Le syndrome latex-aliments

	Domaine hévéine	Profiline	LTP	PR10
latex	X	X	X
avocat	X	X
banane	X	X
châtaigne	X		X
kiwi	X	X	X	X
pêche		X	X	X

[1] - M'Raihi ML, Charpin D, Pons A, Bongrand P, Vervloet D. Allergénicité croisée entre latex et banane. Rev Fr Allergol Immunol Clin 1989;29:187-189

[3] - Blanco C, Carrillo T, Castillo R, Quiralte J, Cuevas M. Latex allergy: clinical features and cross-reactivity with fruits. Ann Allergy 1994;73:309-314

Latex IgE-mediated allergy is an important medical problem, but its clinical characteristics and association with food allergies are not well defined. OBJECTIVE: Our objectives were to determine the clinical features of latex-allergic patients, and latex-associated food hypersensitivities. METHODS: A prospective study was performed in our outpatient clinic. It consisted of a clinical questionnaire, skin prick tests with aeroallergens and foods, skin test with a latex extract, determination of total and specific IgE by CAP/RAST methods, and RAST inhibition. Latex and food allergies were diagnosed on the basis of a suggestive clinical history and a positive skin test with the corresponding allergen. RESULTS: Twenty-five patients were diagnosed as having latex allergy. Their mean age was 33 +/- 9.0 years, with female predominance (23:2). There were nine greenhouse and six hospital workers. Latex-induced reactions included systemic anaphylaxis in nine patients (36%). Average total IgE was 161 kU/L, and it was within normal limits in 16 cases. Latex skin prick tests had excellent diagnostic precision with no adverse reactions, and CAP for latex diagnostic sensitivity was 80%. Forty-two food allergies were diagnosed in 13 of our patients (52%), and 23 of these consisted of systemic anaphylaxis. The most frequent food hypersensitivities were to avocado (9), chestnut (9), banana (7), kiwi (5) and papaya (3). Through RAST-inhibition, cross-reactivity among latex, avocado, chestnut, and banana was demonstrated. CONCLUSIONS: In our experience, latex allergy affects middle-aged women in certain professions at increased risk. Our data suggest the existence of a "latex-fruit syndrome," because 52% of our latex allergic patients had allergies to certain fruits.

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[4] - Rodriguez M, Vega F, Garcia MT, Panizo C, Laffond E, Montalvo A, et al. Hypersensitivity to latex, chestnut, and banana. Ann Allergy 1993;70:31-34

The incidence of latex-allergic patients is probably higher than suspected. A spectrum of IgE-dependent allergic reactions to latex products including urticaria, rhinitis, asthma, angioedema, and life-threatening anaphylaxis has been increasingly reported in recent years. We describe three patients with rubber hypersensitivity and allergy to fruit (banana and chestnut). Immediate positive responses were obtained in prick tests with latex, banana, and chestnut extracts. Histamine release was positive and specific IgE antibodies to all three extracts were detected by fluorescence radioimmunoassay. In the RAST-inhibition studies, the extract of latex inhibited the binding of chestnut and banana, but chestnut and banana extracts did not inhibit the binding of latex. These results suggest a sensitivity to crossreacting antigens in latex allergy associated with allergy to certain fruits.

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[5] - Le Sellin J. Allergie croisée latex-épinard. Allerg Immunol (Paris) 1994;26:77-78

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[6] - Guinnepain MT, Guilloux L, Laurent J. Buckwheat allergy: an additional cross-reactivity between latex and food. Rev Fr Allergol Immunol Clin 1997;37:1218

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[7] - Maillard H, Drouet M, Sabbah A. Allergies associées au poivron et au latex: nouvelle allergie croisée ? Allerg Immunol (Paris) 1995;27:292-294

The aim of this study was to point out the frequency of associated sensitization to rubber latex and to sweet pepper. The study included three populations of patients: Patients allergic to rubber latex, patients sensitized to rubber latex and patients without any clinical symptoms for rubber latex and sweet pepper (negative controls). We pointed out a high frequency of patients sensitized to sweet pepper among the patients allergic or sensitized to rubber latex which lead to the hypothesis of a cross reaction between rubber latex and sweet pepper.

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

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

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[9] - Blanco C. Latex-fruit syndrome. Curr Allergy Asthma Rep 2003;3:47-53

Natural rubber latex immunoglobulin E-mediated hypersensitivity is probably one of the most relevant challenges that has been faced in the treatment of allergies during recent years. Additionally, allergen cross-reactivity has arisen as another very important problem, in the difficulty in diagnosing it and in its clinical implications. It is clear that some latex allergens cross-react with plant-derived food allergens, the so-called latex-fruit syndrome, with evident clinical consequences. Although the foods most frequently involved are banana, avocado, kiwi, and chestnut, several others are also implicated. Investigations point to a group of defense-related plant proteins, class I chitinases, which cross-react with a major latex allergen, hevein, as the panallergens responsible for the syndrome. This review focuses on our current understanding of the latex-fruit syndrome.

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[10] - Wagner S, Breiteneder H. The latex-fruit syndrome. Biochem Soc Trans 2002;30:935-940

Approximately 30-50% of individuals who are allergic to natural rubber latex (NRL) show an associated hypersensitivity to some plant-derived foods, especially freshly consumed fruits. This association of latex allergy and allergy to plant-derived foods is called latex-fruit syndrome. An increasing number of plant sources, such as avocado, banana, chestnut, kiwi, peach, tomato, potato and bell pepper, have been associated with this syndrome. The prevailing hypothesis is that allergen cross-reactivity is due to IgE antibodies that recognize structurally similar epitopes on different proteins that are phylogenetically closely related or represent evolutionarily conserved structures. Several types of proteins have been identified to be involved in the latex-fruit syndrome. Two of these are plant defence proteins. Class I chitinases containing an N-terminal hevein-like domain cross-react with hevein (Hev b 6.02), a major IgE-binding allergen for patients allergic to NRL. A beta-1,3-glucanase was identified as an important latex allergen which shows cross-reactivity with proteins of bell pepper. Another important NRL allergen, Hev b 7, is a patatin-like protein that shows cross-reactivity with its analogous protein in potato. Furthermore, patients with allergy to plant-derived foods and associated pollinosis show a high frequency of IgE reactivity to the pan-allergen profilin, which may cause positive serum IgE determinations to NRL. Although there is much information about the plant-derived foods and some data about the allergens involved in the latex-fruit syndrome, it is not always clear whether latex sensitization precedes or follows the onset of food allergy.

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[11] - Blanco C, Carrillo T, Castillo R, Quiralte J, Cuevas M. Latex allergy: clinical features and cross-reactivity with fruits. Ann Allergy 1994;73:309-314

Latex IgE-mediated allergy is an important medical problem, but its clinical characteristics and association with food allergies are not well defined. OBJECTIVE: Our objectives were to determine the clinical features of latex-allergic patients, and latex-associated food hypersensitivities. METHODS: A prospective study was performed in our outpatient clinic. It consisted of a clinical questionnaire, skin prick tests with aeroallergens and foods, skin test with a latex extract, determination of total and specific IgE by CAP/RAST methods, and RAST inhibition. Latex and food allergies were diagnosed on the basis of a suggestive clinical history and a positive skin test with the corresponding allergen. RESULTS: Twenty-five patients were diagnosed as having latex allergy. Their mean age was 33 +/- 9.0 years, with female predominance (23:2). There were nine greenhouse and six hospital workers. Latex-induced reactions included systemic anaphylaxis in nine patients (36%). Average total IgE was 161 kU/L, and it was within normal limits in 16 cases. Latex skin prick tests had excellent diagnostic precision with no adverse reactions, and CAP for latex diagnostic sensitivity was 80%. Forty-two food allergies were diagnosed in 13 of our patients (52%), and 23 of these consisted of systemic anaphylaxis. The most frequent food hypersensitivities were to avocado (9), chestnut (9), banana (7), kiwi (5) and papaya (3). Through RAST-inhibition, cross-reactivity among latex, avocado, chestnut, and banana was demonstrated. CONCLUSIONS: In our experience, latex allergy affects middle-aged women in certain professions at increased risk. Our data suggest the existence of a "latex-fruit syndrome," because 52% of our latex allergic patients had allergies to certain fruits.

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

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

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[13] - Rodriguez J, Crespo JF, Burks W, Rivas-Plata C, Fernández-Anaya S, Vives R, et al. Randomized, double-blind, crossover challenge study in 53 subjects reporting adverse reactions to melon (Cucumis melo). J Allergy Clin Immunol 2000;106:968-972

BACKGROUND: Few studies have evaluated IgE-mediated hypersensitivity to melon with details of clinical reactions confirmed by double-blind, placebo-controlled, food challenges (DBPCFCs). OBJECTIVE: We sought to investigate clinical features (type and severity of reactions, age at onset, results of skin prick and in vitro tests, and incidence of other allergic diseases and associated food allergies) of acute allergic reactions to melon confirmed by DBPCFCs. METHODS: Fifty-three consecutive adult patients complaining of adverse reactions to melon were included in the study. Skin prick tests and detection of specific IgE were performed in all patients with melon, avocado, kiwi, banana, chestnut, latex, pollen, and other offending foods. Patients first underwent an open food challenge, unless they had a convincing history of severe anaphylaxis. Positive open food challenge reactions were subsequently evaluated by DBPCFCs. RESULTS: Actual clinical reactivity was confirmed in 19 (36%) of 53 patients. The most frequent symptom was oral allergy syndrome (n = 14), but two patients experienced life-threatening reactions, including respiratory symptoms and hypotension. The positive predictive value for a skin prick test was 42%, and that for specific IgE measurement was 44%. Forty-five reactions to 15 other foods were confirmed in 18 patients. The most common foods associated with melon allergy were avocado (n = 7), banana (n = 7), kiwi (n = 6), watermelon (n = 6), and peach (n = 5). Onset of melon-induced allergic symptoms occurred from 6 to 45 years (median, 20 years), preceded by seasonal rhinitis, asthma, or both in 88% (15/17). CONCLUSION: About one third of reported reactions to melon are confirmed by means of DBPCFC, which has been proven to be the most reliable procedure in the diagnosis of clinical fruit allergy. Isolated melon allergy is rare, with most patients either having allergic rhinitis, asthma, or both and associated food allergies.

