Le ficus

[1] - Piirilä P, Mäkinen-Kiljunen S, Kajosaari M, Kiistala R, Petman L, Haahtela T. Nonoccupational Sensitization to Indoor Plants. Allergy Clin Immunol Int 2006;18:106-113

Background: Indoor plants can cause imunoglobulin E (IgE)-mediated allergy. We studied sensitization to indoor plants and factors affecting sensitization in an allergy outpatient clinic. Methods/Data base: 205 atopic and 90 nonatopic patients were skin prick tested for sensitivity to 12 common indoor plants. Sera from 34 adult plant-positive patients were im-munospot tested. The occurrence of the plants in homes and associated respiratory symptoms were assessed by questionnaire. Results: Of the atopic patients, 39% had positive reactions to the plants; 54% to Ficus benjamina, 36% to Hibiscus rosa sinensis, 35% to Yucca aloifolia, 23% to Dracaena fragrans, and 21% to Asplenium nidus. Of the nonatopics, 2% had skin reactions to the plants. In immunospot studies, 62% of the plant-positive patients showed IgE specific to at least one plant; 44% to Ficus benjamina, 35% to Dieffenbachia picta, and 32% to Hibiscus rosa sinensis and Chamaedorea elegans. Forty percent of patients sensitized to Ficus benjamina and 33% of those sensitized to Dieffenbachia picta reported clinical symptoms. Conclusion: Sensitization to indoor plants, particularly to Ficus spp., is commonly detected by skin and immunospot tests in atopic patients. A minority (0-40% for various plants) of prick test-positive patients reported clinical symptoms. Clustering of pollen, vegetable food, and indoor plant sensitivities suggested crossreactivity of allergens.

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[2] - Faller M, Bessot JC, Lieutier-Colas F, Lett E, Wachsmann D, Pauli G, et al. Ficus antigen in dust. Allergy 2001;56:584-585

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[3] - Werfel S, Rueff F, Przybilla B. [Anaphylactic reaction to Ficus benjamina (weeping fig)]. Hautarzt 2001;52:935-937

Ficus benjamina (weeping fig) is a widespread indoor ornamental plant. Allergens of Ficus benjamina are a well-known cause of IgE-mediated respiratory diseases. We treated a 32-year-old female who for 10 years had suffered from perennial rhinoconjunctivitis. When dusting her 2 meter high Ficus benjamina, she developed an anaphylactic reaction which resolved without sequelae. Skin prick testing revealed a strong immediate type reaction to a Ficus extract, the serum concentration of specific IgE-antibodies to Ficus was > 100 kU/I (CAP class 6). In view of these strong test reactions and the conclusive history, no challenge tests with Ficus allergens were performed. After removal of the Ficus plants which she had owned for 17 years and after thorough cleaning of her dwelling, the patient's symptoms of perennial rhinoconjunctivitis stopped. The patient also was sensitized to, but not allergic to natural rubber latex, which occurs frequently in Ficus allergy and probably is due to cross reactivity to allergens from both sources. As Ficus benjamina is an important source of indoor allergens, it should not be used in dwellings or work places.

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[4] - 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

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[5] - Axelsson IG, Johansson SG, Larsson PH, Zetterstrom O. Serum reactivity to other indoor ficus plants in patients with allergy to weeping fig (Ficus benjamina) . Allergy 1991;46:92-98

Ornamental plants have long been used for indoor decoration. An example is the india rubber tree (Ficus elastica). With the increased popularity of green plants, both in private homes and public premises, small-leaf species, such as weeping fig or Ficus benjamina (Fb), have become widely used. Exposure to dust from Fb may cause sensitization and allergic airway symptoms, which among occupationally exposed plant keepers occur both in atopics and non-atopics. The serum reactivity to sap extracts from Fb and seven other indoor plants of the genus Ficus were investigated with RAST and a RAST inhibition technique, using sera from 12 atopic subjects and 12 plant keepers, sensitized to Fb. The allergenic similarity between the different extracts was found to be extensive. The specific IgE antibodies with the highest concentrations in serum were those against Fb and its variegate form, "star light", with decreasing values for the other species, especially those with larger leaves. The binding of IgE antibodies to the other Ficus RAST discs could be completely inhibited by extract of Fb. These reactions were probably due to cross-reactivity. Sensitization is believed to occur by inhalation of allergen-enriched dust, emanating from the leaves of the plants. The high allergenic potency of the species with many small leaves may be due to their large total leaf area

