La figue et autres Moracées

% d’identité	en italiques : IgE-réactivité connue
90%	manioc
80-85%	haricot, riz, chou, palmier à huile , ..
75-80%	pois, pomme de terre, carotte, patate douce, ..
70-75%	tournesol, fève, ..
65-70%	Gly m Bd30K, pois mungo, pois chiche, colza, ..
60-65%	actinidine
50-55%	broméline, chymopapaïne
45-50%	papaïne, ananaïne

[1] - Bourrier T, Noormahomed T, Drai M, Albertini M. Un cas d'allergie alimentaire pédiatrique à la figue. Rev Fr Allergol Immunol Clin 2004;44:131-132

↩

[2] - Caiaffa MF, Cataldo VM, Tursi A, Macchia L. Fig and mulberry cross-allergy. Ann Allergy Asthma Immunol 2003;91:493-495

BACKGROUND: Hypersensitivity reactions to ingestion of figs (Ficus carica) and mulberries (Morus nigra and Morus alba) are considered uncommon and have never been reported as occurring in the same patient. OBJECTIVE: To determine whether hypersensitivity to figs and mulberries can induce cross-allergy. METHODS: We describe 3 cases of associated fig and mulberry allergy in 3 patients with multiple sensitizations to food allergens (mostly fruit) and airborne allergens. The presence of specific IgE was investigated by skin prick tests and radioallergosorbent tests. RESULTS: The 3 patients had a convincing clinical history of food allergy caused by eating fresh figs, and in all 3 cases clinical and/or laboratory evidence of sensitization to mulberries was also collected. CONCLUSIONS: We reason that Ficus and Morus are closely related genera of the Moraceae family and speculate that hypersensitivity to figs and mulberries might be associated as the result of allergen cross-reactivity rather than mere coincidence.

↩

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

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

↩

[4] - Gandolfo M, Baeza M, De Barrio M. Anaphylaxis to fig. Allergy 2001;56:462-463

↩

[5] - García Alvarez-Eire M, Pineda de la Losa F, Varela Losada S, González De la Cuesta C. Anaphylaxis due to early fig. Allergy 2007;62(suppl. 83):336

Background: The fig (ficus carica), which belongs to the family Moraceae, has been, until now, a rare cause of food allergy. We report a case of anaphylaxis due to the ingestion of an early fig, in a patient who later could eat autumn figs. Some of the fig trees bear a single crop (fig); others can bear a first crop (early fig) in the spring and a second crop (late fig) in the autumn. Early figs are a high-value fruits because they are bigger than late figs and have a sweet taste. Material and methods: We present the case of a 58-year-old-female, who developed two episodes of facial angioedema, eyes itching and bronchospasm, immediately after eating early figs. She improved with corticosteroids and B2-agonists. Afterwards, she had no reaction after the ingestion of autumn figs. The patient also suffered from seasonal rhinocojunctivitis, and referred itching into her mouth after eating apples and peaches. Skin prick tests (SPT) were performed with a battery of common inhalants and food allergens. Prick by prick tests, with fresh fruits (fig, early fig, apple and peach), were also realized. Total and specifc IgE to tree pollen, apple, peach and fig were determined using CAP system . An IgE-inmunoblot assay was realized to determine the reactivity of the patient serum against the proteins of early fig, late fig, Betula verrucosa and Olea europaea Results: Prick-by prick tests were positive to fresh early fig (wheal of 5x5mm), fig (wheal of 7x7mm), apple (6x5mm) and peach (5x4 mm). Prick tests with commercial extracts were positive to Betula verrucosa, Alnus glutinosa and Corylus avellana pollens. Levels of Total IgE were 34 kU/l and levels of specific IgE to Betula, alnus, Corylus, olea were 6.15, 3.28, 2.51 and 3.28 kU/L respectively and Lolium, chestnut, Apple , peach, plum and fig were <0.35 kU/L. Immunoblotting assay revealed a common recognized band around 32 kDa in the late fig and early fig extracts, and a more intense recognition for a protein around 16 kDa in the early fig extract. Two proteins nearly to15-17 KDa and 20-21 KDa in the Betula and Olea extracts were recognized by the serum of the patient Conclusions: We report a case of anaphylaxis due to the ingestion of an early fig, in a patient with pollinosis due to Betulaceae and Oral Allergy Syndrome with Rosaceae. The patient could eat autumn figs after the allergy reaction to early figs. To our knowledge, this is the first case of early fig allergy

↩

[6] - Antico A, Zoccatelli G, Marcotulli C, Curioni A. Oral Allergy Syndrome to Fig. Int Arch Allergy Immunol 2003;131:138-142

BACKGROUND: The few cases of food allergy to fig reported to date, whose main manifestations were anaphylactic reactions, have been related to a cross-sensitisation to weeping fig (Ficus benjamina) or to the 'latex-fruit syndrome'. Here we report on two cases of the oral allergy syndrome (OAS) to fig in patients whose main allergic manifestations were related to sensitisation to grass and birch pollens . METHODS: The patients were characterised by clinical history, skin prick tests (SPT) with commercial and in-house extracts, prick-by-prick test, specific IgE measurements and challenge tests. PBS-soluble and insoluble extracts of both fig skin and pulp were examined for the presence of potential allergens by IgE immunoblotting . RESULTS: Both patients showed OAS followed by respiratory symptoms when challenged with fig. They were negative in both specific IgE detection and SPT with commercial extracts of fig and many other plant materials, including F. benjamina and Hevea Brasiliensis, while grass and birch pollens gave positive results. Prick-by-prick tests and SPT with in-house extracts indicated that the fig skin had a much higher allergenicity than the pulp. Despite negative IgE detection by the CAP assay, immunoblotting experiments showed that potential fig allergens were PBS-soluble and present only in the skin of the fruit . CONCLUSIONS: OAS to fig followed by respiratory symptoms can be present in patients not sensitised to weeping fig or having the latex-fruit syndrome. Different parts of the fig can have different allergenicities, the most important allergens being proteins related to the skin of the fruit. Improved commercial fig extracts to be used for the diagnosis of this type of allergy have to be developed.

↩

[7] - Caiaffa MF, Cataldo VM, Tursi A, Macchia L. Fig and mulberry cross-allergy. Ann Allergy Asthma Immunol 2003;91:493-495

BACKGROUND: Hypersensitivity reactions to ingestion of figs (Ficus carica) and mulberries (Morus nigra and Morus alba) are considered uncommon and have never been reported as occurring in the same patient. OBJECTIVE: To determine whether hypersensitivity to figs and mulberries can induce cross-allergy. METHODS: We describe 3 cases of associated fig and mulberry allergy in 3 patients with multiple sensitizations to food allergens (mostly fruit) and airborne allergens. The presence of specific IgE was investigated by skin prick tests and radioallergosorbent tests. RESULTS: The 3 patients had a convincing clinical history of food allergy caused by eating fresh figs, and in all 3 cases clinical and/or laboratory evidence of sensitization to mulberries was also collected. CONCLUSIONS: We reason that Ficus and Morus are closely related genera of the Moraceae family and speculate that hypersensitivity to figs and mulberries might be associated as the result of allergen cross-reactivity rather than mere coincidence.

↩

[8] - Dechamp C, Bessot JC, Pauli G, Deviller P. First report of anaphylactic reaction after fig (Ficus carica) ingestion. Allergy 1995;50:514-516

We report an anaphylactic reaction which occurred very shortly after ingestion of a fresh fig. The IgE-dependent mechanism was demonstrated on the basis of positivity of the prick test performed with fresh fig (Ficus carica) extract. In addition, we were able to detect specific IgE to the same extract in the serum. The patient did not demonstrate sensitization to other common allergens involved in respiratory and food allergies. However, detection of specific IgE to F. benjamina indicated a sensitization to weeping fig. The CAP F. benjamina was partially inhibited by preincubation of the serum with fig extract, suggesting that these two species of Ficus share some common allergens. In this context, the assumption can be made that weeping fig was responsible for the initial sensitization in this patient.

↩

[9] - Oei HD, Tjiook SB. A case report of an anaphylactic reaction after fig (Ficus carica) ingestion. Allergy 1998;53(suppl. 43):85

↩

[10] - Focke M, Hemmer W, Wöhrl S, Götz M, Jarisch R. Cross-reactivity between Ficus benjamina latex and fig fruit in patients with clinical fig allergy. Clin Exp Allergy 2003;33:971-977

BACKGROUND: Anaphylactic reactions to fig fruits (Ficus carica) have been reported from subjects sensitized to Ficus benjamina (FB) latex allergens. Figs may also be involved in the latex-fruit syndrome . OBJECTIVE: To study the immunologic relationship between fig fruit, Ficus benjamina, natural rubber latex (Hevea brasiliensis), and other tropical fruits . METHODS: RAST inhibition and Western blotting with FB and fruit extracts was performed in five patients with oral allergy syndrome (OAS) or anaphylaxis after the ingestion of figs and one patient with symptoms from exposure to FB trees. Co-sensitization to rubber latex and tropical fruits (kiwi, banana, avocado, papaya, pineapple, mulberry) was studied by skin testing . RESULTS: RAST to FB was inhibited >95% by FB extracts and 16-65% (mean 49%) by extracts from fresh fig. RAST to fig fruit was inhibited >95% by FB and fresh fig, 63-97% (mean 86%) by dried fig, and 0-84% (mean 35.5%) by kiwi fruit. FB and fig extracts lost most of their allergenicity when denatured by heat (95 degrees C) or reduced by dithiothreitol. Western blotting after non-reducing gel electrophoresis revealed IgE binding to proteins of 22 and 28-34 kDa in FB latex; however, no corresponding allergens could be detected in fig extracts. Positive skin tests were obtained most often with kiwi fruit, papaya, and avocado. Sensitization to rubber latex could not be demonstrated in any of the patients. RAST to papain was positive in three of five patients . CONCLUSIONS: Allergic reactions to fresh or dried figs can present as a consequence of primary sensitization to airborne FB allergens independent of sensitization to rubber latex allergens. Kiwi fruit, papaya, and avocado as well as pineapple and banana may be other fruits associated with sensitization to Ficus allergens

↩

[11] - 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.