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[14] - Fernández-Nieto M, Quirce S, De las Heras M, Cuesta J, Aleman A, Sastre J. Latex-Fruit Syndrome: A Study on Health Care Workers Allergic to Natural Rubber Latex. AAAAI 58th Annual Meeting, New York, 1-6 March, 2002, Poster n°866

We conducted a study on 30 health care workers with latex allergy diagnosed by skin prick test with a non-ammoniated latex extract 100 HEP/ml (ALK-Abelló, Madrid, Spain). Of these patients, 9 had asthma, 6 rhinoconjunctivitis and 15 contact urticaria from latex products, mainly latex gloves. The results of inhalation challenge and cutaneous provocation tests with latex gloves confirmed the diagnosis of latex allergy. Skin tests were performed using the „prick by prick‰ method with fresh kiwi, avocado, banana and chestnut. Specific IgE against latex and the aforementioned fruits or nuts was determined by the CAP method (Pharmacia, Uppsala, Sweden). A positive skin test to kiwi was observed in 66.6% of the patients and specific IgE to kiwi was confirmed in 13.3% of them. Nine out of the 30 patients (30%) presented with allergic symptoms after kiwi ingestion: 6 had oral allergy syndrome (OAS), 1 urticaria and angioedema, 1 anaphylaxis and 1 epigastralgia and diarrhea. Three patients had never eaten kiwi and the remaining patients tolerated kiwi ingestion without any reaction. A positive skin prick test with avocado was found in 50% of the patients and 20% of them had positive specific IgE to avocado. Seven patients (23.3%) presented with allergic reactions after eating avocado: 5 OAS and 2 urticaria and angioedema. Three patients did not eat avocado. The remaining patients could eat avocado without any ill effect. A positive skin test to banana was observed in 60% of the patients and 16.6% of them had positive specific IgE to this fruit. After banana ingestion, 9 patients (30%) suffered from allergic symptoms: 2 OAS, 4 urticaria and angioedema and 3 other symptoms. A positive skin test to chestnut was found in 53.3% of the patients and in 10% of them specific IgE was positive. Five patients (16.7%) showed allergic symptoms after eating chestnut: 1 anaphylaxis, 1 OAS, 2 urticaria and angioedema and 1 other symptoms. One patient had never eaten chestnut. The remaining patients tolerated chestnut ingestion. In our study, between 17% and 30% of the latex-allergic health care workers showed allergy symptoms after eating fruits. However, the prevalence of positive skin tests to these fruits ranged between 50 and 67%. The fruits most frequently implicated in the latex-fruit syndrome were kiwi and banana.

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[15] - 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.

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

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

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[17] - Beezhold DH, Sussman GL, Liss GM, Chang NS. Latex allergy can induce clinical reactions to specific foods. Clin Exp Allergy 1996;26:416-422

The purpose of this study was to investigate crossreactivity between latex and foods, to identify crossreacting IgE binding proteins, and to assess the clinical significance. METHODS: Forty-seven latex allergic patients and 46 non-latex allergic patient controls were studied. Allergen sensitization was determined by skin-prick testing (SPT) and allergenic proteins were identified by immunoblot reactivity and amino acid sequence analysis. RESULTS: Immunological reactivity to foods was found to be common, occurring in 33 latex-allergic individuals but in only seven controls (P < 0.000001); 100 of 376 (27%) food skin-prick tests were positive in the latex-allergic subjects. Twenty-seven out of 100 positive food SPTs were associated with clinical symptoms. Seventeen patients manifested a clinical allergy to at least one food including 11 with anaphylaxis, and 14 with local sensitivity reactions. Positive food skin tests occurred most frequently with avocado (53%), potato (40%), banana (38%), tomato (28%), chestnut (28%), and kiwi (17%). Latex-allergic patients (23%) recognize a protein that had sequence homology to a broad class of plant proteins known as patatins. Crossreactivity between latex and several potato proteins was observed by immunoblot inhibition analysis. CONCLUSIONS: Sensitization to latex has extensive crossreactivity with certain foods and leads to clinical allergic reactions. Potatoes and tomatoes are newly reported cross-reacting foods. Plant proteins with structural homology to latex proteins may predispose to food allergy.

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[18] - Guinnepain MT, Guilloux L, Laurent J. Buckwheat allergy: an additional cross-reactivity between latex and food. Rev Fr Allergol Immunol Clin 1997;37:1218

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

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

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

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

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

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

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[22] - Möller M, Kayma M, Vieluf D, Paschke A, Steinhart H. Determination and characterization of cross-reacting allergens in latex, avocado, banana, and kiwi fruit. Allergy 1998;53:289-296

Sera of 11 patients were used to characterize allergens in kiwi fruit, latex, avocado, and banana by SDS-PAGE/immunoblotting and to determine cross-reactions between these allergen extracts in EAST inhibition and immunoblot inhibition. By SDS-PAGE/immunoblotting, allergens with apparent molecular weights of 21, 38, 40, and 42 kDa were visualized in latex extract. In avocado extract, IgE-binding components of 27, 43, 52, 58, 65, 75, and 88 kDa were to be seen, whereas, in banana extract, a 40-kDa protein showed strong IgE binding. Furthermore, allergens of 52, 58, 88, and 94 kDa were detected in the extract of banana. Cross-reactions between these allergen extracts were determined by EAST inhibition. Immunoblot inhibition demonstrated that almost all IgE-reactive bands in nitrocellulose-blotted latex, avocado, and banana extracts and two components of 43 and 67 kDa in kiwi fruit shared common IgE epitopes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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[40] - Vidal C, Gonzalez-Quintela A, Rodriguez V, Armisen M, Linares T, Fernandez-Caldas E. Anaphylaxis to Cyphomandra betacea Sendth (tamarillo) in an obeche wood (Triplochiton scleroxylon)--allergic patient. Ann Allergy Asthma Immunol 2006;96:870-873

BACKGROUND: Anaphylaxis after the first exposure to a food allergen is uncommon unless a cross-reaction is present. OBJECTIVE: To investigate a possible relationship between the fruit Cyphomandra betacea Sendth (commonly known as tamarillo) and the wood of Triplochiton scleroxylon (obeche) in a patient with allergic occupational bronchial asthma due to obeche wood who began to experience anaphylaxis episodes after eating tamarillo. METHODS: A 33-year-old carpenter exposed to obeche wood in his occupation was initially seen with rhinitis and bronchial asthma. The causal relationship of these symptoms to obeche wood exposure was investigated by means of peak flow monitoring and bronchial inhalation testing. Furthermore, the patient had 2 acute episodes of anaphylaxis a few minutes after eating salad containing tamarillo. He had never tasted tamarillo before. The allergologic study included skin prick tests, serum specific IgE determinations, bronchial challenges, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and immunoblotting. RESULTS: Results of skin prick tests with common aeroallergens were negative. Strong skin prick test responses were obtained with obeche and tamarillo. Results of bronchial challenge testing with obeche extract were positive. In tamarillo extract, a 28-kDa band appeared as the most relevant IgE-binding antigen. A similar band of 28 kDa happens to be frequently detected in obeche-allergic patients. CONCLUSION: To our knowledge, this is the first reported case of anaphylaxis to tamarillo presented in a patient allergic to obeche, which raises the question of a new cross-reactivity antigen

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[41] - Paradis J, Paradis L, des Roches A, Bui LK, Bougeard H, et al. Anaphylactic reaction to Sechium edule (chayote). Allergy 1997;52(suppl. 37):115

The Sechium edule, commonly named chayote, is classified in the Cucurbitaceae family. This vegetable originates from Latin America, where it is commonly used since pre-Columbian time. It is now produced in many sub-tropical countries. rcpoa: We report 2 cases of anaphylactic reaction to chayote. A 30 year-old woman presented 30 minutes after eating a mixed salad with various exotic vegetables containing chayote, oral itching, angioedema, throat tightness, shortness of breath and an urticarian rash on the upper part of the body. The second patient was a 40 year-old woman. She reported oral itching and throat tightness 15 minutes after eating a similar salad containing chayote. Both patients ate the salad in a Californian style restaurant. We tested all the foods eaten before the reaction and the only positive skin tests was the chayote. We used fresh foods to perform the skin prick tests. In the same time, we performed an extensive battery of skin prick tests to inhalant allergens. Both were polysensitized to birch, grass, artemesia species and ragweed pollens. Conclusion: The apparition on the accidental food market of various fruits and vegetables from foreign countries has led to the apparition of new allergic reaction. In our knowledge, it is the first report of anaphylactic reaction to the chayote. A cross-reactivity with ragweed pollen, known to react with other cucurbitaceae family members as melon, could be possible. Other cases of chayote allergy are susceptible to be reported in the future.

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

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[43] - Morisset M, Sergeant P, Kanny G, Moneret-Vautrin DA. Régime d'éviction et conduite préventive en cas d'allergie au latex. Alim'Inter 2003;8:187+193-197

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[44] - Braun JJ, de Blay F. La rhinite allergique au latex : du diagnostic à la prise en charge. Rev Fr Allergol Immunol Clin 2008;48:237-241

Malgré de nombreuses publications concernant la pathologie respiratoire professionnelle, l‚allergie au latex et les relations nezˆbronches, la rhinite allergique au latex (RAL) dans la littérature n‚est que très incomplètement individualisée dans ses aspects cliniques, épidémiologiques, évolutifs et thérapeutiques. À travers leur expérience et la revue de la littérature, les auteurs cherchent à situer la RAL dans son contexte environnemental et à préciser les principaux critères diagnostiques et modalités thérapeutiques. La précocité du diagnostic, avant la survenue de l‚asthme, et les mesures d‚éviction du latex permettent de limiter l‚impact socioéconomique de la RAL.

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[45] - Mertes PM, Malinovsky JM, Alla F, Studnicska D, Tréchot P, Laxenaire MC. Epidémiologie des réactions d'hypersensibilité immédiates peranesthésiques chez l'adulte et l'enfant: bilan de 8 années du Gerap. Rev Fr Allergol Immunol Clin 2008;48:217-221

Les réactions d‚hypersensibilité immédiate, qu‚elles soient médiée par les immunoglobulines E (HSI IgE) ou non (HSI non IgE) survenant au cours de l‚anesthésie demeurent un sujet de préoccupation majeure. Les auteurs rapportent les données de huit années de surveillance épidémiologique effectuée par le Gerap. Deux mille cinq cent seize patients ayant présenté une réaction clinique évocatrice d‚une hypersensibilité immédiate entre le 1er janvier 1997 et le 31 décembre 2004 ont été inclus dans l‚étude. Une réaction non IgE-médiée a été diagnostiquée dans 700 cas (27,82 %), un diagnostic de réaction à médiation IgE ayant été retenu dans 1816 cas (72,18 %). Les agents plus fréquemment incriminés étaient les curares (n =1067, 58,08 %), suivi du latex (n =361, 19,65 %) et des antibiotiques (n =236, 12,85 %). Chez l‚enfant, les résultats étaient significativement différents. Le latex étant impliqué dans plus de 50 % des cas, suivi des curares (39 %) et des antibiotiques (10,2 %). Chez l‚adulte, les résultats confirment l‚existence d‚une prédominance féminine, quelque soit le mécanisme de la réaction, cette prédominance n‚est pas retrouvée chez l‚enfant. Ces résultats confirment la nécessité d‚un bilan systématique en cas de survenue d‚une réaction d‚hypersensibilité immédiate survenant au cours de l‚anesthésie et l‚intérêt du développement de centres de consultation spécialisé en allergo-anesthésie capables d‚apporter une aide aux anesthésistes et aux allergologues.