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[6] - Axelsson IG, Johansson SG, Larsson PH, Zetterstrom O. Serum reactivity to other indoor ficus plants in patients with allergy to weeping fig (Ficus benjamina) . Allergy 1991;46:92-98

Ornamental plants have long been used for indoor decoration. An example is the india rubber tree (Ficus elastica). With the increased popularity of green plants, both in private homes and public premises, small-leaf species, such as weeping fig or Ficus benjamina (Fb), have become widely used. Exposure to dust from Fb may cause sensitization and allergic airway symptoms, which among occupationally exposed plant keepers occur both in atopics and non-atopics. The serum reactivity to sap extracts from Fb and seven other indoor plants of the genus Ficus were investigated with RAST and a RAST inhibition technique, using sera from 12 atopic subjects and 12 plant keepers, sensitized to Fb. The allergenic similarity between the different extracts was found to be extensive. The specific IgE antibodies with the highest concentrations in serum were those against Fb and its variegate form, "star light", with decreasing values for the other species, especially those with larger leaves. The binding of IgE antibodies to the other Ficus RAST discs could be completely inhibited by extract of Fb. These reactions were probably due to cross-reactivity. Sensitization is believed to occur by inhalation of allergen-enriched dust, emanating from the leaves of the plants. The high allergenic potency of the species with many small leaves may be due to their large total leaf area

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[7] - Kortekangas-Savolainen O, Kalimo K, Savolainen J. Allergens of Ficus benjamina (weeping fig): unique allergens in sap. Allergy 2006;61:393-394

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[8] - Drouet M, Bonneau JC, Nicolie B, Le Sellin J. Les allergènes respiratoires des horticulteurs et pépiniéristes. Rev Fr Allergol Immunol Clin 2005;45:406-410

Les horticulteurs et pépiniéristes côtoient de multiples substances tant dans le domaine végétal que dans le domaine chimique et toutes ces substances sont potentiellement allergéniques. Le contact peut entraîner des manifestations allergiques cutanées et la voie inhalée des symptômes respiratoires. Les végétaux sont probablement plus impliqués dans les allergies de contact alors que les produits chimiques induisent sans doute les deux types de symptômes. Ces données de la littérature méritent toutefois peut-être quelques réserves du fait du manque de standardisation des tests diagnostiques. Ne seront évoqués que les symptômes respiratoires.

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[9] - Axelsson G, Skedinger M, Zetterström O. Allergy to weeping fig - A new occupational disease. Allergy 1985;40:461-464

During the last decade green plants have become more common in interior decoration. There are companies specializing in the leasing of green plants to public buildings and offices. Weeping fig is one of the most popular green plants. Dust and dry components of the plant are usually removed by vigorous shaking. In this way the allergen becomes airborne. During a few months we have seen several plant keepers who have developed airway allergy to weeping fig. Two of them have been thoroughly investigated. Both are atopics. Extracts were made from leaves and branches and both patients had positive skin prick tests and RAST. The risk of sensitization in plant keepers who work with weeping fig is probably considerable.

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[10] - 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.

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[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.

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[12] - Axelsson IG, Johansson SG, Zetterstrom O. A new indoor allergen from a common non-flowering plant. Allergy 1987;42:604-611

Ficus benjamina or weeping fig (w-fig) is one of the most common indoor non-flowering green plants in northern Europe. We have previously reported that occupational exposure to w-fig in plant keepers, both atopic and non-atopic, gives rise to IgE-mediated allergy with airway symptoms. About one-fourth of the plant keepers had become sensitized. We now report a study of sensitization in non-occupationally exposed persons comprising 395 patients, consecutively referred for allergological investigation, and 107 employees from two offices decorated with an abundance of w-figs. Of the patients, 56% were found to be atopic and more than half of them reported exposure to w-fig. Sensitization, as judged by a positive skin prick test and positive RAST, was found in 13 of the patients and in three of the employees. All of them suffered from rhinitis and/or asthma and were atopics and sensitized to one or several common allergens. We conclude that sensitization to w-fig is not uncommon and that in Sweden it is of the same magnitude as sensitization to the most common mould, Cladosporium herbarum. The risk that subjects with a genuine atopic constitution exposed to w-fig will become sensitized is about 6%. In approximately half of the patients the sensitization was considered to be clinically important.