↩

[12] - Hemmer W, Focke M, Marzban G, Swoboda I, Jarisch R, Laimer M. Identification of Bet v 1-related allergens in fig and other Moraceae fruits. Clin Exp Allergy 2010;40:679-687

Background Allergy to fig fruit (Ficus carica) has been described in patients allergic to Ficus benjamina or rubber latex but may occur also in pollen-allergic patients. Objective To study the potential cross-reactivity between fig and taxonomically related fruits with the major birch pollen allergen Bet v 1. Methods One hundred and eighty-eight patients with or without birch pollen allergy were prick-to-prick tested with fig (F. carica), mulberry (Morus alba), jackfruit (Artocarpus heterophyllus; all family Moraceae) and other pollen-associated foods. Moraceae fruit extracts were separated by SDS-PAGE and tested with patient sera and polyclonal antisera against Mal d 1. Western blot inhibition was performed with Moraceae fruit extracts, birch pollen and recombinant Bet v 1. Putative Bet v 1 homologs in Moraceae fruits were analysed by liquid chromatography-ion trap mass spectrometry. Results Among 85 patients with isolated birch pollen allergy, 78% had a positive skin test to fresh fig, 10% to dried fig, 91% to mulberry, 91% to jackfruit, 77% to Rosaceae fruits and 83% to hazelnut. Sixty-six per cent of birch pollen-allergic patients positive for fig, reported symptoms after consumption of fresh figs, whereas dried figs were mostly well tolerated. In 60 patients with isolated Ficus benjamina sensitization, the reactivity rates to the same foods were 83-40-0-0-0-0%. None of 32 mugwort pollen-allergic patients reacted to Moraceae fruits. Rabbit anti-Mal d 1 and patient sera reacted to a 17 kDa band in all Moraceae extracts. IgE binding to these proteins was completely inhibited by birch pollen and rBet v 1. Mass spectrometry identified several peptides from the 17 kDa fig, mulberry and jackfruit allergen with respectively 60%, 56% and 76% homology to Bet v 1. Conclusion Fig and other Moraceae fruits contain allergens homologous to Bet v 1 and represent clinically relevant birch pollen-associated foods.

↩

[13] - Caiaffa MF, Cataldo VM, Tursi A, Macchia L. Fig and mulberry cross-allergy. Ann Allergy Asthma Immunol 2003;91:493-495

BACKGROUND: Hypersensitivity reactions to ingestion of figs (Ficus carica) and mulberries (Morus nigra and Morus alba) are considered uncommon and have never been reported as occurring in the same patient. OBJECTIVE: To determine whether hypersensitivity to figs and mulberries can induce cross-allergy. METHODS: We describe 3 cases of associated fig and mulberry allergy in 3 patients with multiple sensitizations to food allergens (mostly fruit) and airborne allergens. The presence of specific IgE was investigated by skin prick tests and radioallergosorbent tests. RESULTS: The 3 patients had a convincing clinical history of food allergy caused by eating fresh figs, and in all 3 cases clinical and/or laboratory evidence of sensitization to mulberries was also collected. CONCLUSIONS: We reason that Ficus and Morus are closely related genera of the Moraceae family and speculate that hypersensitivity to figs and mulberries might be associated as the result of allergen cross-reactivity rather than mere coincidence.

↩

[14] - Oei HD, Tjiook SB. A case report of an anaphylactic reaction after fig (Ficus carica) ingestion. Allergy 1998;53(suppl. 43):85

↩

[15] - Antico A, Zoccatelli G, Marcotulli C, Curioni A. Oral Allergy Syndrome to Fig. Int Arch Allergy Immunol 2003;131:138-142

BACKGROUND: The few cases of food allergy to fig reported to date, whose main manifestations were anaphylactic reactions, have been related to a cross-sensitisation to weeping fig (Ficus benjamina) or to the 'latex-fruit syndrome'. Here we report on two cases of the oral allergy syndrome (OAS) to fig in patients whose main allergic manifestations were related to sensitisation to grass and birch pollens . METHODS: The patients were characterised by clinical history, skin prick tests (SPT) with commercial and in-house extracts, prick-by-prick test, specific IgE measurements and challenge tests. PBS-soluble and insoluble extracts of both fig skin and pulp were examined for the presence of potential allergens by IgE immunoblotting . RESULTS: Both patients showed OAS followed by respiratory symptoms when challenged with fig. They were negative in both specific IgE detection and SPT with commercial extracts of fig and many other plant materials, including F. benjamina and Hevea Brasiliensis, while grass and birch pollens gave positive results. Prick-by-prick tests and SPT with in-house extracts indicated that the fig skin had a much higher allergenicity than the pulp. Despite negative IgE detection by the CAP assay, immunoblotting experiments showed that potential fig allergens were PBS-soluble and present only in the skin of the fruit . CONCLUSIONS: OAS to fig followed by respiratory symptoms can be present in patients not sensitised to weeping fig or having the latex-fruit syndrome. Different parts of the fig can have different allergenicities, the most important allergens being proteins related to the skin of the fruit. Improved commercial fig extracts to be used for the diagnosis of this type of allergy have to be developed.

↩

[16] - Erdmann SM, Hipler UC, Merk HF, Raulf-Heimsoth M. Sensitization to Fig with Cross-Sensitization to Weeping Fig and Natural Rubber Latex. Int Arch Allergy Immunol 2004;133:316

↩

[17] - Hemmer W, Focke M, Marzban G, Swoboda I, Jarisch R, Laimer M. Identification of Bet v 1-related allergens in fig and other Moraceae fruits. Clin Exp Allergy 2010;40:679-687

Background Allergy to fig fruit (Ficus carica) has been described in patients allergic to Ficus benjamina or rubber latex but may occur also in pollen-allergic patients. Objective To study the potential cross-reactivity between fig and taxonomically related fruits with the major birch pollen allergen Bet v 1. Methods One hundred and eighty-eight patients with or without birch pollen allergy were prick-to-prick tested with fig (F. carica), mulberry (Morus alba), jackfruit (Artocarpus heterophyllus; all family Moraceae) and other pollen-associated foods. Moraceae fruit extracts were separated by SDS-PAGE and tested with patient sera and polyclonal antisera against Mal d 1. Western blot inhibition was performed with Moraceae fruit extracts, birch pollen and recombinant Bet v 1. Putative Bet v 1 homologs in Moraceae fruits were analysed by liquid chromatography-ion trap mass spectrometry. Results Among 85 patients with isolated birch pollen allergy, 78% had a positive skin test to fresh fig, 10% to dried fig, 91% to mulberry, 91% to jackfruit, 77% to Rosaceae fruits and 83% to hazelnut. Sixty-six per cent of birch pollen-allergic patients positive for fig, reported symptoms after consumption of fresh figs, whereas dried figs were mostly well tolerated. In 60 patients with isolated Ficus benjamina sensitization, the reactivity rates to the same foods were 83-40-0-0-0-0%. None of 32 mugwort pollen-allergic patients reacted to Moraceae fruits. Rabbit anti-Mal d 1 and patient sera reacted to a 17 kDa band in all Moraceae extracts. IgE binding to these proteins was completely inhibited by birch pollen and rBet v 1. Mass spectrometry identified several peptides from the 17 kDa fig, mulberry and jackfruit allergen with respectively 60%, 56% and 76% homology to Bet v 1. Conclusion Fig and other Moraceae fruits contain allergens homologous to Bet v 1 and represent clinically relevant birch pollen-associated foods.

↩

[18] - Somoza ML, Rico P, Feliu A, Jiménez A, Rodriguez J, Crespo JF. Banana allergy confirmed by double-blind placebo-controlled food challenge (DBPCFC). EAACI 22th Congress, Paris, 7-11 June, 2003, Poster n°132

Background: Banana, a member of the Musaceae family, is widely consumed all over the world. It is available almost all year round in temperate climates due to heavy exporting from banana-growing countries. Banana allergy has been reported mainly associated to latex allergy. The aim of the study was to investigate clinical features of acute allergic reactions to banana confirmed by double-blind, placebo-controlled, food challenge (DBPCFC). Methods: Case series of 23 adult patients diagnosed with clinical banana allergy in the Food Allergy Unit from 'Hospital Universitario 12 de Octubre' (Madrid). Diagnostic procedure including a clinical questionnaire, skin testing by prick-prick with fresh fruit and detection of specific IgE (CAP FEIA) were performed in all patients reporting adverse reactions to foods. Patients first underwent an open food challenge (OFC), unless they had a convincing history of severe anaphylaxis. Positive OFC reactions were subsequently evaluated by DBPCFCs. All negative results of DBPCFCs were followed by an open feeding. Results: The age of patients ranged from 10 to 66 yr. (median= 24 yr.) with a female/male ratio of 2.8. Most patients (62%) experienced multiple allergic reactions after banana ingestion before being diagnosed with banana allergy. The most common clinical manifestation was the oral allergy syndrome (52%), followed by gastrointestinal anaphylaxis (8%) and acute respiratory symptoms (8%). The results of allergy testing were positive in 94% of the patients; however, an IgE-mediated mechanism could not be demostrated in two patients. In addition, 54 adverse reactions to other 20 different foods of vegetable origin were confirmed by DBPCFC‚s in the banana allergic patients; including melon, 12 patients; chestnut, 6 pt.; and avocado and kiwi, 5 pt. each. Latex allergy was diagnosed in 8 out of 23 (35%). Seventy-eight percent of the patients had pollen allergy. Conclusions: Banana can induce severe anaphylaxis, although most adverse reactions consist of oral allergy syndrome. Isolated banana allergy is uncommon, being associated frequently to melon allergy and latex allergy.

↩

[19] - Figueredo E, Cuesta-Herranz J, De-Miguel J, Lazaro M, Sastre J, Quirce S, et al. Clinical characteristics of melon (Cucumis melo) allergy. Ann Allergy Asthma Immunol 2003;91:303-308

BACKGROUND: Although melon is a frequent allergy-eliciting fruit, allergic reactions to melon have rarely been reported. OBJECTIVE: To evaluate and describe the clinical characteristics of melon allergy in melon-allergic patients. MATERIALS AND METHODS: We evaluated patients allergic to melon and a control group of patients allergic to pollen. The diagnosis of melon allergy was based on a convincing clinical history, positive skin test results (prick-by-prick test), and positive results on oral challenge tests to melon. RESULTS: A total of 161 patients were included in the study: 66 in the melon allergy group and 95 in the pollen control group. The melon allergy group included 35 female and 31 male patients with a mean age of 26.6 +/- 2.7 years (range, 5-61 years). Although all patients had oral symptoms, 13 (19.7%) of the patients had extraoral symptoms and none experienced generalized urticaria or anaphylaxis. Excluding other Cucurbitaceae fruits, peach, fig, and kiwi most frequently elicited positive skin test results and symptoms. Up to 23% of melon-allergic patients had a concomitant latex sensitization. Melon allergy was especially linked to pollen allergy, since all the melon-allergic patients were also allergic to pollen. Some differential features with respect to the pollen allergy control group were a higher prevalence of asthma (odds ratio [OR], 2.13; P < 0.05) and a statistical increase in the frequency of sensitization to several tree and weed pollens, including Ulmus (OR, 42.8) and Ambrosia (OR, 22.4). CONCLUSION: The most important conditions linked to melon allergy are pollen allergy (100%), allergy to other nonrelated fruits, mainly peach (up to 62%), and latex sensitivity (up to 23%). Some differential features of the pollinosis in melon allergy were a higher prevalence of asthma and a higher frequency of sensitization to several weed and tree pollens.