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[46] - Blanco Guerra C. [Latex-fruit syndrome]. Allergol Immunopathol (Madr) 2002;30:156-163

During the last decade, latex IgE-mediated allergy has been recognized as a very important medical problem. At the same time, many studies have dealt with allergic cross-reactions between aeroallergens and foods. In this context, there is clear evidence now on the existence of significant clinical association between latex and fruit allergies. Therefore, a latex-fruit syndrome has been postulated.Several studies have demonstrated that from 20% to 60% of latex-allergic patients show IgE-mediated reactions to a wide variety of foods, mainly fruits. Although implicated foods vary among the studies, banana, avocado, chestnut and kiwi are the most frequently involved. Clinical manifestations of these reactions may vary from oral allergy syndrome to severe anaphylactic reactions, which are not uncommon, thus remarking the clinical relevance of this syndrome.The diagnosis of food hypersensitivities associated to latex allergy is based on the clinical history of immediate adverse reactions, suggestive of an IgE-mediated sensitivity. Prick by prick test with the fresh foods implicated in the reactions shows an 80% concordance with the clinical diagnosis, and therefore it seems to be the best diagnostic test available nowadays in order to confirm the suspicion of latex-fruit allergy. Once the diagnosis is achieved, a diet free of the offending fruits is mandatory.Recently, some of the common allergens responsible for the cross-reactions among latex and the fruits most commonly implicated in the syndrome have been identified. Class I chitinases, with an N-terminal hevein like domain, which cross-react with the major latex allergen hevein, seem to be the panallergens responsible for the latex-fruit syndrome.

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[47] - Rancé F, Dutau G. Asthme et allergies alimentaires: à propos de 163 observations pédiatriques. Arch Pediatr 2002;9(suppl. 3):402-407

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[48] - Pumphrey RS. Fatal anaphylaxis in the UK, 1992-2001. Novartis Found Symp 2004;257:116-128

Each year in the UK, around nine deaths are attributed to anaphylaxis to pharmaceuticals, six to food and four to stings. I have identified 214 deaths associated with anaphylaxis, and have sufficient information for 196 to determine that 88 deaths were due to shock, 96 to asphyxia. Five deaths followed epinephrine overdose, seven were complicated by disseminated intravascular coagulation. There will have been other unrecognized fatal antibiotic and asthmatic food reactions. For foods, peak age was 17-27 with a female and atopic predominance; the first arrest was commonly from asthma 25-35 minutes after the implicated food. For stings, peak age was 45-70 with male and non-atopic predominance; death was commonly from shock 10-15 minutes after the sting. A majority of deaths from pharmaceuticals in hospital took 5 minutes or less from dose to arrest; peak age was 60-75. Maximum time for any cause from trigger to first arrest was 6 hours. The danger of epinephrine overdose and its limitations in reversing anaphylaxis must be recognized. The patient should remain supine with legs raised throughout sting and other shock reactions. Prevention of fatal food reactions will depend on avoidance and optimal daily control of asthma.

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[49] - Beezhold DH, Sussman GL, Liss GM, Chang NS. Latex allergy can induce clinical reactions to specific foods. Clin Exp Allergy 1996;26:416-422

The purpose of this study was to investigate crossreactivity between latex and foods, to identify crossreacting IgE binding proteins, and to assess the clinical significance. METHODS: Forty-seven latex allergic patients and 46 non-latex allergic patient controls were studied. Allergen sensitization was determined by skin-prick testing (SPT) and allergenic proteins were identified by immunoblot reactivity and amino acid sequence analysis. RESULTS: Immunological reactivity to foods was found to be common, occurring in 33 latex-allergic individuals but in only seven controls (P < 0.000001); 100 of 376 (27%) food skin-prick tests were positive in the latex-allergic subjects. Twenty-seven out of 100 positive food SPTs were associated with clinical symptoms. Seventeen patients manifested a clinical allergy to at least one food including 11 with anaphylaxis, and 14 with local sensitivity reactions. Positive food skin tests occurred most frequently with avocado (53%), potato (40%), banana (38%), tomato (28%), chestnut (28%), and kiwi (17%). Latex-allergic patients (23%) recognize a protein that had sequence homology to a broad class of plant proteins known as patatins. Crossreactivity between latex and several potato proteins was observed by immunoblot inhibition analysis. CONCLUSIONS: Sensitization to latex has extensive crossreactivity with certain foods and leads to clinical allergic reactions. Potatoes and tomatoes are newly reported cross-reacting foods. Plant proteins with structural homology to latex proteins may predispose to food allergy.

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[50] - Rodriguez J, Crespo JF, Burks W, Rivas-Plata C, Fernández-Anaya S, Vives R, et al. Randomized, double-blind, crossover challenge study in 53 subjects reporting adverse reactions to melon (Cucumis melo). J Allergy Clin Immunol 2000;106:968-972

BACKGROUND: Few studies have evaluated IgE-mediated hypersensitivity to melon with details of clinical reactions confirmed by double-blind, placebo-controlled, food challenges (DBPCFCs). OBJECTIVE: We sought to investigate clinical features (type and severity of reactions, age at onset, results of skin prick and in vitro tests, and incidence of other allergic diseases and associated food allergies) of acute allergic reactions to melon confirmed by DBPCFCs. METHODS: Fifty-three consecutive adult patients complaining of adverse reactions to melon were included in the study. Skin prick tests and detection of specific IgE were performed in all patients with melon, avocado, kiwi, banana, chestnut, latex, pollen, and other offending foods. Patients first underwent an open food challenge, unless they had a convincing history of severe anaphylaxis. Positive open food challenge reactions were subsequently evaluated by DBPCFCs. RESULTS: Actual clinical reactivity was confirmed in 19 (36%) of 53 patients. The most frequent symptom was oral allergy syndrome (n = 14), but two patients experienced life-threatening reactions, including respiratory symptoms and hypotension. The positive predictive value for a skin prick test was 42%, and that for specific IgE measurement was 44%. Forty-five reactions to 15 other foods were confirmed in 18 patients. The most common foods associated with melon allergy were avocado (n = 7), banana (n = 7), kiwi (n = 6), watermelon (n = 6), and peach (n = 5). Onset of melon-induced allergic symptoms occurred from 6 to 45 years (median, 20 years), preceded by seasonal rhinitis, asthma, or both in 88% (15/17). CONCLUSION: About one third of reported reactions to melon are confirmed by means of DBPCFC, which has been proven to be the most reliable procedure in the diagnosis of clinical fruit allergy. Isolated melon allergy is rare, with most patients either having allergic rhinitis, asthma, or both and associated food allergies.

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[51] - Crespo JF, Rodriguez J, James JM, Daroca P, Reaño M, Vives R. Reactivity to potential cross-reactive foods in fruit-allergic patients: implications for prescribing food avoidance. Allergy 2002;57:946-949

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[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.

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[53] - Fritsche P, Pfister M, Theler B, Helbling A, Ballmer-Weber B. Kiwi: a food allergy with different clinical faces !. EAACI 25th Congress, Vienna, 10-14 June, 2006, Poster n°527

Background: We observe an increasing prevalence of kiwi allergy in Switzerland. Objectives: The aim of the present study was to investigate the clinical characteristics of kiwi allergic patients and to validate the currently used routine diagnostic tools. Methods: Patients with a positive case history of a kiwi allergy underwent a double-blind placebo-controlled food challenge (DBPCFC) with fresh kiwi, skin prick test (SPT) with extracts from kiwi, latex, different pollen and foods, prick-to-prick-test with native kiwi and serum-IgE analysis to birch pollen allergens, latex and kiwi. Personal history of allergy and the family history were recorded with a standardized questionnaire. Results: In 30 out of 38 patients (32.1 +/- 13.0 years) the case history of a kiwi allergy was confirmed by a positive DBPCFC. The most frequently reported symptoms were localized to the oral mucosa (100%), but severe symptoms (emesis, dyspnea or collapse) were reported by 23% of subjects. According to the case histories and the pattern of sensitisation in SPT and serum analysis we could recognise three different groups of patients: Eight patients were monosensitized to kiwi (group A), 17 patients were sensitized to kiwi and different types of pollen (group B), in particular to birch (71%) and grass pollen (77%), and 5 patients suffered from a combined kiwi and latex allergy (group C). Sensitivity of the SPT with a commercial kiwi extract was 71% and 80% for group A and C, respectively, but just 18% for group B. The sensitivity of the kiwi-CAP and the prick-prick-test with native kiwi was 17% and 83%, respectively, for all kiwi allergic patients. 30% of the patients with combined kiwi-pollen allergy were sensitized to latex without suffering from a relevant latex allergy. Four of the 5 kiwi-latex allergic patients suffered first from a pollen allergy, whereas the latex and the kiwi allergy developed after an average interval of more than 10 years. In conclusion: Kiwi may induce severe and even anaphylactic reactions. Kiwi allergy may manifest as a ''monoallergy'' or in association with a pollen and/or latex-allergy. Identification of cross-reactive allergens and inhibition assays will identify the primary sensitizer in latex-pollen-kiwi allergic patients. In patients with combined kiwi-pollen hypersensitivity kiwi allergy is most likely mediated by a labile protein, underrepresented in commercial extracts.

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[54] - 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.

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

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

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

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

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[57] - Diaz-Perales A, Collada C, Blanco C, Sanchez-Monge R, Carrillo T, Aragoncillo C, et al. Class I chitinases with hevein-like domain, but not class II enzymes, are relevant chestnut and avocado allergens. J Allergy Clin Immunol 1998;102:127-133

BACKGROUND: Several foods associated with the latex-fruit syndrome present relevant allergens of around 30 kd. Neither these components nor any other responsible for the reported cross-reactions have been identified and purified. OBJECTIVE: We sought to isolate and characterize the 30 kd allergens from avocado fruit and chestnut seed, two of the main allergenic foods linked with latex allergy. METHODS: Sera from patients allergic to chestnut and avocado were selected according to clinical symptoms, specific IgE levels, and positive skin prick test responses. Class I and II chitinases were purified by affinity and cation-exchange chromatography and characterized by specific IgE and anti-chitinase immunodetection, immunoblot inhibition assays, enzymatic activity tests, and N-terminal sequencing. RESULTS: Relevant 32 kd allergens were detected by specific IgE immunodetection in both avocado and chestnut crude extracts. The same bands, together with others of 25 kd, were revealed by a monospecific antiserum against class II chitinases. Purification and characterization of the 32 kd allergens from both plant sources allowed their identification as class I chitinases with an N-terminal hevein-domain. The purified allergens fully inhibited IgE binding by the corresponding crude extract when tested in immunoblot inhibition assays. Highly related 25 kd class II chitinases that lack the hevein-like domain were also isolated from the same protein preparations. No IgE-binding capacity was shown by these class II enzymes. CONCLUSION: Class I chitinases are relevant allergens of avocado and chestnut and could be the panallergens responsible for the latex-fruit syndrome. The hevein-like domain seems to be involved in their allergenic reactivity.