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[13] - 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.

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[14] - Piirilä P, Mäkinen-Kiljunen S, Kajosaari M, Kiistala R, Petman L, Haahtela T. Nonoccupational Sensitization to Indoor Plants. Allergy Clin Immunol Int 2006;18:106-113

Background: Indoor plants can cause imunoglobulin E (IgE)-mediated allergy. We studied sensitization to indoor plants and factors affecting sensitization in an allergy outpatient clinic. Methods/Data base: 205 atopic and 90 nonatopic patients were skin prick tested for sensitivity to 12 common indoor plants. Sera from 34 adult plant-positive patients were im-munospot tested. The occurrence of the plants in homes and associated respiratory symptoms were assessed by questionnaire. Results: Of the atopic patients, 39% had positive reactions to the plants; 54% to Ficus benjamina, 36% to Hibiscus rosa sinensis, 35% to Yucca aloifolia, 23% to Dracaena fragrans, and 21% to Asplenium nidus. Of the nonatopics, 2% had skin reactions to the plants. In immunospot studies, 62% of the plant-positive patients showed IgE specific to at least one plant; 44% to Ficus benjamina, 35% to Dieffenbachia picta, and 32% to Hibiscus rosa sinensis and Chamaedorea elegans. Forty percent of patients sensitized to Ficus benjamina and 33% of those sensitized to Dieffenbachia picta reported clinical symptoms. Conclusion: Sensitization to indoor plants, particularly to Ficus spp., is commonly detected by skin and immunospot tests in atopic patients. A minority (0-40% for various plants) of prick test-positive patients reported clinical symptoms. Clustering of pollen, vegetable food, and indoor plant sensitivities suggested crossreactivity of allergens.

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[15] - Axelsson IG, Johansson SG, Larsson PH, Zetterstrom O. Serum reactivity to other indoor ficus plants in patients with allergy to weeping fig (Ficus benjamina) . Allergy 1991;46:92-98

Ornamental plants have long been used for indoor decoration. An example is the india rubber tree (Ficus elastica). With the increased popularity of green plants, both in private homes and public premises, small-leaf species, such as weeping fig or Ficus benjamina (Fb), have become widely used. Exposure to dust from Fb may cause sensitization and allergic airway symptoms, which among occupationally exposed plant keepers occur both in atopics and non-atopics. The serum reactivity to sap extracts from Fb and seven other indoor plants of the genus Ficus were investigated with RAST and a RAST inhibition technique, using sera from 12 atopic subjects and 12 plant keepers, sensitized to Fb. The allergenic similarity between the different extracts was found to be extensive. The specific IgE antibodies with the highest concentrations in serum were those against Fb and its variegate form, "star light", with decreasing values for the other species, especially those with larger leaves. The binding of IgE antibodies to the other Ficus RAST discs could be completely inhibited by extract of Fb. These reactions were probably due to cross-reactivity. Sensitization is believed to occur by inhalation of allergen-enriched dust, emanating from the leaves of the plants. The high allergenic potency of the species with many small leaves may be due to their large total leaf area

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[16] - Piirilä P, Mäkinen-Kiljunen S, Kajosaari M, Kiistala R, Petman L, Haahtela T. Nonoccupational Sensitization to Indoor Plants. Allergy Clin Immunol Int 2006;18:106-113

Background: Indoor plants can cause imunoglobulin E (IgE)-mediated allergy. We studied sensitization to indoor plants and factors affecting sensitization in an allergy outpatient clinic. Methods/Data base: 205 atopic and 90 nonatopic patients were skin prick tested for sensitivity to 12 common indoor plants. Sera from 34 adult plant-positive patients were im-munospot tested. The occurrence of the plants in homes and associated respiratory symptoms were assessed by questionnaire. Results: Of the atopic patients, 39% had positive reactions to the plants; 54% to Ficus benjamina, 36% to Hibiscus rosa sinensis, 35% to Yucca aloifolia, 23% to Dracaena fragrans, and 21% to Asplenium nidus. Of the nonatopics, 2% had skin reactions to the plants. In immunospot studies, 62% of the plant-positive patients showed IgE specific to at least one plant; 44% to Ficus benjamina, 35% to Dieffenbachia picta, and 32% to Hibiscus rosa sinensis and Chamaedorea elegans. Forty percent of patients sensitized to Ficus benjamina and 33% of those sensitized to Dieffenbachia picta reported clinical symptoms. Conclusion: Sensitization to indoor plants, particularly to Ficus spp., is commonly detected by skin and immunospot tests in atopic patients. A minority (0-40% for various plants) of prick test-positive patients reported clinical symptoms. Clustering of pollen, vegetable food, and indoor plant sensitivities suggested crossreactivity of allergens.