↩

[20] - 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)

↩

[21] - Asero R, Mistrello G, Roncarolo D, Amato S. Detection of Some Safe Plant-Derived Foods for LTP-Allergic Patients. Int Arch Allergy Immunol 2007;144:57-63

BACKGROUND: Lipid transfer protein (LTP) is a widely cross-reacting plant pan-allergen. Adverse reactions to Rosaceae, tree nuts, peanut, beer, maize, mustard, asparagus, grapes, mulberry, cabbage, dates, orange, fig, kiwi, lupine, fennel, celery, tomato, eggplant, lettuce, chestnut and pineapple have been recorded . OBJECTIVE: To detect vegetable foods to be regarded as safe for LTP-allergic patients . METHODS: Tolerance/intolerance to a large spectrum of vegetable foods other than Rosaceae, tree nuts and peanut was assessed by interview in 49 subjects monosensitized to LTP and in three distinct groups of controls monosensitized to Bet v 1 (n = 24) or Bet v 2 (n = 18), or sensitized to both LTP and birch pollen (n = 16), all with a history of vegetable food allergy. Patients and controls underwent skin prick test (SPT) with a large spectrum of vegetable foods. The absence of IgE reactivity to foods that were negative in both clinical history and SPT was confirmed by immunoblot analysis and their clinical tolerance was finally assessed by open oral challenge (50 g per food) . RESULTS: All patients reported tolerance and showed negative SPT to carrot, potato, banana and melon; these foods scored positive in SPT and elicited clinical symptoms in a significant proportion of patients from all three control groups. All patients tolerated these four foods on oral challenge. Immunoblot analysis confirmed the lack of IgE reactivity to these foods by LTP-allergic patients . CONCLUSION: Carrot, potato, banana and melon seem safe for LTP-allergic patients. This finding may be helpful for a better management of allergy to LTP.

↩

[22] - García Alvarez-Eire M, Pineda de la Losa F, Varela Losada S, González De la Cuesta C. Anaphylaxis due to early fig. Allergy 2007;62(suppl. 83):336

Background: The fig (ficus carica), which belongs to the family Moraceae, has been, until now, a rare cause of food allergy. We report a case of anaphylaxis due to the ingestion of an early fig, in a patient who later could eat autumn figs. Some of the fig trees bear a single crop (fig); others can bear a first crop (early fig) in the spring and a second crop (late fig) in the autumn. Early figs are a high-value fruits because they are bigger than late figs and have a sweet taste. Material and methods: We present the case of a 58-year-old-female, who developed two episodes of facial angioedema, eyes itching and bronchospasm, immediately after eating early figs. She improved with corticosteroids and B2-agonists. Afterwards, she had no reaction after the ingestion of autumn figs. The patient also suffered from seasonal rhinocojunctivitis, and referred itching into her mouth after eating apples and peaches. Skin prick tests (SPT) were performed with a battery of common inhalants and food allergens. Prick by prick tests, with fresh fruits (fig, early fig, apple and peach), were also realized. Total and specifc IgE to tree pollen, apple, peach and fig were determined using CAP system . An IgE-inmunoblot assay was realized to determine the reactivity of the patient serum against the proteins of early fig, late fig, Betula verrucosa and Olea europaea Results: Prick-by prick tests were positive to fresh early fig (wheal of 5x5mm), fig (wheal of 7x7mm), apple (6x5mm) and peach (5x4 mm). Prick tests with commercial extracts were positive to Betula verrucosa, Alnus glutinosa and Corylus avellana pollens. Levels of Total IgE were 34 kU/l and levels of specific IgE to Betula, alnus, Corylus, olea were 6.15, 3.28, 2.51 and 3.28 kU/L respectively and Lolium, chestnut, Apple , peach, plum and fig were <0.35 kU/L. Immunoblotting assay revealed a common recognized band around 32 kDa in the late fig and early fig extracts, and a more intense recognition for a protein around 16 kDa in the early fig extract. Two proteins nearly to15-17 KDa and 20-21 KDa in the Betula and Olea extracts were recognized by the serum of the patient Conclusions: We report a case of anaphylaxis due to the ingestion of an early fig, in a patient with pollinosis due to Betulaceae and Oral Allergy Syndrome with Rosaceae. The patient could eat autumn figs after the allergy reaction to early figs. To our knowledge, this is the first case of early fig allergy

↩

[23] - Ledent C, Bonduelle Y, Mairesse M. Syndrome ficus-fruits. Rev Fr Allergol 2009;49:28-30

Les plantes arbustives, en particulier le Ficus benjamina , sont devenues un élément important de la décoration intérieure de nos lieux de séjour. Les allergènes du F. benjamina peuvent être à l‚origine de manifestations respiratoires et cutanées, mais aussi d‚une sensibilisation croisée avec certains fruits, dont la figue, donnant lieu à des réactions anaphylactiques parfois sévères. Les auteurs rapportent cinq observations de cette association étiquetée syndrome ficus-fruits.

↩

[24] - 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.

↩

[25] - Hemmer W, Focke M, Marzban G, Swoboda I, Jarisch R, Laimer M. Identification of Bet v 1-related allergens in fig and other Moraceae fruits. Clin Exp Allergy 2010;40:679-687

Background Allergy to fig fruit (Ficus carica) has been described in patients allergic to Ficus benjamina or rubber latex but may occur also in pollen-allergic patients. Objective To study the potential cross-reactivity between fig and taxonomically related fruits with the major birch pollen allergen Bet v 1. Methods One hundred and eighty-eight patients with or without birch pollen allergy were prick-to-prick tested with fig (F. carica), mulberry (Morus alba), jackfruit (Artocarpus heterophyllus; all family Moraceae) and other pollen-associated foods. Moraceae fruit extracts were separated by SDS-PAGE and tested with patient sera and polyclonal antisera against Mal d 1. Western blot inhibition was performed with Moraceae fruit extracts, birch pollen and recombinant Bet v 1. Putative Bet v 1 homologs in Moraceae fruits were analysed by liquid chromatography-ion trap mass spectrometry. Results Among 85 patients with isolated birch pollen allergy, 78% had a positive skin test to fresh fig, 10% to dried fig, 91% to mulberry, 91% to jackfruit, 77% to Rosaceae fruits and 83% to hazelnut. Sixty-six per cent of birch pollen-allergic patients positive for fig, reported symptoms after consumption of fresh figs, whereas dried figs were mostly well tolerated. In 60 patients with isolated Ficus benjamina sensitization, the reactivity rates to the same foods were 83-40-0-0-0-0%. None of 32 mugwort pollen-allergic patients reacted to Moraceae fruits. Rabbit anti-Mal d 1 and patient sera reacted to a 17 kDa band in all Moraceae extracts. IgE binding to these proteins was completely inhibited by birch pollen and rBet v 1. Mass spectrometry identified several peptides from the 17 kDa fig, mulberry and jackfruit allergen with respectively 60%, 56% and 76% homology to Bet v 1. Conclusion Fig and other Moraceae fruits contain allergens homologous to Bet v 1 and represent clinically relevant birch pollen-associated foods.

↩

[26] - 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.

↩

[27] - Focke M, Hemmer W, Wöhrl S, Götz M, Jarisch R. Cross-reactivity between Ficus benjamina latex and fig fruit in patients with clinical fig allergy. Clin Exp Allergy 2003;33:971-977

BACKGROUND: Anaphylactic reactions to fig fruits (Ficus carica) have been reported from subjects sensitized to Ficus benjamina (FB) latex allergens. Figs may also be involved in the latex-fruit syndrome . OBJECTIVE: To study the immunologic relationship between fig fruit, Ficus benjamina, natural rubber latex (Hevea brasiliensis), and other tropical fruits . METHODS: RAST inhibition and Western blotting with FB and fruit extracts was performed in five patients with oral allergy syndrome (OAS) or anaphylaxis after the ingestion of figs and one patient with symptoms from exposure to FB trees. Co-sensitization to rubber latex and tropical fruits (kiwi, banana, avocado, papaya, pineapple, mulberry) was studied by skin testing . RESULTS: RAST to FB was inhibited >95% by FB extracts and 16-65% (mean 49%) by extracts from fresh fig. RAST to fig fruit was inhibited >95% by FB and fresh fig, 63-97% (mean 86%) by dried fig, and 0-84% (mean 35.5%) by kiwi fruit. FB and fig extracts lost most of their allergenicity when denatured by heat (95 degrees C) or reduced by dithiothreitol. Western blotting after non-reducing gel electrophoresis revealed IgE binding to proteins of 22 and 28-34 kDa in FB latex; however, no corresponding allergens could be detected in fig extracts. Positive skin tests were obtained most often with kiwi fruit, papaya, and avocado. Sensitization to rubber latex could not be demonstrated in any of the patients. RAST to papain was positive in three of five patients . CONCLUSIONS: Allergic reactions to fresh or dried figs can present as a consequence of primary sensitization to airborne FB allergens independent of sensitization to rubber latex allergens. Kiwi fruit, papaya, and avocado as well as pineapple and banana may be other fruits associated with sensitization to Ficus allergens

↩

[28] - 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.

↩

[29] - 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.

↩

[30] - Dechamp C, Bessot JC, Pauli G, Deviller P. First report of anaphylactic reaction after fig (Ficus carica) ingestion. Allergy 1995;50:514-516

We report an anaphylactic reaction which occurred very shortly after ingestion of a fresh fig. The IgE-dependent mechanism was demonstrated on the basis of positivity of the prick test performed with fresh fig (Ficus carica) extract. In addition, we were able to detect specific IgE to the same extract in the serum. The patient did not demonstrate sensitization to other common allergens involved in respiratory and food allergies. However, detection of specific IgE to F. benjamina indicated a sensitization to weeping fig. The CAP F. benjamina was partially inhibited by preincubation of the serum with fig extract, suggesting that these two species of Ficus share some common allergens. In this context, the assumption can be made that weeping fig was responsible for the initial sensitization in this patient.

