez-Fernandez C, Baz G, Moradiellos FJ, et al. Fruit-pollen-latex cross-reactivity: implication of profilin (Bet v 2). Allergy 1999;54:951-961

An association between allergy to fruits and latex, and between pollen and plant-derived food has been described. The cross-reactive structures responsible for these associations have not yet been completely elucidated. METHODS: IgE reactivity to the recombinant allergens Bet v 1 and Bet v 2, different pollens, natural latex, papain, and bromelain was investigated in 29 patients with allergy to fruits or vegetables who lived in an area without birch trees. RESULTS: Exactly 79.3% of patients were allergic to grass pollen, and two of them had clinical allergy to latex. Serum IgE reactivity (CAP) to birch pollen was found in 65% of patients, to Bet v 2 in 51.7%, to Bet v 1 in 3.4%, to latex in 58.6%, to bromelain in 51.7%, and to papain in 17.2% of patients. All subjects with positive IgE to Bet v 2 had also reactivity to latex, grass, olive tree, birch, and mugwort pollens. The six patients not allergic to pollen did not show IgE reactivity to latex, Bet v 1, or Bet v 2. A significant correlation was found between CAP to latex with Bet v 2 (r=0.86, P<0.001), with birch (r=0.86, P<0.001), and with ryegrass (r=0.81, P<0.001). Immunoblotting using nine sera with positive CAP to birch pollen showed IgE-binding to a 15-kDa band that was recognized by antiprofilin monoclonal antibody. Bet v 2 CAP could be inhibited up to 52% by ryegrass and up to 23% by mugwort. CAP to latex was almost completely inhibited by ryegrass pollen with sera from five subjects without symptoms due to latex, whereas no inhibition was observed with serum from one patient with allergy to latex. CONCLUSIONS: Patients with allergy to plant-derived food and associated pollinosis showed a high frequency of IgE reactivity to Bet v 2, which may cause positive serum IgE determinations to latex and birch pollen due to the presence of cross-reactive epitopes. IgE reactivity to Bet v 2 may serve as an indicator of broad sensitization.

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[151] - Gaspar A, Neto-Braga C, Pires G, Murta R, Morais-Almeida M, Rosado-Pinto J. Anaphylactic reaction to manioc: cross-reactivity to latex. Allergy 2003;58:683-684

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[152] - Galvao CES, Iwai LK, Andrade MEB, Kalil J, Morato Castro FF. Latex allergy and cross-reactivity to manioc: Report of 2 cases. AAAAI 60th Annual Meeting, San Francisco, 19-23 March 2004, Poster n°144

Rationale Allergy to natural latex is frequently associated with hypersensitivity to fruits and recently, a case of cross-reactivity to manioc was reported. Objective : The authors present the cases of two female patients sensitized to latex who have developed anaphylactic reaction with urticaria and bronchospasm immediately after eating boiled manioc. Method : Skin prick test to common aeroallergens, latex, manioc and other foods were performed. Serum latex specific IgE levels were measured with CAP-RAST method and RAST inhibition tests were carried out with manioc and latex. Result s : Skin prick tests to common aeroallergens were negative. Skin prick tests to commercial latex extract were positive in both patients as well as prick tests with raw and boiled manioc. They both had positive skin tests to fresh papaya and one of them to pineapple. Tests were negative to banana, kiwi and chestnut. They both presented elevated serum latex specific IgE. RAST inhibition assays revealed cross-reactivity between latex and manioc. Conclusion : These two cases support the previously reported cross-reactivity between latex and manioc, definitely adding it to the list of foods cross-reacting with latex.

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[153] - Soto-Mera MT, Lopez-Rico MR, Filgueira JF, Villamil E, Cidras R. Occupational allergy to papain. Allergy 2000;55:983-984

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[154] - Lavaud F, Capy B, Fontaine JF, Deslée G, Bouvet M, Deschamps F, et al. Allergie respiratoire professionnelle à la papaïne en industrie pharmaceutique. Rev Fr Allergol Immunol Clin 2002;42:344

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[155] - Baur X. Studies on the specificity of human IgE-antibodies to the plant proteases papain and bromelain. Clin Allergy 1979;9:451-457

The sera of seven patients clinically hypersensitive to papain--in one case also to baromelain--and the sera of sixty asthmatic patients with allergies to other inhalant and food allergens were investigated for IgE antibody activity to the plant proteases papain and bromelain and to common allergens by RAST, confirmed in some sera by RAST inhibition. There seems to be a relation between the antibody reactions to papain and bromelain, in several cases also between the reactions to these proteases and to grass pollen and flour. Studies by RAST inhibition showed that papain, bromelain, wheat flour, rye flour, grass pollen and birch pollen mutually inhibit IgE antibody to each antigen; but the degree of inhibition varies among the different sera and allergens. Our results suggest that these allergens from various plants, besides having specific antigenic determinants, also possess similar or even identical antigenically active regions, leading to immunological cross-reactivity.