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[17] - Schmid P, Stöger P, Wüthrich B. Severe isolated allergy to Ficus benjamina after bedroom exposure. Allergy 1993;48:466-467

Allergies to Ficus benjamina (Fb, weeping fig) have been described first as an occupational disease in plant keepers and later in clearly atopic subjects with known sensitizations to other inhalant allergens. We report a case of a hitherto nonatopic man with allergic rhinoconjunctivitis, contact urticaria, and asthma caused by a Fb kept in his bedroom for 18 months. Rubbing and skin prick test with native fig leaves and sap, and RAST to Fb were clearly positive. No other sensitization could be detected. After eliminating his Fb, he became asymptomatic within a few months. This case shows that private close contact to Fb can also induce allergy even in hitherto nonatopic subjects. Therefore, Fb should not be kept in bedrooms.

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[18] - Axelsson IG, Johansson SG, Larsson PH, Zetterstrom O. Serum reactivity to other indoor ficus plants in patients with allergy to weeping fig (Ficus benjamina) . Allergy 1991;46:92-98

Ornamental plants have long been used for indoor decoration. An example is the india rubber tree (Ficus elastica). With the increased popularity of green plants, both in private homes and public premises, small-leaf species, such as weeping fig or Ficus benjamina (Fb), have become widely used. Exposure to dust from Fb may cause sensitization and allergic airway symptoms, which among occupationally exposed plant keepers occur both in atopics and non-atopics. The serum reactivity to sap extracts from Fb and seven other indoor plants of the genus Ficus were investigated with RAST and a RAST inhibition technique, using sera from 12 atopic subjects and 12 plant keepers, sensitized to Fb. The allergenic similarity between the different extracts was found to be extensive. The specific IgE antibodies with the highest concentrations in serum were those against Fb and its variegate form, "star light", with decreasing values for the other species, especially those with larger leaves. The binding of IgE antibodies to the other Ficus RAST discs could be completely inhibited by extract of Fb. These reactions were probably due to cross-reactivity. Sensitization is believed to occur by inhalation of allergen-enriched dust, emanating from the leaves of the plants. The high allergenic potency of the species with many small leaves may be due to their large total leaf area

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

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

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[20] - Delbourg MF, Moneret-Vautrin DA, Guilloux L, Ville G. Hypersensitivity to latex and Ficus benjamina allergens. Ann Allergy Asthma Immunol 1995;75:496-500

Association between allergy to Ficus benjamina and Hevea brasiliensis, two botanically unrelated plants, was suspected in consequence of two clinical observations. Symptoms were rhinitis and asthma. This study was undertaken to assess the in vivo and in vitro cross-reactivity between Ficus benjamina and Hevea brasiliensis allergens. METHODS: The two patients were asked about use and contact with latex devices and relationship between symptoms and Ficus benjamina exposure. Skin prick tests were performed with Ficus benjamina, Hevea brasiliensis extracts and common allergens. Double-blind nasal and bronchial challenge tests were done using the rinse fluid from a brand of latex gloves. Total and specific IgE antibodies to Ficus benjamina and Hevea brasiliensis were determined. In vitro cross-reactivity was investigated by means of CAP RAST and immunodot inhibition experiments. RESULTS: We observed that for the first patient the primary phenomenon is probably allergy to latex followed by allergy to Ficus benjamina. For the second patient, allergy to Ficus benjamina was diagnosed (improvement related to the avoidance of exposure to Ficus benjamina allergens) and positivity to latex skin prick tests may be due to the cross-reacting allergens. In vitro assays showed specific IgE antibodies to both allergens and cross-reactivity was confirmed in the two cases by reciprocal inhibition of the two extracts. CONCLUSION: The increasing risk of sensitization to widely used latex devices and extensive exposure to Ficus species in households and offices indicates increased allergenic risk from this newly recognized cross-reactivity.