↩

[31] - Diez-Gomez ML, Quirce S, Aragoneses E, Cuevas M. Asthma caused by Ficus benjamina latex: evidence of cross-reactivity with fig fruit and papain. Ann Allergy Asthma Immunol 1998;80:24-30

BACKGROUND: Ficus benjamina or weeping fig is a plant used increasingly for indoor decoration that can cause allergic rhinitis and asthma. OBJECTIVE: We report a clinical and immunologic study in a patient with perennial asthma caused by F. benjamina latex in whom several episodes of angioedema of the oropharyngeal tract and tongue followed ingestion of figs and kiwi. METHODS: Hypersensitivity to latex from F. benjamina and from Hevea brasiliensis, fig fruit, kiwi, papain, and bromelain was investigated by means of skin prick test, specific IgE determination by CAP, histamine release test, and bronchial provocation test to F. benjamina latex. CAP-inhibition assays were carried out to study possible cross-reactivity among these antigens. RESULTS: Hypersensitivity to F. benjamina latex, fig, kiwi, and proteases was demonstrated by means of skin prick test, determination of specific IgE and histamine release test. Bronchial provocation test with F. benjamina latex resulted in a dual asthmatic reaction, confirming the etiologic role of this plant. A rise of eosinophil cationic protein in patient's serum was observed 21 hours after bronchial challenge, suggesting activation of eosinophils. Inhibition assays showed that F. benjamina latex as liquid-phase inhibited up to 95% the CAP to fig and up to 57% the CAP to papain. Neither sensitization nor cross-allergenicity with H. brasiliensis latex was found. CONCLUSIONS: Hypersensitivity to F. benjamina latex may cause IgE-mediated respiratory allergy. The association with allergy to fig and papain is likely due to the existence of cross-reactive allergen structures.

↩

[32] - Bartra J, Gaig P, Bartolomé B, García-Ortega P. Allergy to fig (Ficus carica). Alergol Immunol Clin 2000;15:15-19

Background: The fig, the fruit of the fig tree, belongs to the Moraceae family and is a frequently consumed foodstuff in our area. Only a few cases of hyper-sensitivity reactions after the ingestion of figs have been reported. Material and methods: Eight patients with allergic symptoms after fig ingestion were selec-ted for this study. Skin tests were performed with fig (a commercial extract and prick-by-prick with the fresh fruit) and also with related allergens (Ficus benja-mina, mulberry pollen, latex, kiwi, papain and bromelin); the fig-specific IgE was quantified (enzyme-linked immunoassay), and SDS-PAGE immunoblotting with fig extract was performed. An oral challenge test was carried out in five cases. Results: The prick-by-prick test with fresh fig was positive in all eight patients, and none of them had a positive reaction to the commercial extract. The specific IgE levels were positive in six patients. The immunoblot revealed the presence of IgE-binding proteins with molecular weights ranging between 14 and 90 kDa. The skin tests with related allergens were positive with Ficus benjamina in all eight patients, with kiwi in 3, and with latex and papain in one patient each. The challenge test was positive in the five cases in which it was performed. Conclusions: Allergy to fig should be considered in countries where this fruit is frequently consumed. The prick-by-prick test with the fresh fruit is the most sensitive method for detection. In patients with fig allergy, sensitiza-tion to other related allergens must be ruled out.

↩

[33] - Gandolfo M, Baeza M, De Barrio M. Anaphylaxis to fig. Allergy 2001;56:462-463

↩

[34] - Mock B, Rudeschko O, Henzgen M, Schlenvoigt G, Jäger L. Fig allergy: cross-reactivities to Ficus benjamina and attempt for the characterization of allergens. Allergologie 1998;21:588-592

↩

[35] - Hemmer W, Focke M, Goetz M, Jarisch R. Sensitization to Ficus benjamina allergens and its relationship to natural rubber latex and fruit allergy. EAACI 22th Congress, Paris, 7-11 June, 2003, Poster n°615

Background: Ornamental Ficus benjamina (FB) has been recognized as a new indoor allergen. Little is known about the prevalence of sensitization in moderately exposed subjects and the proposed association with Hevea latex allergy. Methods: A skin prick test solution prepared from fresh FB latex (200 mg/ml) was included in routine allergy screening in patients with suspect inhalant allergy. Patients reacting with the FB extract were further skin tested with exotic fruits by the prick-prick method. RAST inhibition with FB, fig fruit (Ficus carica) and the thiolproteases ficin (from fig) and papain (from papaya) was performed in selected patients. Results: Among 2662 consecutive patients with a positive skin test to any aeroallergen, 66 (2.5%) reacted with the FB extract. 10/66 patients showed isolated sensitization to FB. The prevalence of Hevea latex sensitivity was higher in FB-sensitized subjects than in non-sensitized (10.6% vs 3.8%, p=0.053). Sensitization to FB was specifically associated with positive skin tests to exotic fruits including fresh fig (81%), dried fig (34%), kiwi (30%), avocado (22%), papaya (26%), banana (17%), and pineapple (11%) (n=47). Clinical reactions were reported mainly from fig (54%) and kiwi (62%), including 6 patients with systemic reactions (urticaria, angioedema, asthma). RAST to fig fruit in 7 patients with clinical fig allergy was inhibited on average by >95% by FB latex and fig extracts (100 mg/ml), and by 66% and 43% by ficin and papain (50 mg/ml), respectively. Conclusions: Sensitization to FB latex is found in 2.5% of atopic individuals and mostly occurs independent of Hevea latex sensitivity. Sensitization may be associated with allergic reactions to figs and other tropical fruits ("Ficus-fruit-syndrome"). This cross-reactivity is mediated at least in part by thiolproteases such as ficin and papain.

↩

[36] - Focke M, Hemmer W, Wöhrl S, Götz M, Jarisch R. Cross-reactivity between Ficus benjamina latex and fig fruit in patients with clinical fig allergy. Clin Exp Allergy 2003;33:971-977

BACKGROUND: Anaphylactic reactions to fig fruits (Ficus carica) have been reported from subjects sensitized to Ficus benjamina (FB) latex allergens. Figs may also be involved in the latex-fruit syndrome . OBJECTIVE: To study the immunologic relationship between fig fruit, Ficus benjamina, natural rubber latex (Hevea brasiliensis), and other tropical fruits . METHODS: RAST inhibition and Western blotting with FB and fruit extracts was performed in five patients with oral allergy syndrome (OAS) or anaphylaxis after the ingestion of figs and one patient with symptoms from exposure to FB trees. Co-sensitization to rubber latex and tropical fruits (kiwi, banana, avocado, papaya, pineapple, mulberry) was studied by skin testing . RESULTS: RAST to FB was inhibited >95% by FB extracts and 16-65% (mean 49%) by extracts from fresh fig. RAST to fig fruit was inhibited >95% by FB and fresh fig, 63-97% (mean 86%) by dried fig, and 0-84% (mean 35.5%) by kiwi fruit. FB and fig extracts lost most of their allergenicity when denatured by heat (95 degrees C) or reduced by dithiothreitol. Western blotting after non-reducing gel electrophoresis revealed IgE binding to proteins of 22 and 28-34 kDa in FB latex; however, no corresponding allergens could be detected in fig extracts. Positive skin tests were obtained most often with kiwi fruit, papaya, and avocado. Sensitization to rubber latex could not be demonstrated in any of the patients. RAST to papain was positive in three of five patients . CONCLUSIONS: Allergic reactions to fresh or dried figs can present as a consequence of primary sensitization to airborne FB allergens independent of sensitization to rubber latex allergens. Kiwi fruit, papaya, and avocado as well as pineapple and banana may be other fruits associated with sensitization to Ficus allergens

↩

[37] - Caiaffa MF, Cataldo VM, Tursi A, Macchia L. Fig and mulberry cross-allergy. Ann Allergy Asthma Immunol 2003;91:493-495

BACKGROUND: Hypersensitivity reactions to ingestion of figs (Ficus carica) and mulberries (Morus nigra and Morus alba) are considered uncommon and have never been reported as occurring in the same patient. OBJECTIVE: To determine whether hypersensitivity to figs and mulberries can induce cross-allergy. METHODS: We describe 3 cases of associated fig and mulberry allergy in 3 patients with multiple sensitizations to food allergens (mostly fruit) and airborne allergens. The presence of specific IgE was investigated by skin prick tests and radioallergosorbent tests. RESULTS: The 3 patients had a convincing clinical history of food allergy caused by eating fresh figs, and in all 3 cases clinical and/or laboratory evidence of sensitization to mulberries was also collected. CONCLUSIONS: We reason that Ficus and Morus are closely related genera of the Moraceae family and speculate that hypersensitivity to figs and mulberries might be associated as the result of allergen cross-reactivity rather than mere coincidence.

↩

[38] - Bourrier T, Noormahomed T, Drai M, Albertini M. Un cas d'allergie alimentaire pédiatrique à la figue. Rev Fr Allergol Immunol Clin 2004;44:131-132

↩

[39] - Oei HD, Tjiook SB. A case report of an anaphylactic reaction after fig (Ficus carica) ingestion. Allergy 1998;53(suppl. 43):85

↩

[40] - Erdmann SM, Hipler UC, Merk HF, Raulf-Heimsoth M. Sensitization to Fig with Cross-Sensitization to Weeping Fig and Natural Rubber Latex. Int Arch Allergy Immunol 2004;133:316

↩

[41] - Bircher AJ, Langauer S, Levy F, Wahl R. The allergen of Ficus benjamina in house dust. Clin Exp Allergy 1995;25:228-233

Ficus benjamina, a member of the Moraceae family, is a tropical, non-flowering green plant which is widely used for ornamental purposes. It is an occupational allergen in plant keepers but sensitization is also increasingly found in non-occupationally exposed atopic and non-atopic patients. The allergen of Ficus benjamina is located in the plant sap, a so-called latex. By radioallergosorbent test-(RAST)-inhibition studies allergen could also be demonstrated in the dust collected from the leaf surface and in dust samples from the floor of rooms where the plant was placed. These findings could result in more extensive preventive measures in patients sensitized to Ficus benjamina. In addition there is some evidence that possibly a crossreactivity between latex of Ficus benjamina and latex from the rubber tree Hevea brasiliensis, a member of the Euphorbiaceae family, may exist.

↩

[42] - 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.

↩

[43] - Laurent J, Guinnepain MT. Un arbre dangereux: le Ficus benjamina. Rev Fr Allergol Immunol Clin 2005;45:293-294

↩

[44] - 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.

↩

[45] - 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

↩

[46] - 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.

↩

[47] - 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.

↩

[48] - 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.

↩

[49] - 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.

↩

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

↩

[51] - Yman L, Lundberg M. Latex-related allergens of the plant family Euphorbiaceae. ICACI 2000, 15-20 Oct. 2000, Sydney, Australia, Abstract P-676

↩

[52] - Alemán A, Sastre J, Quirce S, de las Heras M, Carnés J, Fernández-Caldas E, et al. Allergy to kiwi: A double-blind, placebo-controlled food challenge study in patients from a birch-free area. J Allergy Clin Immunol 2004;113:543-550

Background Allergy to kiwi fruit is being increasingly reported, but it has never been evaluated by means of a double-blind, placebo-controlled food challenge (DBPCFC) study. Objective : We sought to assess kiwi allergy on the basis of a DBPCFC and identify the patterns of allergen recognition in sensitized patients from a birch-free area. Method s : Forty-three patients with allergy symptoms who were sensitized to kiwi were evaluated by means of clinical history, skin tests, IgE determinations, and DBPCFCs. The pattern of allergen recognition was assessed by means of IgE immunoblotting. Sequence analysis of IgE-binding bands was performed by using Edman degradation. Result s : DBPCFCs were performed in 33 patients; 4 patients had experienced severe anaphylaxis, and 6 patients declined informed consent. DBPCFC results were positive in 23 patients and negative in 10 patients. The most frequent clinical manifestation was oral allergy syndrome. Twenty-one percent of the patients were not allergic to pollen. Forty-six percent of patients experienced systemic symptoms, and this happened with higher frequency in patients not allergic to pollen (100%). Twenty-eight percent of the patients were sensitized to latex. The IgE-binding bands in kiwi extract more frequently recognized by patient sera were those of 30, 24, 66, and 12 kd, and they could not be associated with any pattern of kiwi-induced allergic reactions. Conclusion : The results provide evidence that kiwi allergy is not a homogeneous disorder because several clinical subgroups can be established. No definite allergen-recognition pattern was associated with the type of allergic reactions to kiwi. One of 5 patients with kiwi allergy was not allergic to pollen, and these patients had the highest risk of systemic reactions to kiwi.