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[156] - Quinones D, Alonso S, Lopez R, Sanchez I, Rodriguez F, Fernandez L, et al. Contact urticaria, rhinoconjunctivitis and bronchial asthma from occupational use of papain. Allergol Immunopathol (Madr) 1999;27:273-275

Papain is a plant protein with a wide pharmacological, domestic and industrial use. It leads a high sensitisation, being the most common rotue of entry the inhalation. The occupational allergy to papain in exposed workers was described some years ago, being presented with bronchial asthma, rhinitis or both. In most of the cases, the specific IgE was positive. We present a case contact urticaria, rhinoconjunctivitis and bronchial asthma per papain of occupational origin. Papain prick test, specific IgE and nasal challenge were positive. The peak flow record showed diary decreases during the working week and the basal spirometry showed obstruction to the airflow. The patient was moved away the place where papain was handled and this resolved the clinical symptoms and the spirometry returns to the normal values. We present a case of IgE-mediated allergy, vehicled by tow routes: contact and airborne. The latest produced clinical manifestations later. Papain was used as Cephalopoda softening, because of that it wo rth emphasising its seasonal use

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[157] - Damiani E, Aloia AM, Priore MG, Delle Donne P, Nettis E, Ferrannini A. Allergy to red pitaya. Allergy 2008;63:1252-1253

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[158] - Hegde VL, Venkatesh YP. Anaphylaxis following ingestion of mango fruit. J Investig Allergol Clin Immunol 2007;17:341-344

Allergic reactions to fresh fruits and nuts have become increasingly common. Mango (Mangifera indica) is a popular fruit eaten all over the world. We report the case of a 43-year-old woman who experienced oropharyngeal itching, swelling of the face and other parts of the body, and difficulty breathing within a few minutes of eating ripe mango fruit. The woman had no history of pollen or latex allergy. However, she reported instances of milder food allergic reactions to Indian dill and cashew apple. Skin prick tests using mango fruit pulp, Indian dill, and cashew apple extracts were positive. Prick tests with a panel of common grass and weed pollen extracts were negative. Enzyme-linked immunosorbent assay for mango-specific serum immunoglobulin (Ig) E was positive. A specific protein allergen in mango could not be detected by immunoblotting. Based on the strongly positive clinical history and results of allergy testing, it was concluded that the woman had IgE-mediated anaphylactic reactions to mango fruit.

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[159] - Comstock SS, Robotham JM, Tawde P, Kshirsagar H, Sathe SK, Roux KH, et al. Immunoglobulin E-Reactive Proteins in Cashew (Anacardium occidentale) Apple Juice Concentrate. J Agric Food Chem 2008;56:5977-5982

Cashew apple juice has the potential to be a natural source of vitamin C and sugar in processed foods. The juice of the cashew apple is obtained by pressing the fleshy peduncle or receptacle, which forms a rounded apple that sits above the true fruit, the cashew nut. Cashew nut allergy is the second most commonly reported tree nut allergy in the United States. To determine if cashew apple juice contains cashew nut allergens, immunoblotting was performed using a cashew apple juice 6X concentrate that was extracted and further concentrated through dialysis, lyophilization, and resuspension. Serum IgE of individuals allergic to cashew nut bound proteins in the cashew apple juice concentrate extract. For some serum samples, IgE reactivity could be inhibited by preincubation of the serum with cashew nut extract, suggesting the presence of cashew nut-related allergens. Using monoclonal antibodies specific for cashew nut allergens, the concentrate was found to contain Ana o 1 (vicilin) and Ana o 2 (legumin). Neither IgE from cashew nut allergic sera nor the monoclonal antibodies bound any peptides in 5 kDa filtered cashew apple juice concentrate. The cashew apple juice concentrate used in these studies contains proteins with IgE-reactive epitopes, including cashew nut legumin and vicilin. No IgE-binding peptides remained after 5 kDa filtration of the concentrate.

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