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[58] - Chen Z, Posch A, Cremer R, Raulf-Heimsoth M, Baur X. Identification of hevein (Hev b 6,02) in Hevea latex as a major cross-reacting allergen with avocado fruit in patients with latex allergy. J Allergy Clin Immunol 1998;102:476-481

BACKGROUND: Recent studies demonstrated that allergy to natural rubber latex is frequently associated with hypersensitivity to avocado fruit. The responsible cross-sensitizing allergen has not been identified. OBJECTIVE: The purpose of this study was to investigate the cross-reactivity of a latex major allergen, hevein, with avocado proteins. METHODS: Serum samples from 118 health care workers (HCWs) allergic to latex (HCW group) and 78 patients with spina bifida (SB) allergic to latex (SB group) were included in this study. Anti-hevein and anti-avocado IgE antibodies were measured by enzyme-linked allergosorbent assay. Cross-reactivity of hevein to avocado proteins was assessed by inhibition of the IgE binding in individual patients' sera containing IgE antibodies to both hevein and avocado. RESULTS: The prevalence of seropositive IgE antibodies to avocado was found to be strongly associated with the presence of hevein-specific IgE antibodies in subjects of both groups (P < .001). Sixty-seven of 91 (73%) subjects from the HCW group and all 19 subjects in the SB group with positive IgE antibodies to hevein also had elevated IgE values to avocado. Competitive RAST inhibition with 42 sera showed that IgE binding to avocado could be completely inhibited in 27 (64%) sera by preincubation with hevein. By contrast, the degrees of inhibition of IgE to hevein by avocado extract ranged from 0% to 36% (n = 16). These results indicate that sensitization to avocado in most patients allergic to latex is caused exclusively by IgE-binding epitopes present in hevein. Results of immunoblots and immunoblot inhibition with 11 serum samples confirmed that a 30-kd protein in avocado was the major IgE-binding component; the IgE-binding reactivity to this protein could be inhibited by hevein in all sera tested. CONCLUSION: Hevein is the major cross-reacting allergen with avocado in subjects with latex allergy.

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[59] - Barre A, Bienvenu F, Culerrier R, Selman L, Granier C, Van Damme E et al. Hev b 2, un allergène important de l’allergie au latex et du syndrome latex-fruits. Rev Fr Allergol 2009;49:331

Hev b 2, une 1,3b-glucanase, est un allergène majeur de l‚allergie au latex et du syndrome latex-fruits.L‚allergénicité d‚Hev b 2 dépend de l‚existence d‚épitopes B que nous avons identifiés à l‚aide de la technologie SPOT. Ces épitopes se localisent sur la surface moléculaire de l‚allergène dans des régions riches en résidus chargés, arginine et lysine essentiellement. Un de ces épitopes est glycosylé et correspond probablement à un glycotope. Certains de ces épitopes offrent des homologies de séquence et de conformation avec les épitopes B identifiés sur la 1,3b-glucanase de banane. Ces homologies interviennent dans les réactions croisées observées entre le latex (allergie au latex) et différents fruits/ légumes (syndrome latex-fruits). Des oligopeptides synthétiques correspondant aux épitopes B identifiés sur la 1,3b-glucanase de banane sont capables d‚inhiber l‚interaction des IgE de patients allergiques avec cet allergène. Les résidus immunodominants de ces épitopes sont en cours de caractérisation. Localisation des épitopes B sur la surface moléculaire d‚Hev b 2 (le glycanne est en vert).

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[60] - Conti A, Giuffrida MG, Hoffmann-Sommergruber K, Wagner S, Amato S, Mistrello G, et al. Identification of latex UDP glucose pyrophosphorylase (Hev b UDPGP) as a novel cause of latex fruit allergy syndrome. Eur Ann Allergy Clin Immunol 2007;39:116-118

Based on a recently published unusual case of food allergy in a latex-allergic patients, the present study identifies Hev b UDPGP as a novel allergen in natural rubber latex able to cause latex-fruit allergy syndrome and as a novel, potential pan-allergen in vegetable foods.

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[61] - Asero R, Mistrello MG, Roncarolo D, Amato S, Falagiani P. Detection of novel latex allergens associated with clinically relevant allergy to plant-derived foods. J Allergy Clin Immunol 2005;115:1312-1314

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[62] - Rodriguez J, Crespo JF, Burks W, Rivas-Plata C, Fernández-Anaya S, Vives R, et al. Randomized, double-blind, crossover challenge study in 53 subjects reporting adverse reactions to melon (Cucumis melo). J Allergy Clin Immunol 2000;106:968-972

BACKGROUND: Few studies have evaluated IgE-mediated hypersensitivity to melon with details of clinical reactions confirmed by double-blind, placebo-controlled, food challenges (DBPCFCs). OBJECTIVE: We sought to investigate clinical features (type and severity of reactions, age at onset, results of skin prick and in vitro tests, and incidence of other allergic diseases and associated food allergies) of acute allergic reactions to melon confirmed by DBPCFCs. METHODS: Fifty-three consecutive adult patients complaining of adverse reactions to melon were included in the study. Skin prick tests and detection of specific IgE were performed in all patients with melon, avocado, kiwi, banana, chestnut, latex, pollen, and other offending foods. Patients first underwent an open food challenge, unless they had a convincing history of severe anaphylaxis. Positive open food challenge reactions were subsequently evaluated by DBPCFCs. RESULTS: Actual clinical reactivity was confirmed in 19 (36%) of 53 patients. The most frequent symptom was oral allergy syndrome (n = 14), but two patients experienced life-threatening reactions, including respiratory symptoms and hypotension. The positive predictive value for a skin prick test was 42%, and that for specific IgE measurement was 44%. Forty-five reactions to 15 other foods were confirmed in 18 patients. The most common foods associated with melon allergy were avocado (n = 7), banana (n = 7), kiwi (n = 6), watermelon (n = 6), and peach (n = 5). Onset of melon-induced allergic symptoms occurred from 6 to 45 years (median, 20 years), preceded by seasonal rhinitis, asthma, or both in 88% (15/17). CONCLUSION: About one third of reported reactions to melon are confirmed by means of DBPCFC, which has been proven to be the most reliable procedure in the diagnosis of clinical fruit allergy. Isolated melon allergy is rare, with most patients either having allergic rhinitis, asthma, or both and associated food allergies.

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[63] - 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.

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

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

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[65] - Gaspar A, Pires G, Marques S, Romeira AM, Godinho N, Matos V, et al. Prevalence and risk factors for latex-fruit syndrome in patients with latex allergy. EAACI 22th Congress, Paris, 7-11 June, 2003, Poster n°31

Background: The association of latex allergy and allergy to plant-derived foods is called latex-fruit syndrome (LFS). There are no studies concerning risk factors for LFS in latex-allergic populations including different risk groups. Purpose: To investigate the prevalence and risk factors for LFS in patients with latex allergy. Material and Methods: We studied 53 latex-allergic patients, mean age of 25.7 (±15.8) years and male/female ratio of 0.4/1, belonging to different risk groups: 14 with spina bifida (SB), 11 submitted to multiple surgeries without SB (MS) and 28 health care workers (HCW). All patients performed: questionnaire; skin prick tests (SPT) with common aeroallergens, five commercial latex extracts and foods with known cross reactivity with latex (commercial extracts and fresh foods); serum total IgE (AlaSTAT®, DPC-Amerlab) and latex specific IgE (UniCAP®, Pharmacia Diagnostics). LFS was defined if both positive clinical history and positive food SPT. RESULTS: The prevalence of LFS in latex-allergic patients was 30%. The foods implicated were: chestnut-69% (11), banana-38% (6), avocado, kiwi and peach-25% (4), passion fruit and pineapple-19% (3), papaya, apricot and melon-13% (2), mango, fig, grape, tomato, spinach and manioc-6% (1). The LFS clinical symptoms were: anaphylaxis-56% (9), urticaria-25% (4) and oral allergy syndrome-19% (3). Almost all the patients with LFS were HCW. The prevalence of LFS in HCW achieved 50% (14). The non HCW were a SB teenager, and an adult with MS. Comparing HCW with LFS (14) and HCW without LFS (14), we found a relation between LFS and higher levels of latex specific IgE (median: 15.0 vs. 0.5kU/l; p<0.01). HCW with CAP-class “ 3 had LFS in 75%, against 31% in HCW with CAP class <3 (p=0.02). Age, sex, personal and familial allergic history, number of surgical interventions, years of occupational exposure, atopy and total IgE were not associated with LFS. CONCLUSIONS: LFS concerns essentially the latex-allergic HCW, being very frequent in this group. This finding is consistent with literature reports, and is supported by the different profiles of allergen sensitisation related with exposure route (major latex allergens of HCW are the ones implicated in cross-reactivity). Latex sensitisation with CAP-class “ 3 is a risk factor for LFS in HCW group. LFS was revealed in most cases by anaphylaxis, emphasizing the importance of diagnosing this potentially life- threatening syndrome.

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[66] - Wagner B, Buck D, Hafner C, Sowka S, Niggemann B, Scheiner O, et al. Hev b 7 is a Hevea brasiliensis protein associated with latex allergy in children with spina bifida. J Allergy Clin Immunol 2001;108:621-627

In addition to their disease-associated handicaps, patients with spina bifida (SB) are at high risk of developing latex allergy. Individuals with SB represent a special group of latex-allergic patients, inasmuch as their IgE-binding patterns differ from those of other populations of latex-allergic individuals. Two allergens strongly associated with latex allergy in patients with SB-Hev b 1 and Hev b 3-have already been identified. OBJECTIVE: We intended to identify a predominant IgE-binding band-in addition to Hev b 1 and 3-at 43 kDa in a study population of 38 latex-allergic (IgE antibodies to latex and symptoms on provocation with latex gloves) and 15 latex sensitized (IgE antibodies to latex but no symptoms on provocation) children with SB (mean age, 12.3 years) and to determine its frequency of recognition. METHODS: Sera of latex-sensitized or latex-allergic patients with SB were tested on latex C extract containing natural Hev b 1, Hev b 3, and Hev b 7 and with the recombinant 43-kDa Hev b 7 in immunoblot and inhibition studies. RESULTS: Natural Hev b 1 was recognized by 82% and natural Hev b 3 by 79% of the latex-allergic children with SB. In addition to some other proteins, 15 (39.5%) of 38 latex-allergic and 2 (13%) of 5 latex-sensitized children with SB revealed IgE binding to a 43-kDa band in the latex protein extract. We identified this 43-kDa IgE-binding band as natural Hev b 7 by immunoblotting and inhibition experiments using recombinant Hev b 7. CONCLUSION: From these data, we conclude that Hev b 7, the patatinlike Hevea latex protein, is the third SB-associated latex allergen. Future immunotherapy for latex-allergic individuals with SB will have to include Hev b 7 in addition to Hev b 1 and Hev b 3.