↩

[53] - Bublin M, Mari A, Ebner C, Knulst A, Scheiner O, Hoffmann-Sommergruber K, et al. IgE sensitization profiles toward green and gold kiwifruits differ among patients allergic to kiwifruit from 3 European countries. J Allergy Clin Immunol 2004;114:1169-1175

Background Kiwifruits have become a major elicitor of plant food allergy. Until recently, the only species of kiwifruit grown commercially was the common green-fleshed Actinidia deliciosa cv Hayward. In 1999, the yellow-fleshed cultivar Actinidia chinensis cv Hort16A was introduced into the international market. Objective : We compared the allergen compositions of green and gold kiwifruits and assessed the sensitization patterns of patients with kiwifruit allergy toward both varieties. Method s : Sera from 90 patients with kiwifruit allergy from Austria, central Italy, and the Netherlands were tested for IgE binding to green and gold kiwifruit protein extracts and to purified actinidin, the major kiwifruit allergen, by ELISA. In addition, ELISA inhibitions and immunoblots were performed with selected sera. Relevant allergens were identified by N-terminal sequencing and immunoblotting with allergen-specific antibodies. Result s : IgE immunoblotting showed marked differences in the allergen compositions of green and gold kiwifruit extracts. Phytocystatin, a novel plant food allergen, and a thaumatin-like protein were identified as allergens common for both cultivars. Two allergens with homologies to chitinases were found in gold kiwifruits, whereas actinidin was detected exclusively in green kiwifruits. Patients from Central Europe and central Italy showed distinct sensitization profiles toward green and gold kiwifruit extracts as well as actinidin. Whereas sera from Austrian and Dutch patients mainly recognized green kiwifruit extract and actinidin, almost all Italian sera showed IgE binding to both kiwifruit species, but only half of them contained actinidin-specific IgE. Green and gold kiwifruit extracts were shown to be highly cross-reactive as determined by IgE ELISA inhibition. Conclusion : The presence of common allergens and the IgE cross-reactivity to green kiwifruit qualifies gold kiwifruit as a potential new allergen source for patients allergic to green kiwifruits.

↩

[54] - Caraballo L, Mercado D, Pantoja A, Mercado J. The allergenic properties of cassava (Manihot esculenta): a case of cassava allergy. AAAAI 57th Annual Meeting, New Orleans, 16-21 March, 2001, Poster n°606

↩

[55] - 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

↩

[56] - 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.

↩

[57] - Figueredo E, Cuesta-Herranz J, De-Miguel J, Lazaro M, Sastre J, Quirce S, et al. Clinical characteristics of melon (Cucumis melo) allergy. Ann Allergy Asthma Immunol 2003;91:303-308

BACKGROUND: Although melon is a frequent allergy-eliciting fruit, allergic reactions to melon have rarely been reported. OBJECTIVE: To evaluate and describe the clinical characteristics of melon allergy in melon-allergic patients. MATERIALS AND METHODS: We evaluated patients allergic to melon and a control group of patients allergic to pollen. The diagnosis of melon allergy was based on a convincing clinical history, positive skin test results (prick-by-prick test), and positive results on oral challenge tests to melon. RESULTS: A total of 161 patients were included in the study: 66 in the melon allergy group and 95 in the pollen control group. The melon allergy group included 35 female and 31 male patients with a mean age of 26.6 +/- 2.7 years (range, 5-61 years). Although all patients had oral symptoms, 13 (19.7%) of the patients had extraoral symptoms and none experienced generalized urticaria or anaphylaxis. Excluding other Cucurbitaceae fruits, peach, fig, and kiwi most frequently elicited positive skin test results and symptoms. Up to 23% of melon-allergic patients had a concomitant latex sensitization. Melon allergy was especially linked to pollen allergy, since all the melon-allergic patients were also allergic to pollen. Some differential features with respect to the pollen allergy control group were a higher prevalence of asthma (odds ratio [OR], 2.13; P < 0.05) and a statistical increase in the frequency of sensitization to several tree and weed pollens, including Ulmus (OR, 42.8) and Ambrosia (OR, 22.4). CONCLUSION: The most important conditions linked to melon allergy are pollen allergy (100%), allergy to other nonrelated fruits, mainly peach (up to 62%), and latex sensitivity (up to 23%). Some differential features of the pollinosis in melon allergy were a higher prevalence of asthma and a higher frequency of sensitization to several weed and tree pollens.

↩

[58] - 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)

↩

[59] - Asero R, Mistrello G, Roncarolo D, Amato S. Detection of Some Safe Plant-Derived Foods for LTP-Allergic Patients. Int Arch Allergy Immunol 2007;144:57-63

BACKGROUND: Lipid transfer protein (LTP) is a widely cross-reacting plant pan-allergen. Adverse reactions to Rosaceae, tree nuts, peanut, beer, maize, mustard, asparagus, grapes, mulberry, cabbage, dates, orange, fig, kiwi, lupine, fennel, celery, tomato, eggplant, lettuce, chestnut and pineapple have been recorded . OBJECTIVE: To detect vegetable foods to be regarded as safe for LTP-allergic patients . METHODS: Tolerance/intolerance to a large spectrum of vegetable foods other than Rosaceae, tree nuts and peanut was assessed by interview in 49 subjects monosensitized to LTP and in three distinct groups of controls monosensitized to Bet v 1 (n = 24) or Bet v 2 (n = 18), or sensitized to both LTP and birch pollen (n = 16), all with a history of vegetable food allergy. Patients and controls underwent skin prick test (SPT) with a large spectrum of vegetable foods. The absence of IgE reactivity to foods that were negative in both clinical history and SPT was confirmed by immunoblot analysis and their clinical tolerance was finally assessed by open oral challenge (50 g per food) . RESULTS: All patients reported tolerance and showed negative SPT to carrot, potato, banana and melon; these foods scored positive in SPT and elicited clinical symptoms in a significant proportion of patients from all three control groups. All patients tolerated these four foods on oral challenge. Immunoblot analysis confirmed the lack of IgE reactivity to these foods by LTP-allergic patients . CONCLUSION: Carrot, potato, banana and melon seem safe for LTP-allergic patients. This finding may be helpful for a better management of allergy to LTP.

↩

[60] - Hemmer W, Focke M, Marzban G, Swoboda I, Jarisch R, Laimer M. Identification of Bet v 1-related allergens in fig and other Moraceae fruits. Clin Exp Allergy 2010;40:679-687

Background Allergy to fig fruit (Ficus carica) has been described in patients allergic to Ficus benjamina or rubber latex but may occur also in pollen-allergic patients. Objective To study the potential cross-reactivity between fig and taxonomically related fruits with the major birch pollen allergen Bet v 1. Methods One hundred and eighty-eight patients with or without birch pollen allergy were prick-to-prick tested with fig (F. carica), mulberry (Morus alba), jackfruit (Artocarpus heterophyllus; all family Moraceae) and other pollen-associated foods. Moraceae fruit extracts were separated by SDS-PAGE and tested with patient sera and polyclonal antisera against Mal d 1. Western blot inhibition was performed with Moraceae fruit extracts, birch pollen and recombinant Bet v 1. Putative Bet v 1 homologs in Moraceae fruits were analysed by liquid chromatography-ion trap mass spectrometry. Results Among 85 patients with isolated birch pollen allergy, 78% had a positive skin test to fresh fig, 10% to dried fig, 91% to mulberry, 91% to jackfruit, 77% to Rosaceae fruits and 83% to hazelnut. Sixty-six per cent of birch pollen-allergic patients positive for fig, reported symptoms after consumption of fresh figs, whereas dried figs were mostly well tolerated. In 60 patients with isolated Ficus benjamina sensitization, the reactivity rates to the same foods were 83-40-0-0-0-0%. None of 32 mugwort pollen-allergic patients reacted to Moraceae fruits. Rabbit anti-Mal d 1 and patient sera reacted to a 17 kDa band in all Moraceae extracts. IgE binding to these proteins was completely inhibited by birch pollen and rBet v 1. Mass spectrometry identified several peptides from the 17 kDa fig, mulberry and jackfruit allergen with respectively 60%, 56% and 76% homology to Bet v 1. Conclusion Fig and other Moraceae fruits contain allergens homologous to Bet v 1 and represent clinically relevant birch pollen-associated foods.

↩

[61] - Ledent C, Bonduelle Y, Mairesse M. Syndrome ficus-fruits. Rev Fr Allergol 2009;49:28-30

Les plantes arbustives, en particulier le Ficus benjamina , sont devenues un élément important de la décoration intérieure de nos lieux de séjour. Les allergènes du F. benjamina peuvent être à l‚origine de manifestations respiratoires et cutanées, mais aussi d‚une sensibilisation croisée avec certains fruits, dont la figue, donnant lieu à des réactions anaphylactiques parfois sévères. Les auteurs rapportent cinq observations de cette association étiquetée syndrome ficus-fruits.

↩

[62] - Diez-Gomez ML, Quirce S, Aragoneses E, Cuevas M. Asthma caused by Ficus benjamina latex: evidence of cross-reactivity with fig fruit and papain. Ann Allergy Asthma Immunol 1998;80:24-30

BACKGROUND: Ficus benjamina or weeping fig is a plant used increasingly for indoor decoration that can cause allergic rhinitis and asthma. OBJECTIVE: We report a clinical and immunologic study in a patient with perennial asthma caused by F. benjamina latex in whom several episodes of angioedema of the oropharyngeal tract and tongue followed ingestion of figs and kiwi. METHODS: Hypersensitivity to latex from F. benjamina and from Hevea brasiliensis, fig fruit, kiwi, papain, and bromelain was investigated by means of skin prick test, specific IgE determination by CAP, histamine release test, and bronchial provocation test to F. benjamina latex. CAP-inhibition assays were carried out to study possible cross-reactivity among these antigens. RESULTS: Hypersensitivity to F. benjamina latex, fig, kiwi, and proteases was demonstrated by means of skin prick test, determination of specific IgE and histamine release test. Bronchial provocation test with F. benjamina latex resulted in a dual asthmatic reaction, confirming the etiologic role of this plant. A rise of eosinophil cationic protein in patient's serum was observed 21 hours after bronchial challenge, suggesting activation of eosinophils. Inhibition assays showed that F. benjamina latex as liquid-phase inhibited up to 95% the CAP to fig and up to 57% the CAP to papain. Neither sensitization nor cross-allergenicity with H. brasiliensis latex was found. CONCLUSIONS: Hypersensitivity to F. benjamina latex may cause IgE-mediated respiratory allergy. The association with allergy to fig and papain is likely due to the existence of cross-reactive allergen structures.