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[21] - Brehler R, Abrams E, Sedlmayr S. Cross-reactivity between Ficus benjamina (weeping fig) and natural rubber latex. Allergy 1998;53:402-406

The importance of hypersensitivity to Ficus allergens is reported. Cross-sensitization between fig (Ficus carica), weeping fig (F. benjamina [Fb]), and natural rubber latex (NRL) was confirmed by RAST inhibition. We performed skin prick tests with fresh Fb tree sap and NRL extracts in 346 consecutive patients and in 151 patients with immediate-type hypersensitivity to NRL. Total serum IgE and IgE antibodies to NRL and Ficus spp. were analyzed in sera. By the RAST-inhibition method, we studied cross-reactivity among latex, fig, and weeping fig. Sensitization to Fb was diagnosed in 23 of the 346 consecutive patients, and the simultaneous presence of latex-specific IgE was highly significant. Of 151 NRL-allergic patients, 35 were also sensitized to Fb. Cross-reacting IgE antibodies recognizing latex and Ficus allergens were demonstrated by RAST inhibition. The present study reinforces the importance of Fb as an indoor allergen. Cross-reacting IgE antibodies to NRL and Ficus spp. allergens are frequently found in the sera of atopic patients. Development of commercially available standardized extracts for skin tests is urgently necessary.

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[22] - Chen Z, Duser M, Flagge A, Maryska S, Sander I, Raulf-Heimsoth M, et al. Identification and Characterization of Cross-Reactive Natural Rubber Latex and Ficus benjamina Allergens. Int Arch Allergy Immunol 2000;123:291-298

An association between allergy to Ficus benjamina and natural rubber latex (NRL) has been suspected based on clinical and immunological observations. The responsible cross-reactive allergens have not been identified yet. This study was undertaken to investigate the cross-reactivity between hevein (Hev b 6.02, 4.7 kD), a major allergen of NRL, and F. benjamina and identify its counterpart in F. benjamina. Methods: 89 serum samples from subjects allergic to NRL were used in the study. Skin prick tests were performed with highly purified hevein and sap extract of F. benjamina. Specific IgE antibodies to NRL, F. benjamina and Hev b 6.02 were determined by the Pharmacia CAP method. Cross-reactivity among these allergens was investigated by means of CAP and immunoblot inhibition experiments. Two-dimensional gel electrophoresis separation and protein microsequencing were performed to identify the cross-reactive allergens in F. benjamina. Results: 67 out of 89 (75%) sera showed elevated IgE to hevein. Specific IgE to Ficus were found in 22 (24.7%) sera, and with 1 exception, all these sera also had IgE to Hev b 6.02. Results of CAP inhibition assays using 11 sera showing IgE to both Hev b 6.02 and Ficus demonstrated that the IgE to Ficus could be completely inhibited by Hev b 6.02 in 6 of 11 sera. Immunoblots and immunoblot inhibition assays revealed that a protein of about 45 kD in F. benjamina is strongly recognized by serum IgE. In addition, the IgE-binding reactivity to this 45-kD protein could be completely inhibited by preincubation of the sera with Hev b 6.02. N-terminal protein sequencing of 14 amino acids indicated that this 45-kD protein has a hevein-like domain at the N-terminal region and may belong to the endochitinase family. Conclusion: Latex-allergic patients are at higher risk of becoming sensitized to Ficus. Hev b 6.02 in latex is a major cross-reactive allergen and its counterpart in F. benjamina is an acidic protein with a molecular weight of about 45 kD and a hevein-like N-terminal domain

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[23] - Piirilä P, Mäkinen-Kiljunen S, Kajosaari M, Kiistala R, Petman L, Haahtela T. Nonoccupational Sensitization to Indoor Plants. Allergy Clin Immunol Int 2006;18:106-113

Background: Indoor plants can cause imunoglobulin E (IgE)-mediated allergy. We studied sensitization to indoor plants and factors affecting sensitization in an allergy outpatient clinic. Methods/Data base: 205 atopic and 90 nonatopic patients were skin prick tested for sensitivity to 12 common indoor plants. Sera from 34 adult plant-positive patients were im-munospot tested. The occurrence of the plants in homes and associated respiratory symptoms were assessed by questionnaire. Results: Of the atopic patients, 39% had positive reactions to the plants; 54% to Ficus benjamina, 36% to Hibiscus rosa sinensis, 35% to Yucca aloifolia, 23% to Dracaena fragrans, and 21% to Asplenium nidus. Of the nonatopics, 2% had skin reactions to the plants. In immunospot studies, 62% of the plant-positive patients showed IgE specific to at least one plant; 44% to Ficus benjamina, 35% to Dieffenbachia picta, and 32% to Hibiscus rosa sinensis and Chamaedorea elegans. Forty percent of patients sensitized to Ficus benjamina and 33% of those sensitized to Dieffenbachia picta reported clinical symptoms. Conclusion: Sensitization to indoor plants, particularly to Ficus spp., is commonly detected by skin and immunospot tests in atopic patients. A minority (0-40% for various plants) of prick test-positive patients reported clinical symptoms. Clustering of pollen, vegetable food, and indoor plant sensitivities suggested crossreactivity of allergens.