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[67] - Toche P, Lagos M, Salinas J, De la Fuente C, Hernandez P, Zanartu P, et al. Latex - fruit syndrome in a group of children with spina bifida. Allergy Clin Immunol Int 2005;17(Suppl. 1):490-491

Background: In a previously studied group of 42 patients with spina bifida (SB), 11 (26,2%) had clinical latex allergy and 24 (57,1%) were sensitized to latex. Latex allergy is a known risk factor for the development of latex-fruit syndrome. Our objetive was to determine the prevalence of latex-fruit syndrome in children with SB, from a pediatric Hospital, in Santiago, Chile. METHODS: During a five 1month period, 42 parents of patients with SB answered a questionnaire and their children were skin prick tested by the prick in prick method with fresh foods from the latex- fruit family: avocado, banana, kiwi, tomato, pineapple, paprika, and potatoes. Chestnut was tested with a commercial extract. We also tested a commercially available latex extract, ammoniated latex, a home-made extract, two trademarks of latex gloves and 5 common aeroallergens. A weal 3 mm greater than the negative control was considered positive. Atopy was defined as having at least one positive skin prick test to common aeroallergens. RESULTS: Fourteen of the 42 patients (33%) were sensitized to fruits; 13 of the 24 patients sensitized to latex were sensitized to fruits (54,1%) and only one patient latex negative was sensitized to fruits (5,5%) (p<0.01). Four patients (9,5%) were allergic to latex related fruits (urticaria, angioedema, oral syndrome), all of them were latex sensitized, but only two of them had latex allergy. Atopy was also a risk factor for developing fruit sensitization (OR= 4,5). Fruits most frequently involved in allergic reactions were avocado, paprika and banana. In sensitized patients, avocado, paprika, banana, ananas and chestnut were the most frequent. CONCLUSIONS: Latex sensitization in SB patients is a risk factor for developing sensitization to latex related fruits (OR = 20,1). Latex allergic SB patients have a tendency towards fruit allergy, but the small number of patients does not allow us to confirm it. Avocado, paprika and banana, three foods commonly consumed, were the most frequently involved in the latex ˆ fruit syndrome.

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[68] - Oberhuber C, Bulley SM, Ballmer-Weber BK, Bublin M, Gaier S, DeWitt AM et al. Characterization of Bet v 1-related allergens from kiwifruit relevant for patients with combined kiwifruit and birch pollen allergy. Mol Nutr Food Res 2008;52(suppl. 2):S230-S240

Allergy to kiwifruit appears to have become more common in Europe and elsewhere during the past several years. Seven allergens have been identified from kiwifruit so far, with actinidin, kiwellin and the thaumatin-like protein as the most relevant ones. In contrast to other fruits, no Bet v 1 homologues were characterized from kiwifruit so far. We cloned, purified, and characterized recombinant Bet v 1-homologous allergens from green (Actinidia deliciosa, Act d 8) and gold (Actinidia chinensis, Act c 8) kiwifruit, and confirmed the presence of its natural counterpart by inhibition assays. Well-characterized recombinant Act d 8 and Act c 8 were recognized by birch pollen/kiwifruit (confirmed by double-blind placebo-controlled food challenge) allergic patients in IgE immunoblots and ELISA experiments. The present data point out that Bet v 1 homologues are allergens in kiwifruit and of relevance for patients sensitized to tree pollen and kiwifruit, and might have been neglected so far due to low abundance in the conventional extracts used for diagnosis.

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[69] - Wagner S, Breiteneder H. The latex-fruit syndrome. Biochem Soc Trans 2002;30:935-940

Approximately 30-50% of individuals who are allergic to natural rubber latex (NRL) show an associated hypersensitivity to some plant-derived foods, especially freshly consumed fruits. This association of latex allergy and allergy to plant-derived foods is called latex-fruit syndrome. An increasing number of plant sources, such as avocado, banana, chestnut, kiwi, peach, tomato, potato and bell pepper, have been associated with this syndrome. The prevailing hypothesis is that allergen cross-reactivity is due to IgE antibodies that recognize structurally similar epitopes on different proteins that are phylogenetically closely related or represent evolutionarily conserved structures. Several types of proteins have been identified to be involved in the latex-fruit syndrome. Two of these are plant defence proteins. Class I chitinases containing an N-terminal hevein-like domain cross-react with hevein (Hev b 6.02), a major IgE-binding allergen for patients allergic to NRL. A beta-1,3-glucanase was identified as an important latex allergen which shows cross-reactivity with proteins of bell pepper. Another important NRL allergen, Hev b 7, is a patatin-like protein that shows cross-reactivity with its analogous protein in potato. Furthermore, patients with allergy to plant-derived foods and associated pollinosis show a high frequency of IgE reactivity to the pan-allergen profilin, which may cause positive serum IgE determinations to NRL. Although there is much information about the plant-derived foods and some data about the allergens involved in the latex-fruit syndrome, it is not always clear whether latex sensitization precedes or follows the onset of food allergy.

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[70] - Garcia Ortiz JC, Moyano JC, Alvarez M, Bellido J. Latex allergy in fruit-allergy patients. Allergy 1998;53:532-536

The purpose of this study was to investigate the prevalence of latex allergy in fruit-allergic patients, and to assess its clinical significance. Fifty-seven fruit-allergic patients and 50 non-fruit-allergic atopic patient controls were studied. All patients were questioned about conventional immediate symptoms after contact with latex products. Patients also underwent skin prick testing and determination of specific serum IgE to latex, as well as a screening test for environmental allergens. Immunologic latex sensitization occurred in 49/57 (85.9%) fruit-allergic patients, who showed a positive STP and/or CAP to latex, but in only two controls (P < 0.001). Six out of 57 (10.5%) fruit-allergic patients suffered from clinically relevant latex allergy. Symptoms included contact urticaria, angioedema, conjunctivitis, generalized urticaria, and moderate anaphylactic reactions. No control reported symptoms with latex products (P = 0.052). In all patients, clinical symptoms to fruits preceded a history of latex allergy. The fruits most associated were melon, peach, and banana. From our data, we conclude that there is a potential for allergic reactions to latex in patients with allergy to fruit. All patients with fruit allergy should be screened for individual risk of latex allergy.

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[71] - M'Raihi ML, Charpin D, Pons A, Bongrand P, Vervloet D. Allergénicité croisée entre latex et banane. Rev Fr Allergol Immunol Clin 1989;29:187-189

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

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

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[73] - Blanco C. Latex-fruit syndrome. Curr Allergy Asthma Rep 2003;3:47-53

Natural rubber latex immunoglobulin E-mediated hypersensitivity is probably one of the most relevant challenges that has been faced in the treatment of allergies during recent years. Additionally, allergen cross-reactivity has arisen as another very important problem, in the difficulty in diagnosing it and in its clinical implications. It is clear that some latex allergens cross-react with plant-derived food allergens, the so-called latex-fruit syndrome, with evident clinical consequences. Although the foods most frequently involved are banana, avocado, kiwi, and chestnut, several others are also implicated. Investigations point to a group of defense-related plant proteins, class I chitinases, which cross-react with a major latex allergen, hevein, as the panallergens responsible for the syndrome. This review focuses on our current understanding of the latex-fruit syndrome.

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[74] - Garcia Ortiz JC, Moyano JC, Alvarez M, Bellido J. Latex allergy in fruit-allergy patients. Allergy 1998;53:532-536

The purpose of this study was to investigate the prevalence of latex allergy in fruit-allergic patients, and to assess its clinical significance. Fifty-seven fruit-allergic patients and 50 non-fruit-allergic atopic patient controls were studied. All patients were questioned about conventional immediate symptoms after contact with latex products. Patients also underwent skin prick testing and determination of specific serum IgE to latex, as well as a screening test for environmental allergens. Immunologic latex sensitization occurred in 49/57 (85.9%) fruit-allergic patients, who showed a positive STP and/or CAP to latex, but in only two controls (P < 0.001). Six out of 57 (10.5%) fruit-allergic patients suffered from clinically relevant latex allergy. Symptoms included contact urticaria, angioedema, conjunctivitis, generalized urticaria, and moderate anaphylactic reactions. No control reported symptoms with latex products (P = 0.052). In all patients, clinical symptoms to fruits preceded a history of latex allergy. The fruits most associated were melon, peach, and banana. From our data, we conclude that there is a potential for allergic reactions to latex in patients with allergy to fruit. All patients with fruit allergy should be screened for individual risk of latex allergy.

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[75] - Crespo JF, Rodriguez J, James JM, Daroca P, Reaño M, Vives R. Reactivity to potential cross-reactive foods in fruit-allergic patients: implications for prescribing food avoidance. Allergy 2002;57:946-949

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[76] - Malandain H, Giroux F, Cano Y. The influence of carbohydrate structures present in common allergen sources on specific IgE results. Eur Ann Allergy Clin Immunol 2007;39:216-220

BACKGROUND: Cross-reactive carbohydrate determinants (CCD) are well known interferants in specific IgE assays (sIgE). Glyco-epitopes are not restricted to CCD and extracts used to prepare in vitro tests contain many other glycoproteins able to bind glycan-specific IgE. The overall amounts of IgE-bindable glycan structures in allergen sources are unknown . OBJECTIVE: We aimed at quantifying the influence of N-glycan structures on IgE reactivity to commonly tested allergen sources . METHODS: IgE reactivity to 51 allergen extracts, one purified natural allergen and 10 recombinant allergens was measured on Phadia UniCAP system using 2 sera demonstrating significant levels of glycan-related IgE reactivity. Immobilized bromelain and horseradish peroxidase (HRP) were used to capture N-glycan-specific IgE from these sera. Residual IgE reactivity was measured for 42 allergen sources and 4 recombinant/purified allergens . RESULTS: An obviously excessive number of positive CAP-results were obtained with both sera, especially for plant-based allergen sources. Capture of glycan-specific IgE led to a decrease of serum IgE ractivity, variable among allergen sources and between sera. Among others, peanut results were proven largely interfered by the presence of glycan-specific IgE. Unexpectedly some allergen sources showed a slight influence of glycan-related reactivity, such as cockroach, mosquito, mussel, shrimp and domestic mites . CONCLUSION: In patients sensitized to pollens or to Hymenoptera venoms sIgE results should be interpreted with caution. One cannot substract the result of a glyco-reporter test (bromelain and/or HRP) in order to compute glycan-free slgE results for common allergen sources like peanuts. As long as the demonstration of a significant role for glycan structures in clinical allergic reactions is lacking, a simple pre-treatment able to discard glycan-specific IgE from serum would be useful to improve accuracy of in vitro diagnostic tests.