↩

[63] - Focke M, Hemmer W, Wöhrl S, Götz M, Jarisch R. Cross-reactivity between Ficus benjamina latex and fig fruit in patients with clinical fig allergy. Clin Exp Allergy 2003;33:971-977

BACKGROUND: Anaphylactic reactions to fig fruits (Ficus carica) have been reported from subjects sensitized to Ficus benjamina (FB) latex allergens. Figs may also be involved in the latex-fruit syndrome . OBJECTIVE: To study the immunologic relationship between fig fruit, Ficus benjamina, natural rubber latex (Hevea brasiliensis), and other tropical fruits . METHODS: RAST inhibition and Western blotting with FB and fruit extracts was performed in five patients with oral allergy syndrome (OAS) or anaphylaxis after the ingestion of figs and one patient with symptoms from exposure to FB trees. Co-sensitization to rubber latex and tropical fruits (kiwi, banana, avocado, papaya, pineapple, mulberry) was studied by skin testing . RESULTS: RAST to FB was inhibited >95% by FB extracts and 16-65% (mean 49%) by extracts from fresh fig. RAST to fig fruit was inhibited >95% by FB and fresh fig, 63-97% (mean 86%) by dried fig, and 0-84% (mean 35.5%) by kiwi fruit. FB and fig extracts lost most of their allergenicity when denatured by heat (95 degrees C) or reduced by dithiothreitol. Western blotting after non-reducing gel electrophoresis revealed IgE binding to proteins of 22 and 28-34 kDa in FB latex; however, no corresponding allergens could be detected in fig extracts. Positive skin tests were obtained most often with kiwi fruit, papaya, and avocado. Sensitization to rubber latex could not be demonstrated in any of the patients. RAST to papain was positive in three of five patients . CONCLUSIONS: Allergic reactions to fresh or dried figs can present as a consequence of primary sensitization to airborne FB allergens independent of sensitization to rubber latex allergens. Kiwi fruit, papaya, and avocado as well as pineapple and banana may be other fruits associated with sensitization to Ficus allergens

↩

[64] - 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.

↩

[65] - Asero R, Mistrello G, Roncarolo D, Amato S. Detection of Some Safe Plant-Derived Foods for LTP-Allergic Patients. Int Arch Allergy Immunol 2007;144:57-63

BACKGROUND: Lipid transfer protein (LTP) is a widely cross-reacting plant pan-allergen. Adverse reactions to Rosaceae, tree nuts, peanut, beer, maize, mustard, asparagus, grapes, mulberry, cabbage, dates, orange, fig, kiwi, lupine, fennel, celery, tomato, eggplant, lettuce, chestnut and pineapple have been recorded . OBJECTIVE: To detect vegetable foods to be regarded as safe for LTP-allergic patients . METHODS: Tolerance/intolerance to a large spectrum of vegetable foods other than Rosaceae, tree nuts and peanut was assessed by interview in 49 subjects monosensitized to LTP and in three distinct groups of controls monosensitized to Bet v 1 (n = 24) or Bet v 2 (n = 18), or sensitized to both LTP and birch pollen (n = 16), all with a history of vegetable food allergy. Patients and controls underwent skin prick test (SPT) with a large spectrum of vegetable foods. The absence of IgE reactivity to foods that were negative in both clinical history and SPT was confirmed by immunoblot analysis and their clinical tolerance was finally assessed by open oral challenge (50 g per food) . RESULTS: All patients reported tolerance and showed negative SPT to carrot, potato, banana and melon; these foods scored positive in SPT and elicited clinical symptoms in a significant proportion of patients from all three control groups. All patients tolerated these four foods on oral challenge. Immunoblot analysis confirmed the lack of IgE reactivity to these foods by LTP-allergic patients . CONCLUSION: Carrot, potato, banana and melon seem safe for LTP-allergic patients. This finding may be helpful for a better management of allergy to LTP.

↩

[66] - Figueredo E, Cuesta-Herranz J, De-Miguel J, Lazaro M, Sastre J, Quirce S, et al. Clinical characteristics of melon (Cucumis melo) allergy. Ann Allergy Asthma Immunol 2003;91:303-308

BACKGROUND: Although melon is a frequent allergy-eliciting fruit, allergic reactions to melon have rarely been reported. OBJECTIVE: To evaluate and describe the clinical characteristics of melon allergy in melon-allergic patients. MATERIALS AND METHODS: We evaluated patients allergic to melon and a control group of patients allergic to pollen. The diagnosis of melon allergy was based on a convincing clinical history, positive skin test results (prick-by-prick test), and positive results on oral challenge tests to melon. RESULTS: A total of 161 patients were included in the study: 66 in the melon allergy group and 95 in the pollen control group. The melon allergy group included 35 female and 31 male patients with a mean age of 26.6 +/- 2.7 years (range, 5-61 years). Although all patients had oral symptoms, 13 (19.7%) of the patients had extraoral symptoms and none experienced generalized urticaria or anaphylaxis. Excluding other Cucurbitaceae fruits, peach, fig, and kiwi most frequently elicited positive skin test results and symptoms. Up to 23% of melon-allergic patients had a concomitant latex sensitization. Melon allergy was especially linked to pollen allergy, since all the melon-allergic patients were also allergic to pollen. Some differential features with respect to the pollen allergy control group were a higher prevalence of asthma (odds ratio [OR], 2.13; P < 0.05) and a statistical increase in the frequency of sensitization to several tree and weed pollens, including Ulmus (OR, 42.8) and Ambrosia (OR, 22.4). CONCLUSION: The most important conditions linked to melon allergy are pollen allergy (100%), allergy to other nonrelated fruits, mainly peach (up to 62%), and latex sensitivity (up to 23%). Some differential features of the pollinosis in melon allergy were a higher prevalence of asthma and a higher frequency of sensitization to several weed and tree pollens.

↩

[67] - 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)

↩

[68] - Ledent C, Bonduelle Y, Mairesse M. Syndrome ficus-fruits. Rev Fr Allergol 2009;49:28-30

Les plantes arbustives, en particulier le Ficus benjamina , sont devenues un élément important de la décoration intérieure de nos lieux de séjour. Les allergènes du F. benjamina peuvent être à l‚origine de manifestations respiratoires et cutanées, mais aussi d‚une sensibilisation croisée avec certains fruits, dont la figue, donnant lieu à des réactions anaphylactiques parfois sévères. Les auteurs rapportent cinq observations de cette association étiquetée syndrome ficus-fruits.

↩

[69] - Musu T, Rabillon J, David B, Dandeu JP, Guinnepain MT, Looze Y. IgE antibodies cross-reaction between Der p1, the major allergen of Dermatophagoides pteronyssinus, and ananain, a cysteine protease from Ananas comosus, the pneapple plant. J Allergy Clin Immunol 1996;97:335

↩

[70] - Merima B, Radauer C, Ebner C, Allwardth D, Thomas WR, Mari A, et al. IgE Cross-reactivity between the Cysteine Proteases Der p 1 and Act c 1, the Major Allergens from House Dust Mites and Kiwifruit. AAAAI 62nd Annual Meeting, Miami, 3-7 March 2006, Poster n°194

RATIONALE: The cysteine proteases Act c 1 and Der p 1 are welldescribed major allergens in mites and kiwifruit, respectively. However, there are no data about IgE cross-reactivity between these allergens that are taxonomically not related but belong to the same protein family METHODS: Crystal structures and sequences of Der p 1 and Act c 1 were used to locate identical residues on the molecules' surfaces. Characterization of IgE binding and inhibition experiments were performed using Act c 1 and Der p 1. Sera of 16 patients were selected who had allergy to kiwifruit and/or sensitization to mites RESULTS: Sequence of Der p 1 and Act c 1 showed 30.6% identity and 41.8% similarity. Structural analysis of exterior amino acid side chains showed 18.7% identity and 29.1% similarity. The highest structural similarity was found within and in the vicinity of the active site of the two molecules. All sera tested contained IgE reactive to Der p 1 and 10 sera to Act c 1. The overall range of inhibitory capacity of Act c 1 upon IgE binding to Der p 1 was 20% to 61%. Der p 1 inhibited IgE binding to Act c 1 from 25% to 92% CONCLUSIONS: Here we demonstrate that homologous cysteine proteases of diverse sources share common IgE epitopes despite espite low sequence and structural similarity This work was supported by the Austrian Science Fund grant SFBF01802 Funding: Austrian Science Fund SFB-F01802.

↩

[71] - Caiaffa MF, Cataldo VM, Tursi A, Macchia L. Fig and mulberry cross-allergy. Ann Allergy Asthma Immunol 2003;91:493-495

BACKGROUND: Hypersensitivity reactions to ingestion of figs (Ficus carica) and mulberries (Morus nigra and Morus alba) are considered uncommon and have never been reported as occurring in the same patient. OBJECTIVE: To determine whether hypersensitivity to figs and mulberries can induce cross-allergy. METHODS: We describe 3 cases of associated fig and mulberry allergy in 3 patients with multiple sensitizations to food allergens (mostly fruit) and airborne allergens. The presence of specific IgE was investigated by skin prick tests and radioallergosorbent tests. RESULTS: The 3 patients had a convincing clinical history of food allergy caused by eating fresh figs, and in all 3 cases clinical and/or laboratory evidence of sensitization to mulberries was also collected. CONCLUSIONS: We reason that Ficus and Morus are closely related genera of the Moraceae family and speculate that hypersensitivity to figs and mulberries might be associated as the result of allergen cross-reactivity rather than mere coincidence.