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[24] - 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.

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

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[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.

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[27] - Bessot JC, Tannous R, Newinger G, Feuerstoss D, de Blay F, Pauli G. Allergie respiratoire au Ficus benjamina: à propos de 10 observations. Rev Fr Allergol Immunol Clin 1993;33:270-273

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[28] - Brehler R, Theissen U. [Ficus benjamina allergy]. Hautarzt 1996;47:780-782

We report the case of a 48-year-old patient suffered from asthma and conjunctivitis caused by an immediate type allergy to weeping fig (Ficus benjamina). By RAST inhibition test we could demonstrate that IgE antibodies react with allergens of fig; however our patient tolerated figs in oral provocation test. Sensitization to latex proteins reported to be cross reactive to Ficus species was not found. Ficus benjamina allergens represent relevant indoor allergens. A standardized allergen extract for skin testing is not yet available. Allergen specific IgE is mostly found in patients with strongly positive prick test results using the native sap of the tree. In 12 of 64 latex allergic patients we found simultaneous sensitization to weeping fig, so that cros-sensitization has to been considered in patients with IgE-mediated sensitization to latex.

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[29] - Hipler UC, Frank U, Schliemannwillers S, Kaatz M, Elsner P. Hypersensitivity to Ficus benjamina without cross-reactivity to natural rubber latex. Allergologie 2003;11:490-496

Ficus benjamina is a plant very often used for indoor decorations that can generate allergies, e.g. rhinoconjunctivitis, urticaria and Quinke's edema as well as anaphylactic reactions. We report the case of a patient with hypersensitivity to Ficus benjamina without cross-reactivity to Natural Rubber Latex (NRL) or several fruits, like mango, banana and spinach, but with cross-reactivity to fig. The hypersensitivity to Ficus benjamina was investigated by means of the prick test, the determination of specific IgE antibodies, the cellular antigen stimulation test (CAST) and Westernblots. A self-produced Ficus benjamina extract, a Ficus benjamina extract from Allergopharma, extract of Hevea brasiliensis and extracts of several fruits were used in the prick tests as well as in the CAP and CAST experiments. CAP inhibition assays were carried out to study a suspected cross-reactivity of Ficus benjamina to NRL and several fruits, respectively. The hypersensitivity to Ficus benjamina was clearly demonstrated. Inhibition assay showed the inhibition of the specific IgE antibody up to 95%, and 82% by the self-produced Ficus benjamina extract and the commercial Ficus benjamina, respectively. Neither sensitization nor cross-reactivity to Hevea brasiliensis and several fruit proteins could be found, apart from cross-reactivity to fig. In our patient, an isolated type I hypersensitivity to Ficus benjamina with cross-reactivity to fig could be found, but without cross-reactivity to NRL. The Ficus benjamina protein seems to become an important indoor allergen with increasing significance.

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[30] - Pradalier A, Leriche E, Trinh Ch, Molitor JL. [The return of the prodigue child or allergy to ficus]. Eur Ann Allergy Clin Immunol 2004;36:326-329

Ficus benjamina (FB), the weeping fig, belonging to the Moracea family, is now widely used as an indoor ornamental plant in houses and offices. Its latex can be responsible of IgE allergies : rhinoconjunctivitis, asthma, angiooedema, pruritus, anaphylactic shock. In some occupations such as gardeners, caretakers of plants, it can induce a contact urticaria. Most of these patients are atopics. We describe a case of non-occupational, indoor related rhinoconjunctivitis in a non-atopic patient. Prick-test and RAST to FB latex were positive and removal of the ficus plant resolved their symptoms confirming the etiologic role of the plant. The patient did not demonstrate sensitization to other common allergens (except weeds) involved in respiratory (latex of Hevea brasiliensis, mites...) and food allergies (negativity of the prick-tests for fig, avocado, banana, kiwi). Now, FB is a new hidden allergen in the house. Questionning for its presence and testing it should be considered; as it should be introduced in the standard prick-test panel.