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

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

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

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

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[79] - Quirce S, Bombin C, Aleman A, Sastre J. Allergy to latex, fruit, and pollen. Allergy 2000;55:896-898

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[80] - Rodriguez J, Crespo JF, Burks W, Rivas-Plata C, Fernández-Anaya S, Vives R, et al. Randomized, double-blind, crossover challenge study in 53 subjects reporting adverse reactions to melon (Cucumis melo). J Allergy Clin Immunol 2000;106:968-972

BACKGROUND: Few studies have evaluated IgE-mediated hypersensitivity to melon with details of clinical reactions confirmed by double-blind, placebo-controlled, food challenges (DBPCFCs). OBJECTIVE: We sought to investigate clinical features (type and severity of reactions, age at onset, results of skin prick and in vitro tests, and incidence of other allergic diseases and associated food allergies) of acute allergic reactions to melon confirmed by DBPCFCs. METHODS: Fifty-three consecutive adult patients complaining of adverse reactions to melon were included in the study. Skin prick tests and detection of specific IgE were performed in all patients with melon, avocado, kiwi, banana, chestnut, latex, pollen, and other offending foods. Patients first underwent an open food challenge, unless they had a convincing history of severe anaphylaxis. Positive open food challenge reactions were subsequently evaluated by DBPCFCs. RESULTS: Actual clinical reactivity was confirmed in 19 (36%) of 53 patients. The most frequent symptom was oral allergy syndrome (n = 14), but two patients experienced life-threatening reactions, including respiratory symptoms and hypotension. The positive predictive value for a skin prick test was 42%, and that for specific IgE measurement was 44%. Forty-five reactions to 15 other foods were confirmed in 18 patients. The most common foods associated with melon allergy were avocado (n = 7), banana (n = 7), kiwi (n = 6), watermelon (n = 6), and peach (n = 5). Onset of melon-induced allergic symptoms occurred from 6 to 45 years (median, 20 years), preceded by seasonal rhinitis, asthma, or both in 88% (15/17). CONCLUSION: About one third of reported reactions to melon are confirmed by means of DBPCFC, which has been proven to be the most reliable procedure in the diagnosis of clinical fruit allergy. Isolated melon allergy is rare, with most patients either having allergic rhinitis, asthma, or both and associated food allergies.

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

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

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[82] - Crespo JF, Rodriguez J, James JM, Daroca P, Reaño M, Vives R. Reactivity to potential cross-reactive foods in fruit-allergic patients: implications for prescribing food avoidance. Allergy 2002;57:946-949

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[83] - Crespo JF, Rodriguez J, James JM, Daroca P, Reaño M, Vives R. Reactivity to potential cross-reactive foods in fruit-allergic patients: implications for prescribing food avoidance. Allergy 2002;57:946-949

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

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

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

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

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[86] - M'Raihi ML, Charpin D, Pons A, Bongrand P, Vervloet D. Allergénicité croisée entre latex et banane. Rev Fr Allergol Immunol Clin 1989;29:187-189

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

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

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[88] - Ito A, Ito K, Morishita M, Sakamoto T. A banana-allergic infant with IgE reactivity to avocado, but not to latex. Pediatr Int 2006;48:321-323

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[89] - Quirce S, Bombin C, Aleman A, Sastre J. Allergy to latex, fruit, and pollen. Allergy 2000;55:896-898

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[90] - Fernández-Nieto M, Quirce S, De las Heras M, Cuesta J, Aleman A, Sastre J. Latex-Fruit Syndrome: A Study on Health Care Workers Allergic to Natural Rubber Latex. AAAAI 58th Annual Meeting, New York, 1-6 March, 2002, Poster n°866

We conducted a study on 30 health care workers with latex allergy diagnosed by skin prick test with a non-ammoniated latex extract 100 HEP/ml (ALK-Abelló, Madrid, Spain). Of these patients, 9 had asthma, 6 rhinoconjunctivitis and 15 contact urticaria from latex products, mainly latex gloves. The results of inhalation challenge and cutaneous provocation tests with latex gloves confirmed the diagnosis of latex allergy. Skin tests were performed using the „prick by prick‰ method with fresh kiwi, avocado, banana and chestnut. Specific IgE against latex and the aforementioned fruits or nuts was determined by the CAP method (Pharmacia, Uppsala, Sweden). A positive skin test to kiwi was observed in 66.6% of the patients and specific IgE to kiwi was confirmed in 13.3% of them. Nine out of the 30 patients (30%) presented with allergic symptoms after kiwi ingestion: 6 had oral allergy syndrome (OAS), 1 urticaria and angioedema, 1 anaphylaxis and 1 epigastralgia and diarrhea. Three patients had never eaten kiwi and the remaining patients tolerated kiwi ingestion without any reaction. A positive skin prick test with avocado was found in 50% of the patients and 20% of them had positive specific IgE to avocado. Seven patients (23.3%) presented with allergic reactions after eating avocado: 5 OAS and 2 urticaria and angioedema. Three patients did not eat avocado. The remaining patients could eat avocado without any ill effect. A positive skin test to banana was observed in 60% of the patients and 16.6% of them had positive specific IgE to this fruit. After banana ingestion, 9 patients (30%) suffered from allergic symptoms: 2 OAS, 4 urticaria and angioedema and 3 other symptoms. A positive skin test to chestnut was found in 53.3% of the patients and in 10% of them specific IgE was positive. Five patients (16.7%) showed allergic symptoms after eating chestnut: 1 anaphylaxis, 1 OAS, 2 urticaria and angioedema and 1 other symptoms. One patient had never eaten chestnut. The remaining patients tolerated chestnut ingestion. In our study, between 17% and 30% of the latex-allergic health care workers showed allergy symptoms after eating fruits. However, the prevalence of positive skin tests to these fruits ranged between 50 and 67%. The fruits most frequently implicated in the latex-fruit syndrome were kiwi and banana.

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[91] - 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.

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[92] - Garcia Ortiz JC, Moyano JC, Alvarez M, Bellido J. Latex allergy in fruit-allergy patients. Allergy 1998;53:532-536

The purpose of this study was to investigate the prevalence of latex allergy in fruit-allergic patients, and to assess its clinical significance. Fifty-seven fruit-allergic patients and 50 non-fruit-allergic atopic patient controls were studied. All patients were questioned about conventional immediate symptoms after contact with latex products. Patients also underwent skin prick testing and determination of specific serum IgE to latex, as well as a screening test for environmental allergens. Immunologic latex sensitization occurred in 49/57 (85.9%) fruit-allergic patients, who showed a positive STP and/or CAP to latex, but in only two controls (P < 0.001). Six out of 57 (10.5%) fruit-allergic patients suffered from clinically relevant latex allergy. Symptoms included contact urticaria, angioedema, conjunctivitis, generalized urticaria, and moderate anaphylactic reactions. No control reported symptoms with latex products (P = 0.052). In all patients, clinical symptoms to fruits preceded a history of latex allergy. The fruits most associated were melon, peach, and banana. From our data, we conclude that there is a potential for allergic reactions to latex in patients with allergy to fruit. All patients with fruit allergy should be screened for individual risk of latex allergy.

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

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

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[94] - 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.

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[95] - Rico P, Somoza ML, Feliu A, Jimenez A, Crespo JF, Rodriguez J. Clinical features of chestnut allergy objectively confirmed by double-bind pacebo-controlled food challenges (DBPCFC's). EAACI 22th Congress, Paris, 7-11 June, 2003, Poster n°134

Background: Chestnuts (Castanea sativa) belong to the Fagaceae family, genus Castanea. Sensitization to chestnut has been reported in patients with other allergies, particularly in the 'atex-fruit syndrome' However, few studies have focused on chestnut allergy confirmed by DBPCFC‚s. We sought to analyze the clinical features of adult patients with objectively confirmed chestnut allergy. Methods: Fifteen adult patients diagnosed with chestnut allergy were included in this study. Case histories were evaluated following the diagnostic protocol of the Food Allergy Unit from ŒHospital Universitario 12 de Octubre'; including a detailed clinical history, skin testing by the prick-prick method with fresh foods, and detection of food specific serum IgE (CAP-FEIA, Pharmacia, Uppsala, Sweden). Clinical reactivity to foods was assessed first by open food challenges (OFCs), unless a convincing history of a recent severe anaphylaxis. Positive OFCs reactions were subsequently evaluated by DBPCFCs. All negative results of DBPCFC's were followed by a final open feeding. Results: The age of chestnut adverse reactions ranged from 15 to 70 years (median=28). The most common symptoms were systemic anaphylaxis (47%), isolated oral symptoms (27%), and generalized acute urticaria (14%). Interestingly, the results of allergy testing (both SPT and detection of specific IgE) were negative in 5 out of 15 patients with clinical reactivity to chestnut. Forty-nine reactions to other 13 different foods of vegetable origin were confirmed by DBPCFCs in patients with chestnut allergy, including banana (6 out of 15 patients), avocado (5/15 pt.) and kiwi (4/15 pt.). In addition, 7 out of 15 (47%) patients having clinical allergy to chestnut were found to be allergic to latex. Conclusions: Systemic anaphylaxis is a common clinical feature associated to adverse reactions after chestnut ingestion. Latex-associated allergy is found in nearly half of patients reacting to chestnut ingestion. Allergy testing is a poor predictor of clinical reactivity to chestnut.

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[96] - Daschner A, Crespo JF, Pascual CY. Specific IgE to recombinant vegetal panallergen (rBet v 2) and fruit allergy in pollinic patients. Allergy 1999;53:614-618

The presence of IgE antibodies to the allergens rBet v 1 and rBet v 2 was investigated in patients with known sensitization to rye grass (Lolium perenne) and/or olive (Olea europaea) pollen, by comparing a group of 10 patients who had allergic symptoms after ingestion of fruits [including bananas, figs, kiwifruit, muskmelons, oranges and peaches] with a group of 17 patients who had only seasonal respiratory symptoms. There was no significant difference between the 2 groups for total IgE. All patients showed specific IgE to both L. perenne and O. europaea. No specific IgE binding to rBet v 1 was detected in any patient. The incidence of the presence of IgE antibodies to rBet v 2 was 90% in the group with fruit allergy and 35% in the group [without fruit allergy]. There was a significant association between presence of IgE antibodies to rBet v 2 and fruit allergy (P = 0.007). Specific IgE values to O. europaea pollen were higher in the fruit-allergy group than the group without fruit allergy (P = 0.032). It is concluded that pollen-allergic patients with specific IgE to birch pollen profilin show a significantly elevated frequency of fruit allergy.