↩

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

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

↩

[73] - Navarro AM, Orta JC, Sanchez MC, Delgado J, Barber D, Lombardero M. Primary sensitization to Morus alba. Allergy 1997;52:1144-1145

↩

[74] - Armentia A, Barber D, Lombardero M, Martin Santos JM, Martin Gil FJ, Arranz Pena ML, et al. Anaphylaxis associated with antiphospholipid syndrome. Ann Allergy Asthma Immunol 2001;87:54-59

BACKGROUND: To our knowledge, no previously published reports have described food-induced anaphylaxis associated with the antiphospholipid syndrome. OBJECTIVE: We undertook a study of four patients with thrombosis associated with the antiphospholipid syndrome after each patient experienced anaphylaxis attributable to ingestion of vegetal foods. METHODS: IgE antibody levels to various foods were determined in serum specimens from the study patients, and skin prick tests with the same allergens were conducted to determine their in vivo responses. Hematologic, cardiopulmonary, vascular, and rheumatologic studies were also performed. IgG anticardiolipin antibody levels were determined by ELISA. RESULTS: All four patients fulfilled the criteria for antiphospholipid syndrome and had high levels of specific IgE antibodies for certain food allergens. By immunoblot analysis, the presence of serum IgE specific for a 45-kD protein band in an almond extract was detected in these four patients who experienced food-related anaphylaxis. No specific IgE was detected in sera from normal subjects. No IgE antibodies specific for the food panallergen lipid transfer proteins were detected. CONCLUSIONS: This is the first report of severe food-precipitated anaphylaxis associated with the antiphospholipid syndrome and the first description of a patient with allergy to blackberry. The possible involvement of food panallergens distinct from lipid transfer proteins is also discussed

↩

[75] - Karakaya G, Kalyoncu AF. Allergy to grapes. Ann Allergy Asthma Immunol 2000;84:265

↩

[76] - Hemmer W, Focke M, Marzban G, Swoboda I, Jarisch R, Laimer M. Identification of Bet v 1-related allergens in fig and other Moraceae fruits. Clin Exp Allergy 2010;40:679-687

Background Allergy to fig fruit (Ficus carica) has been described in patients allergic to Ficus benjamina or rubber latex but may occur also in pollen-allergic patients. Objective To study the potential cross-reactivity between fig and taxonomically related fruits with the major birch pollen allergen Bet v 1. Methods One hundred and eighty-eight patients with or without birch pollen allergy were prick-to-prick tested with fig (F. carica), mulberry (Morus alba), jackfruit (Artocarpus heterophyllus; all family Moraceae) and other pollen-associated foods. Moraceae fruit extracts were separated by SDS-PAGE and tested with patient sera and polyclonal antisera against Mal d 1. Western blot inhibition was performed with Moraceae fruit extracts, birch pollen and recombinant Bet v 1. Putative Bet v 1 homologs in Moraceae fruits were analysed by liquid chromatography-ion trap mass spectrometry. Results Among 85 patients with isolated birch pollen allergy, 78% had a positive skin test to fresh fig, 10% to dried fig, 91% to mulberry, 91% to jackfruit, 77% to Rosaceae fruits and 83% to hazelnut. Sixty-six per cent of birch pollen-allergic patients positive for fig, reported symptoms after consumption of fresh figs, whereas dried figs were mostly well tolerated. In 60 patients with isolated Ficus benjamina sensitization, the reactivity rates to the same foods were 83-40-0-0-0-0%. None of 32 mugwort pollen-allergic patients reacted to Moraceae fruits. Rabbit anti-Mal d 1 and patient sera reacted to a 17 kDa band in all Moraceae extracts. IgE binding to these proteins was completely inhibited by birch pollen and rBet v 1. Mass spectrometry identified several peptides from the 17 kDa fig, mulberry and jackfruit allergen with respectively 60%, 56% and 76% homology to Bet v 1. Conclusion Fig and other Moraceae fruits contain allergens homologous to Bet v 1 and represent clinically relevant birch pollen-associated foods.

↩

[77] - Caiaffa MF, Cataldo VM, Tursi A, Macchia L. Fig and mulberry cross-allergy. Ann Allergy Asthma Immunol 2003;91:493-495

BACKGROUND: Hypersensitivity reactions to ingestion of figs (Ficus carica) and mulberries (Morus nigra and Morus alba) are considered uncommon and have never been reported as occurring in the same patient. OBJECTIVE: To determine whether hypersensitivity to figs and mulberries can induce cross-allergy. METHODS: We describe 3 cases of associated fig and mulberry allergy in 3 patients with multiple sensitizations to food allergens (mostly fruit) and airborne allergens. The presence of specific IgE was investigated by skin prick tests and radioallergosorbent tests. RESULTS: The 3 patients had a convincing clinical history of food allergy caused by eating fresh figs, and in all 3 cases clinical and/or laboratory evidence of sensitization to mulberries was also collected. CONCLUSIONS: We reason that Ficus and Morus are closely related genera of the Moraceae family and speculate that hypersensitivity to figs and mulberries might be associated as the result of allergen cross-reactivity rather than mere coincidence.

↩

[78] - Ciardiello MA, Palazzo P, Bernardi ML, Carratore V, Giangrieco I, Longo V et al. Biochemical, immunological and clinical characterization of a cross-reactive nonspecific lipid transfer protein 1 from mulberry. Allergy 2010;65:597-605

↩

[79] - Caiaffa MF, Cataldo VM, Tursi A, Macchia L. Fig and mulberry cross-allergy. Ann Allergy Asthma Immunol 2003;91:493-495

BACKGROUND: Hypersensitivity reactions to ingestion of figs (Ficus carica) and mulberries (Morus nigra and Morus alba) are considered uncommon and have never been reported as occurring in the same patient. OBJECTIVE: To determine whether hypersensitivity to figs and mulberries can induce cross-allergy. METHODS: We describe 3 cases of associated fig and mulberry allergy in 3 patients with multiple sensitizations to food allergens (mostly fruit) and airborne allergens. The presence of specific IgE was investigated by skin prick tests and radioallergosorbent tests. RESULTS: The 3 patients had a convincing clinical history of food allergy caused by eating fresh figs, and in all 3 cases clinical and/or laboratory evidence of sensitization to mulberries was also collected. CONCLUSIONS: We reason that Ficus and Morus are closely related genera of the Moraceae family and speculate that hypersensitivity to figs and mulberries might be associated as the result of allergen cross-reactivity rather than mere coincidence.

↩

[80] - Ciardiello MA, Palazzo P, Bernardi ML, Carratore V, Giangrieco I, Longo V et al. Biochemical, immunological and clinical characterization of a cross-reactive nonspecific lipid transfer protein 1 from mulberry. Allergy 2010;65:597-605

↩

[81] - Hemmer W, Focke M, Marzban G, Swoboda I, Jarisch R, Laimer M. Identification of Bet v 1-related allergens in fig and other Moraceae fruits. Clin Exp Allergy 2010;40:679-687

Background Allergy to fig fruit (Ficus carica) has been described in patients allergic to Ficus benjamina or rubber latex but may occur also in pollen-allergic patients. Objective To study the potential cross-reactivity between fig and taxonomically related fruits with the major birch pollen allergen Bet v 1. Methods One hundred and eighty-eight patients with or without birch pollen allergy were prick-to-prick tested with fig (F. carica), mulberry (Morus alba), jackfruit (Artocarpus heterophyllus; all family Moraceae) and other pollen-associated foods. Moraceae fruit extracts were separated by SDS-PAGE and tested with patient sera and polyclonal antisera against Mal d 1. Western blot inhibition was performed with Moraceae fruit extracts, birch pollen and recombinant Bet v 1. Putative Bet v 1 homologs in Moraceae fruits were analysed by liquid chromatography-ion trap mass spectrometry. Results Among 85 patients with isolated birch pollen allergy, 78% had a positive skin test to fresh fig, 10% to dried fig, 91% to mulberry, 91% to jackfruit, 77% to Rosaceae fruits and 83% to hazelnut. Sixty-six per cent of birch pollen-allergic patients positive for fig, reported symptoms after consumption of fresh figs, whereas dried figs were mostly well tolerated. In 60 patients with isolated Ficus benjamina sensitization, the reactivity rates to the same foods were 83-40-0-0-0-0%. None of 32 mugwort pollen-allergic patients reacted to Moraceae fruits. Rabbit anti-Mal d 1 and patient sera reacted to a 17 kDa band in all Moraceae extracts. IgE binding to these proteins was completely inhibited by birch pollen and rBet v 1. Mass spectrometry identified several peptides from the 17 kDa fig, mulberry and jackfruit allergen with respectively 60%, 56% and 76% homology to Bet v 1. Conclusion Fig and other Moraceae fruits contain allergens homologous to Bet v 1 and represent clinically relevant birch pollen-associated foods.

↩

[82] - Hemmer W, Focke M, Marzban G, Swoboda I, Jarisch R, Laimer M. Identification of Bet v 1-related allergens in fig and other Moraceae fruits. Clin Exp Allergy 2010;40:679-687

Background Allergy to fig fruit (Ficus carica) has been described in patients allergic to Ficus benjamina or rubber latex but may occur also in pollen-allergic patients. Objective To study the potential cross-reactivity between fig and taxonomically related fruits with the major birch pollen allergen Bet v 1. Methods One hundred and eighty-eight patients with or without birch pollen allergy were prick-to-prick tested with fig (F. carica), mulberry (Morus alba), jackfruit (Artocarpus heterophyllus; all family Moraceae) and other pollen-associated foods. Moraceae fruit extracts were separated by SDS-PAGE and tested with patient sera and polyclonal antisera against Mal d 1. Western blot inhibition was performed with Moraceae fruit extracts, birch pollen and recombinant Bet v 1. Putative Bet v 1 homologs in Moraceae fruits were analysed by liquid chromatography-ion trap mass spectrometry. Results Among 85 patients with isolated birch pollen allergy, 78% had a positive skin test to fresh fig, 10% to dried fig, 91% to mulberry, 91% to jackfruit, 77% to Rosaceae fruits and 83% to hazelnut. Sixty-six per cent of birch pollen-allergic patients positive for fig, reported symptoms after consumption of fresh figs, whereas dried figs were mostly well tolerated. In 60 patients with isolated Ficus benjamina sensitization, the reactivity rates to the same foods were 83-40-0-0-0-0%. None of 32 mugwort pollen-allergic patients reacted to Moraceae fruits. Rabbit anti-Mal d 1 and patient sera reacted to a 17 kDa band in all Moraceae extracts. IgE binding to these proteins was completely inhibited by birch pollen and rBet v 1. Mass spectrometry identified several peptides from the 17 kDa fig, mulberry and jackfruit allergen with respectively 60%, 56% and 76% homology to Bet v 1. Conclusion Fig and other Moraceae fruits contain allergens homologous to Bet v 1 and represent clinically relevant birch pollen-associated foods.