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[31] - Brehler R, Theissen U. [Ficus benjamina allergy]. Hautarzt 1996;47:780-782

We report the case of a 48-year-old patient suffered from asthma and conjunctivitis caused by an immediate type allergy to weeping fig (Ficus benjamina). By RAST inhibition test we could demonstrate that IgE antibodies react with allergens of fig; however our patient tolerated figs in oral provocation test. Sensitization to latex proteins reported to be cross reactive to Ficus species was not found. Ficus benjamina allergens represent relevant indoor allergens. A standardized allergen extract for skin testing is not yet available. Allergen specific IgE is mostly found in patients with strongly positive prick test results using the native sap of the tree. In 12 of 64 latex allergic patients we found simultaneous sensitization to weeping fig, so that cros-sensitization has to been considered in patients with IgE-mediated sensitization to latex.

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[32] - Delbourg MF, Moneret-Vautrin DA, Guilloux L, Ville G. Hypersensitivity to latex and Ficus benjamina allergens. Ann Allergy Asthma Immunol 1995;75:496-500

Association between allergy to Ficus benjamina and Hevea brasiliensis, two botanically unrelated plants, was suspected in consequence of two clinical observations. Symptoms were rhinitis and asthma. This study was undertaken to assess the in vivo and in vitro cross-reactivity between Ficus benjamina and Hevea brasiliensis allergens. METHODS: The two patients were asked about use and contact with latex devices and relationship between symptoms and Ficus benjamina exposure. Skin prick tests were performed with Ficus benjamina, Hevea brasiliensis extracts and common allergens. Double-blind nasal and bronchial challenge tests were done using the rinse fluid from a brand of latex gloves. Total and specific IgE antibodies to Ficus benjamina and Hevea brasiliensis were determined. In vitro cross-reactivity was investigated by means of CAP RAST and immunodot inhibition experiments. RESULTS: We observed that for the first patient the primary phenomenon is probably allergy to latex followed by allergy to Ficus benjamina. For the second patient, allergy to Ficus benjamina was diagnosed (improvement related to the avoidance of exposure to Ficus benjamina allergens) and positivity to latex skin prick tests may be due to the cross-reacting allergens. In vitro assays showed specific IgE antibodies to both allergens and cross-reactivity was confirmed in the two cases by reciprocal inhibition of the two extracts. CONCLUSION: The increasing risk of sensitization to widely used latex devices and extensive exposure to Ficus species in households and offices indicates increased allergenic risk from this newly recognized cross-reactivity.

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[33] - Carey AB, Cornish K, Schrank P, Ward B, Simon R. Cross-reactivity of alternate plant sources of latex in subjects with systemic IgE-mediated sensitivity to Hevea brasiliensis latex. Ann Allergy Asthma Immunol 1995;74:317-320

Previous studies have suggested that there is cross-reactivity in subjects sensitive to natural rubber proteins with other plant proteins such as banana, chestnut, and avocado. There are numerous other plants known to produce rubber including Parthenium argentatum and Ficus elastica. It is not known whether patients with IgE-mediated systemic reactions caused by the common source of natural rubber Hevea brasiliensis are also sensitive to the rubber-containing material from these other plant sources of latex. It is also not certain how much the allergenicity of latex made from Hevea brasiliensis can be reduced by extracting proteins from the sap since some proteins are tightly associated with the cis-1,4-polyisoprene. OBJECTIVE: In this study we investigated whether there would be cross-reactivity to other natural sources of latex in these patients. METHODS: Seven patients with histories of systemic type I hypersensitivity to latex products had strongly positive skin tests to Hevea brasiliensis latex from two different sources. These subjects were tested by the prick method for sensitivity to three other natural sources of latex. These included latex-containing material from Parthenium-argentatum and Ficus elastica as well as washed and centrifuged rubber particles from Hevea brasiliensis sap. RESULTS: All subjects had negative skin tests to all dilutions of the rubber samples from these other natural sources of latex. CONCLUSION: These results suggest several potential sources of natural hypoallergenic latex that might be tolerated by latex-sensitive individuals.

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

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

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Ficus et latex d’Hévéa

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