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

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

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[98] - Crespo JF, Rodriguez J, James JM, Daroca P, Reaño M, Vives R. Reactivity to potential cross-reactive foods in fruit-allergic patients: implications for prescribing food avoidance. Allergy 2002;57:946-949

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[99] - Blanco C, Sánchez-Monge R, Recas M, López-Torrejón G, Cumplido J, Figueroa J, et al. Cas s 8, the Lipid Transfer Protein from Chestnut Seeds, is a Major Allergen in Chestnut Allergic Patients without Associated Latex Allergy, but not in those with the Latex-Fruit Syndrome. AAAAI 62nd Annual Meeting, Miami, 3-7 March 2006, Poster n°186

RATIONALE: The allergens involved in chestnut allergy without associated latex hypersensitivity have not been studied METHODS: Sera from 12 patients with chestnut but not latex allergy, as well as from 3 subjects with the latex fruit syndrome, were used. Chestnut lipid transfer protein (LTP) Cas s 8 was purified by gel-filtration chromatography followed by RP-HPLC, and characterized by N-terminal amino acid sequencing and MALDI analysis. Isolated Cas s 8, together with peach LTP Pru p 3, and avocado class I chitinase Pers a 1 (homologous to Cas s 5), were tested in immunodetection, ELISA and skin prick test (SPT) RESULTS: LTPs Cas s 8 and Pru p 3, but not chitinase Pers a 1, were recognized in IgE immunodetection assays using a serum pool from patients with chestnut but not latex allergy. The opposite was true when a pool of sera from patients with latex-fruit syndrome was analyzed. Specific IgE to Cas s 8 was found in 11/12 and 7/12 individual sera from chestnut but not latex allergic patients, tested by immunodetection and direct ELISA, respectively. All these sera had specific IgE to Pru p 3, whereas only one of them to Pers a 1. Cas s 8, as well as Pru p 3, inhibited 61% of the IgE binding to a chestnut crude extract in ELISA-inhibition assays CONCLUSIONS: A different pattern of main allergens is shown in chestnut but not latex allergy, compared to the latex-fruit syndrome, being LTP the major allergen in the former, and class I chitinase in the later case Funding: Instituto de Salud Carlos III (ISCiii RTIC G03/094 & C03/011)

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[100] - Rodriguez J, Crespo JF, Burks W, Rivas-Plata C, Fernández-Anaya S, Vives R, et al. Randomized, double-blind, crossover challenge study in 53 subjects reporting adverse reactions to melon (Cucumis melo). J Allergy Clin Immunol 2000;106:968-972

BACKGROUND: Few studies have evaluated IgE-mediated hypersensitivity to melon with details of clinical reactions confirmed by double-blind, placebo-controlled, food challenges (DBPCFCs). OBJECTIVE: We sought to investigate clinical features (type and severity of reactions, age at onset, results of skin prick and in vitro tests, and incidence of other allergic diseases and associated food allergies) of acute allergic reactions to melon confirmed by DBPCFCs. METHODS: Fifty-three consecutive adult patients complaining of adverse reactions to melon were included in the study. Skin prick tests and detection of specific IgE were performed in all patients with melon, avocado, kiwi, banana, chestnut, latex, pollen, and other offending foods. Patients first underwent an open food challenge, unless they had a convincing history of severe anaphylaxis. Positive open food challenge reactions were subsequently evaluated by DBPCFCs. RESULTS: Actual clinical reactivity was confirmed in 19 (36%) of 53 patients. The most frequent symptom was oral allergy syndrome (n = 14), but two patients experienced life-threatening reactions, including respiratory symptoms and hypotension. The positive predictive value for a skin prick test was 42%, and that for specific IgE measurement was 44%. Forty-five reactions to 15 other foods were confirmed in 18 patients. The most common foods associated with melon allergy were avocado (n = 7), banana (n = 7), kiwi (n = 6), watermelon (n = 6), and peach (n = 5). Onset of melon-induced allergic symptoms occurred from 6 to 45 years (median, 20 years), preceded by seasonal rhinitis, asthma, or both in 88% (15/17). CONCLUSION: About one third of reported reactions to melon are confirmed by means of DBPCFC, which has been proven to be the most reliable procedure in the diagnosis of clinical fruit allergy. Isolated melon allergy is rare, with most patients either having allergic rhinitis, asthma, or both and associated food allergies.

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[101] - 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.

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[102] - Poza P, Somoza ML, Crespo JF, Izquierdo G, Campo P, Rodriguez J. Diagnostic evaluation of 27 patients reporting adverse reactions to tomato. EAACI 21th Congress, Naples, 1-5 June, 2002, Communication n°59

Background: Sensitization to tomato has been reported in patients with other allergies, particularly latex. IgE inhibition studies have shown cross-reactive components shared by latex, potato and tomato. Nevertheless, less information is available on the clinical relevance of tomato sensitization objectively confirmed by DBPCFCs. The purpose of this investigation was to assess clinical and immunological features of adverse reactions to tomato. Methods: Twenty-seven adult patients (median π28 years) complaining of adverse reactions to tomato were included in the study. Skin prick tests and detection of specific IgE (CAP) were performed in all patients with tomato, latex, pollen and other offending foods. Clinical reactivity to foods was evaluated first by open food challenges (OFCs), unless a convincing history of a recent severe anaphylaxis. Positive OFCs were subsequently evaluated by the DBPCFC method. Results: Twelve and 13 patients had positive skin prick tests and CAP FEIA with tomato, respectively. Two patients reported severe systemic anaphylaxis, which excluded any challenge. Twenty-five patients underwent OFC with tomato. Ten of 25 initial OFCs were positive, but only four of the nine performed DBPCFCs elicited positive results. An OFC induced a severe reaction that precluded further provocations. Overall, seven reactions were considered positive in 16 patients with positive results of skin tests and/or CAP FEIA. The positive predictive value of a skin prick test was 46 and 43% for specific IgE. The most frequent symptom was the oral allergy syndrome. Thirty-two reactions to other foods were confirmed in the seven patients with actual allergy to tomato. The most common foods associated were melon (four patients), watermelon (three), banana (three), kiwi (three), avocado (two), peach (two), chestnut (two), hazelnut (two), and peanut (two). Moreover, three out of seven patients allergic to tomato were found to be sensitive to latex (one patient had anaphylactic episodes upon latex exposure and two had positive results of the used tests with latex). All patients have seasonal rhinitis and/or asthma and positive results of skin tests to several pollens. Conclusions: Tomato is an allergenic source that can induce actual clinical allergy, as established by DBPCFCs. Although most patients experienced oral allergy syndrome, severe anaphylactic reactions could be elicited. Isolated allergy to tomato seems to be infrequent, most patients having allergy to a number of foods, pollen and/or latex.

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

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

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[104] - Ahrazem O, Ibáñez D, López-Torrejón G, Sánchez-Monge R, Sastre J, Lombardero M, et al. Lipid Transfer Proteins and Allergy to Oranges. Int Arch Allergy Immunol 2005;137:201-210

BACKGROUND: Lipid transfer proteins (LTPs) are relevant fruit allergens, recently proposed as model plant food allergens. No citrus fruit allergen has been characterized to date. We sought to identify and isolate citrus fruit LTPs and to explore their relevance in orange allergy . METHODS: Twenty-seven patients, showing mainly oral allergy syndrome after orange ingestion, as well as positive prick responses and serum-specific IgE levels to orange, were selected. Natural orange and lemon LTPs, as well as a recombinant orange LTP isoform expressed in Pichia pastoris, were isolated by chromatographic methods and characterized by N-terminal amino acid sequencing and matrix-assisted laser desorption/ionizaion mass spectrometry, and DNA sequencing of the corresponding cDNA in the case of the recombinant allergen. Specific IgE determination, immunodetection, ELISA-inhibition assays and in vivo skin prick tests (SPTs) were performed with all three purified allergens and with the major peach LTP allergen, Pru p 3 . RESULTS: The natural allergens purified from orange (nCit s 3) and lemon (nCit l 3) showed very similar N-terminal amino acid sequences (18 out of 20 identical residues), typical of LTPs, and molecular masses of 9,610 and 9,618 Da, respectively. The recombinant orange isoform (rCit s 3) expressed in P. pastoris (16 out of 20 residues identical to its natural counterpart in the N-terminal region) presented 92 amino acid residues and 9,463 Da, and 67% sequence identity with rPru p 3. Of the 27 sera analyzed, specific IgE to the purified allergens was found in 54% for nCit l 3, 48% for nCit s 3, 46% for rCit s 3 and 37% for rPru p 3. Positive SPT responses were obtained in 7 out of 26 patients tested for nCit s 3, 3 out of 8 for nCit l 3 and 10 out of 26 for nPru p 3. ELISA-inhibition assays showed an equivalent IgE-binding pattern for the natural and recombinant orange LTPs, and IgE cross-reactivity among the purified orange, lemon and peach LTP allergens . CONCLUSIONS: Members of the LTP allergen family are involved in allergy to oranges, displaying positive in vitro and in vivo reactions in 30-50% of the patients studied. Both orange and lemon allergens show cross-reactivity with the major peach allergen Pru p 3.

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[105] - Ibáñez MD, Sastre J, Martinez san Ireneo M, Laso MT, Barber D, Lombardero M. Different patterns of allergen recognition in children allergic to orange. J Allergy Clin Immunol 2004;113:175-176

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[106] - Cuesta-Herranz J, Lazaro M, Figueredo E, Igea JM, Umpierrez A, De Las Heras M. Allergy to plant-derived fresh foods in a birch- and ragweed-free area. Clin Exp Allergy 2000;30:1411-1416

BACKGROUND: Allergy to plant-derived fresh foods has often been reported in geographical areas where birch or ragweed pollens are frequent and has been attributed to cross-reactivity to pollens. OBJECTIVE: The aim of this study has been to evaluate allergy to plant-derived fresh foods among pollen-allergic patients from a birch and ragweed-free area. METHODS: Ninety-five pollen-allergic patients took part in the study. The study consisted of a questionnaire, skin prick tests and challenge tests. Pollen skin tests to five grasses, eight trees and seven weeds were performed in duplicate. Prick tests (prick by prick) and challenge tests were carried out with the fresh foods. RESULTS: Most patients allergic to pollens were sensitized to grass (Lolium and Phleum; 97.9%), followed by tree (Olea; 82.1%) and weed pollens (Plantago; 64.2%). 35 of the 95 pollen-allergic patients had positive skin test responses to some plant-derived fresh foods, the highest percentage corresponding to several fruits in the Rosaceae family (peach and pear, 26.3%), followed by Cucurbitacea fruits (melon, 13.7%). The 21. 05% of the pollen-allergic patients were allergic to some type of plant-derived fresh food. Peach was the plant-derived fresh food which most frequently elicited allergy symptoms (12.6%), followed by melon (7.36%). The cluster of positive responses to Rosaceae fruits was higher for skin testing than for challenge testing. CONCLUSION: Peach was the most important allergy provoking fruit in a birch and ragweed free-area where apples were consumed at a rate of two times more than peaches and the patients allergic to pollen were principally sensitized to grass pollens.