↩

[83] - Wüthrich B, Borga A, Yman L. Oral allergy syndrome to jackfruit (Artocarpus integrifolia). Allergy 1997;52:428-431

A 30-year-old man from the Philippines with pollen allergy noted the appearance of oral allergy syndrome (GAS) after eating raw apple, raw peach, raw celery, and, recently, jackfruit (Artocarpus integrifolia). a tropical fruit which belongs to the Moraceae family (mulberry) and to the genus Artocarpus (breadfruit tree). Despite the patient's multiple sensitization in skin prick tests and in the Pharmacia CAP System to birch, grass, mugwort pollen, related fruits and vegetables, and jackfruit, in RAST-inhibition studies neither rBet v 1 nor rBet v 2 (profilin). the well-known cross-reacting allergenic components in GAS, could inhibit the specific IgE response to jackfruit. Whether the reaction to jackfruit is specific or whether other pollen-related, cross-reacting allergenic components exist should be investigated further

↩

[84] - Petit-Levy I, Didier A. (anaphylaxie au petit jacque). Alim'Inter 1998;3(13):7

↩

[85] - Bolhaar STHP, van Ree R, Bruijnzeel-Koomen CAFM, Knulst AC, Zuidmeer L. Allergy to jackfruit: a novel example of Bet v 1-related food allergy. Allergy 2004;59:1187-1192

Rationale Confirm allergy to jackfruit in 2 patients with an according personal history and characterize allergens and cross-reactivity of specific IgE antibodies to (birch) pollen and food allergens. In addition, determine the prevalence of jackfruit allergy in a group (n=5) of birch pollen (BP) and food allergic patients. Method s : All patients underwent skin prick testing (SPT). Two patients were tested in a double-blind placebo-controlled food challenge (DBPCFC) and the additional 5 underwent an open challenge (OC) with jackfruit. Specific IgE was measured with the radio-allergosorbent test (RAST). RAST and immunoblot (inhibitions) were carried out. In the 2 jackfruit allergic patients, basophil histamine release was measured with several allergens. Result s : Both patients had positive SPT responses to jackfruit and BP and reacted with oral allergy symptoms (OAS) in the DBPCFC. The 5 selected patients reacted with OAS in the OC. Specific IgE of patient 1 to jackfruit was completely inhibited by BP extract and natural (n)Bet v 1 in RAST and immunoblot inhibition. In addition, this patient showed histamine release upon stimulation with jackfruit, apple or BP extracts and nBet v 1. Conclusions : Sensitization to jackfruit allergy is due to the cross-reactive BP allergen Bet v 1. The prevalence of jackfruit allergy in the selected group of 5 patients was 100%, but jackfruit is not regularly consumed in Northern Europe, explaining why jackfruit allergy is not common.

↩

[86] - Petit-Levy I, Didier A. (anaphylaxie au petit jacque). Alim'Inter 1998;3(13):7

↩

[87] - Wüthrich B, Borga A, Yman L. Oral allergy syndrome to jackfruit (Artocarpus integrifolia). Allergy 1997;52:428-431

A 30-year-old man from the Philippines with pollen allergy noted the appearance of oral allergy syndrome (GAS) after eating raw apple, raw peach, raw celery, and, recently, jackfruit (Artocarpus integrifolia). a tropical fruit which belongs to the Moraceae family (mulberry) and to the genus Artocarpus (breadfruit tree). Despite the patient's multiple sensitization in skin prick tests and in the Pharmacia CAP System to birch, grass, mugwort pollen, related fruits and vegetables, and jackfruit, in RAST-inhibition studies neither rBet v 1 nor rBet v 2 (profilin). the well-known cross-reacting allergenic components in GAS, could inhibit the specific IgE response to jackfruit. Whether the reaction to jackfruit is specific or whether other pollen-related, cross-reacting allergenic components exist should be investigated further

↩

[88] - Bolhaar STHP, van Ree R, Bruijnzeel-Koomen CAFM, Knulst AC, Zuidmeer L. Allergy to jackfruit: a novel example of Bet v 1-related food allergy. Allergy 2004;59:1187-1192

Rationale Confirm allergy to jackfruit in 2 patients with an according personal history and characterize allergens and cross-reactivity of specific IgE antibodies to (birch) pollen and food allergens. In addition, determine the prevalence of jackfruit allergy in a group (n=5) of birch pollen (BP) and food allergic patients. Method s : All patients underwent skin prick testing (SPT). Two patients were tested in a double-blind placebo-controlled food challenge (DBPCFC) and the additional 5 underwent an open challenge (OC) with jackfruit. Specific IgE was measured with the radio-allergosorbent test (RAST). RAST and immunoblot (inhibitions) were carried out. In the 2 jackfruit allergic patients, basophil histamine release was measured with several allergens. Result s : Both patients had positive SPT responses to jackfruit and BP and reacted with oral allergy symptoms (OAS) in the DBPCFC. The 5 selected patients reacted with OAS in the OC. Specific IgE of patient 1 to jackfruit was completely inhibited by BP extract and natural (n)Bet v 1 in RAST and immunoblot inhibition. In addition, this patient showed histamine release upon stimulation with jackfruit, apple or BP extracts and nBet v 1. Conclusions : Sensitization to jackfruit allergy is due to the cross-reactive BP allergen Bet v 1. The prevalence of jackfruit allergy in the selected group of 5 patients was 100%, but jackfruit is not regularly consumed in Northern Europe, explaining why jackfruit allergy is not common.

↩

[89] - Hemmer W, Focke M, Marzban G, Swoboda I, Jarisch R, Laimer M. Identification of Bet v 1-related allergens in fig and other Moraceae fruits. Clin Exp Allergy 2010;40:679-687

Background Allergy to fig fruit (Ficus carica) has been described in patients allergic to Ficus benjamina or rubber latex but may occur also in pollen-allergic patients. Objective To study the potential cross-reactivity between fig and taxonomically related fruits with the major birch pollen allergen Bet v 1. Methods One hundred and eighty-eight patients with or without birch pollen allergy were prick-to-prick tested with fig (F. carica), mulberry (Morus alba), jackfruit (Artocarpus heterophyllus; all family Moraceae) and other pollen-associated foods. Moraceae fruit extracts were separated by SDS-PAGE and tested with patient sera and polyclonal antisera against Mal d 1. Western blot inhibition was performed with Moraceae fruit extracts, birch pollen and recombinant Bet v 1. Putative Bet v 1 homologs in Moraceae fruits were analysed by liquid chromatography-ion trap mass spectrometry. Results Among 85 patients with isolated birch pollen allergy, 78% had a positive skin test to fresh fig, 10% to dried fig, 91% to mulberry, 91% to jackfruit, 77% to Rosaceae fruits and 83% to hazelnut. Sixty-six per cent of birch pollen-allergic patients positive for fig, reported symptoms after consumption of fresh figs, whereas dried figs were mostly well tolerated. In 60 patients with isolated Ficus benjamina sensitization, the reactivity rates to the same foods were 83-40-0-0-0-0%. None of 32 mugwort pollen-allergic patients reacted to Moraceae fruits. Rabbit anti-Mal d 1 and patient sera reacted to a 17 kDa band in all Moraceae extracts. IgE binding to these proteins was completely inhibited by birch pollen and rBet v 1. Mass spectrometry identified several peptides from the 17 kDa fig, mulberry and jackfruit allergen with respectively 60%, 56% and 76% homology to Bet v 1. Conclusion Fig and other Moraceae fruits contain allergens homologous to Bet v 1 and represent clinically relevant birch pollen-associated foods.

↩

[90] - de Greef JM, Lieutier-Colas F, Bessot JC, Vérot A, Gallerand AM, Pauli G, et al. Urticaria and rhinitis to shrubs of Ficus benjamina and breadfruit in a banana-allergic road worker: evidence for a cross-sensitization between moracea, banana and latex. Int Arch Allergy Immunol 2001;125:182-184

BACKGROUND: We report the case of a road worker with a food allergy to banana, who developed urticaria and rhinitis when cutting shrubs of Ficus benjamina and breadfruit. He did not develop an allergy to latex of Hevea brasiliensis. RESULTS: Sensitization to latex of F. benjamina, H. brasiliensis, breadfruit and banana was demonstrated using skin tests and specific IgE measurements. RAST inhibitions procedures showed that specific IgE to breadfruit latex cross-reacted more strongly with latex of H. brasiliensis and banana than with latex of F. benjamina with the same extract. CONCLUSION: Given the wide distribution of Moracea trees in tropical regions, sensitization to latex of H. brasiliensis and banana could be a consequence of sensitization to Moracea members; F. benjamina does not seem to be the only Moracea responsible for cross-allergy with latex and fruit. Consequently, it seems interesting to test other members of the Moracea family in patients sensitized to latex of H. brasiliensis and banana. Sensitization to breadfruit could be a risk factor for sensitization to latex of H. brasiliensis

↩

[91] - Hemmer W, Focke M, Marzban G, Swoboda I, Jarisch R, Laimer M. Identification of Bet v 1-related allergens in fig and other Moraceae fruits. Clin Exp Allergy 2010;40:679-687

Background Allergy to fig fruit (Ficus carica) has been described in patients allergic to Ficus benjamina or rubber latex but may occur also in pollen-allergic patients. Objective To study the potential cross-reactivity between fig and taxonomically related fruits with the major birch pollen allergen Bet v 1. Methods One hundred and eighty-eight patients with or without birch pollen allergy were prick-to-prick tested with fig (F. carica), mulberry (Morus alba), jackfruit (Artocarpus heterophyllus; all family Moraceae) and other pollen-associated foods. Moraceae fruit extracts were separated by SDS-PAGE and tested with patient sera and polyclonal antisera against Mal d 1. Western blot inhibition was performed with Moraceae fruit extracts, birch pollen and recombinant Bet v 1. Putative Bet v 1 homologs in Moraceae fruits were analysed by liquid chromatography-ion trap mass spectrometry. Results Among 85 patients with isolated birch pollen allergy, 78% had a positive skin test to fresh fig, 10% to dried fig, 91% to mulberry, 91% to jackfruit, 77% to Rosaceae fruits and 83% to hazelnut. Sixty-six per cent of birch pollen-allergic patients positive for fig, reported symptoms after consumption of fresh figs, whereas dried figs were mostly well tolerated. In 60 patients with isolated Ficus benjamina sensitization, the reactivity rates to the same foods were 83-40-0-0-0-0%. None of 32 mugwort pollen-allergic patients reacted to Moraceae fruits. Rabbit anti-Mal d 1 and patient sera reacted to a 17 kDa band in all Moraceae extracts. IgE binding to these proteins was completely inhibited by birch pollen and rBet v 1. Mass spectrometry identified several peptides from the 17 kDa fig, mulberry and jackfruit allergen with respectively 60%, 56% and 76% homology to Bet v 1. Conclusion Fig and other Moraceae fruits contain allergens homologous to Bet v 1 and represent clinically relevant birch pollen-associated foods.

↩

Figue

Existe-t-il un syndrome Ficus-aliments ?

Mûre

Un syndrome bouleau-Moracées ?

Petit Jacque et arbre à pain

Rubriques

Dans la même rubrique

Autres "fruits exotiques"

Le syndrome latex-aliments

L’avocat

La banane

Le kiwi