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[107] - Beezhold DH, Sussman GL, Liss GM, Chang NS. Latex allergy can induce clinical reactions to specific foods. Clin Exp Allergy 1996;26:416-422

The purpose of this study was to investigate crossreactivity between latex and foods, to identify crossreacting IgE binding proteins, and to assess the clinical significance. METHODS: Forty-seven latex allergic patients and 46 non-latex allergic patient controls were studied. Allergen sensitization was determined by skin-prick testing (SPT) and allergenic proteins were identified by immunoblot reactivity and amino acid sequence analysis. RESULTS: Immunological reactivity to foods was found to be common, occurring in 33 latex-allergic individuals but in only seven controls (P < 0.000001); 100 of 376 (27%) food skin-prick tests were positive in the latex-allergic subjects. Twenty-seven out of 100 positive food SPTs were associated with clinical symptoms. Seventeen patients manifested a clinical allergy to at least one food including 11 with anaphylaxis, and 14 with local sensitivity reactions. Positive food skin tests occurred most frequently with avocado (53%), potato (40%), banana (38%), tomato (28%), chestnut (28%), and kiwi (17%). Latex-allergic patients (23%) recognize a protein that had sequence homology to a broad class of plant proteins known as patatins. Crossreactivity between latex and several potato proteins was observed by immunoblot inhibition analysis. CONCLUSIONS: Sensitization to latex has extensive crossreactivity with certain foods and leads to clinical allergic reactions. Potatoes and tomatoes are newly reported cross-reacting foods. Plant proteins with structural homology to latex proteins may predispose to food allergy.

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

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

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[109] - Wagner B, Buck D, Hafner C, Sowka S, Niggemann B, Scheiner O, et al. Hev b 7 is a Hevea brasiliensis protein associated with latex allergy in children with spina bifida. J Allergy Clin Immunol 2001;108:621-627

In addition to their disease-associated handicaps, patients with spina bifida (SB) are at high risk of developing latex allergy. Individuals with SB represent a special group of latex-allergic patients, inasmuch as their IgE-binding patterns differ from those of other populations of latex-allergic individuals. Two allergens strongly associated with latex allergy in patients with SB-Hev b 1 and Hev b 3-have already been identified. OBJECTIVE: We intended to identify a predominant IgE-binding band-in addition to Hev b 1 and 3-at 43 kDa in a study population of 38 latex-allergic (IgE antibodies to latex and symptoms on provocation with latex gloves) and 15 latex sensitized (IgE antibodies to latex but no symptoms on provocation) children with SB (mean age, 12.3 years) and to determine its frequency of recognition. METHODS: Sera of latex-sensitized or latex-allergic patients with SB were tested on latex C extract containing natural Hev b 1, Hev b 3, and Hev b 7 and with the recombinant 43-kDa Hev b 7 in immunoblot and inhibition studies. RESULTS: Natural Hev b 1 was recognized by 82% and natural Hev b 3 by 79% of the latex-allergic children with SB. In addition to some other proteins, 15 (39.5%) of 38 latex-allergic and 2 (13%) of 5 latex-sensitized children with SB revealed IgE binding to a 43-kDa band in the latex protein extract. We identified this 43-kDa IgE-binding band as natural Hev b 7 by immunoblotting and inhibition experiments using recombinant Hev b 7. CONCLUSION: From these data, we conclude that Hev b 7, the patatinlike Hevea latex protein, is the third SB-associated latex allergen. Future immunotherapy for latex-allergic individuals with SB will have to include Hev b 7 in addition to Hev b 1 and Hev b 3.

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

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

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

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

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

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

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[113] - Radauer C, Wagner S, Allwardt D, Adhami F, Leitzenberger I, Hafner C, et al. Determination of the cross-reactivity between the major latex allergen hevein and hevein-like domains of class I chitinases in a group of latex allergic patients. Allergy Clin Immunol Int 2005;17(Suppl. 1):45

Background: About one half of latex-allergic patients suffer from adverse reactions towards several plant foods including avocado, banana, chestnut, and kiwi fruit. This so-called latex-fruit syndrome is commonly attributed to IgE cross-reactivity between the major latex allergen hevein (Hev b 6.02) and fruit class I chitinases that contain an N-terminal chitin-binding domain homologous to hevein. Several IgE-binding class I chitinases have been characterised as natural or recombinant products. However, serological data on their cross-reactivities with hevein using a larger sample of latex allergic patients' sera are still missing. Methods: We used a panel of 60 sera of patients with latex allergy confirmed by positive case histories and positive skin prick tests or glove provocation tests. All sera were tested in an IgE ELISA with recombinant hevein and the recombinant hevein-like domains derived from the class I chitinases from latex (Hev b 11-Hev), banana (Mus xp-Hev), and avocado (Pers a 1-Hev). The recombinant allergens were expressed in Escherichia coli as fusion proteins with the maltose binding protein using the pMal system. Results: Forty-five of the 60 sera (75%) contained IgE specific for hevein. The frequencies of sensitisation to Hev b 11-Hev, Mus xp-Hev and Pers a 1-Hev were 31 (52%), 27 (45%), and 31 (52%), respectively. Only two patients contained low amounts of IgE specific for the hevein-like domains from banana or avocado chitinases without concomitant hevein sensitisation. In contrast, 13 patients' sera (22%) reacted exclusively to hevein. The amounts of IgE binding to different chitinase-derived hevein-like domains were highly correlated. The frequencies of reported adverse reactions to banana and avocado were 23% and 17%. Nevertheless, no significant connection between sensitisation to hevein-like domains and food allergy symptoms could be observed. Conclusion: Our data suggest that the production of cross-reactive IgE directed to hevein and hevein-like chitin-binding domains is in most cases caused by primary sensitisation to hevein. The missing association between sensitisation to hevein and symptoms of food allergy puts the clinical relevance of heveinlike domains as allergens into question.

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[114] - Lavaud F, Prévost A, Cossart C, Guérin L, Bernard J, Kochman S. Allergy to latex, avocado pear, and banana: evidence for a 30 kd antigen in immunoblotting. J Allergy Clin Immunol 1995;95:557-564

Allergens of natural latex, latex gloves, avocado pear, and banana extracts were investigated by an immunoblotting technique in sera of patients experiencing associated latex and fruit allergies. Extracts were separated by sodium dodecyl-sulfate-polyacrylamide gel electrophoresis and electroblotted onto nitrocellulose. After incubation with patients' sera, IgE antibodies were revealed by a goat anti-human IgE alkaline-phosphatase conjugate. Seventeen serum samples from patients with well-documented latex allergy were studied. Among these patients, 10 demonstrated an allergy to avocado pear sometimes associated with banana. In sera from patients with latex and fruit allergy, prominent IgE binding was revealed at about 30 kd with latex and fruit extracts. Serum controls remained negative. Cross-inhibition of immunoblotting confirmed that this main allergen is linked to a common epitope present in latex and fruits. This must be related to clinical findings and previous observations of cross-reactivity.

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[115] - Guinnepain MT, Guilloux L, Laurent J. Buckwheat allergy: an additional cross-reactivity between latex and food. Rev Fr Allergol Immunol Clin 1997;37:1218

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[116] - Möller M, Kayma M, Vieluf D, Paschke A, Steinhart H. Determination and characterization of cross-reacting allergens in latex, avocado, banana, and kiwi fruit. Allergy 1998;53:289-296

Sera of 11 patients were used to characterize allergens in kiwi fruit, latex, avocado, and banana by SDS-PAGE/immunoblotting and to determine cross-reactions between these allergen extracts in EAST inhibition and immunoblot inhibition. By SDS-PAGE/immunoblotting, allergens with apparent molecular weights of 21, 38, 40, and 42 kDa were visualized in latex extract. In avocado extract, IgE-binding components of 27, 43, 52, 58, 65, 75, and 88 kDa were to be seen, whereas, in banana extract, a 40-kDa protein showed strong IgE binding. Furthermore, allergens of 52, 58, 88, and 94 kDa were detected in the extract of banana. Cross-reactions between these allergen extracts were determined by EAST inhibition. Immunoblot inhibition demonstrated that almost all IgE-reactive bands in nitrocellulose-blotted latex, avocado, and banana extracts and two components of 43 and 67 kDa in kiwi fruit shared common IgE epitopes.

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[117] - Lucas JSA, Grimshaw KEC, Collins WK, Warner JO, Hourihane JOB. Kiwi fruit is a significant allergen and is associated with differing patterns of reactivity in children and adults. Clin Exp Allergy 2004;34:1115-1121

BACKGROUND: Allergy to kiwi fruit appears increasingly common, but few studies have evaluated its clinical characteristics, or evaluated methods of investigating the allergy . OBJECTIVE: To characterize the clinical characteristics of kiwi fruit allergy and to study the role of double-blind placebo-controlled food challenge (DBPCFC), skin tests and specific IgE in the diagnosis of this food allergy . METHODS: Two-hundred and seventy-three subjects with a history suggestive of allergy to kiwi completed a questionnaire. Forty-five were investigated by DBPCFC, prick-to-prick skin testing with fresh kiwi pulp, and specific IgE measurement. Nineteen subjects were also skin tested using a commercially available solution . RESULTS: The most frequently reported symptoms were localized to the oral mucosa (65%), but severe symptoms (wheeze, cyanosis or collapse) were reported by 18% of subjects. Young children were significantly more likely than adults to react on their first known exposure (P<0.001), and to report severe symptoms (P=0.008). Twenty-four of 45 subjects (53%) had allergy confirmed by DBPCFC. Prick-to-prick skin test with fresh kiwi was positive in 93% of subjects who had allergy confirmed by DBPCFC, and also in 55% of subjects with a negative food challenge. The commercial extract was significantly less sensitive, but with fewer false-positive reactions. CAP sIgE was only positive in 54% of subjects who had a positive challenge . CONCLUSIONS: Kiwi fruit should be considered a significant food allergen, capable of causing severe reactions, particularly in young children. DBPCFC confirmed allergy to kiwi fruit in 53% of the subjects tested, who had a previous history suggestive of kiwi allergy. Skin testing with fresh fruit has good sensitivity (93%), but poor specificity (45%) in this population. CAP sIgE and a commercially available skin test solution were both much less sensitive (54%; 75%) but had better specificity (90%; 67%).

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[118] - 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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[119] - Karisola P, Kotovuori A, Poikonen S, Niskanen E, Kalkkinen N, Turjanmaa K, et al. Isolated hevein-like domains, but not 31-kd endochitinases, are responsible for IgE-mediated in vitro and in vivo reactions in latex-fruit syndrome. J Allergy Clin Immunol 2005;115:598-605

BACKGROUND: Individuals with natural rubber latex allergy often have immediate reactions to plant-derived foods and fresh fruits, such as avocado and banana. IgE of these patients has been shown to bind endochitinases containing an N-terminal hevein-like domain (HLD). However, evidence on 31-kd endochitinase-induced reactions in vivo is lacking . OBJECTIVE: We sought to assess the clinical significance of 31-kd endochitinases and isolated HLDs in latex-fruit syndrome . METHODS: The 31-kd endochitinases and corresponding HLDs were purified or produced from avocado, banana, latex, and wheat germ. Skin prick test reactivities against purified proteins were examined in 15 patients with natural rubber latex allergy. The binding efficiency of IgE to purified proteins was studied by using an inhibition ELISA. Experimentally resolved or modeled structures of the proteins were compared to clarify the molecular basis of clinical reactions . RESULTS: Eleven (73%) patients had skin prick test reactions to isolated HLDs of avocado and banana, but only 1 (7%) patient reacted to their corresponding 31-kd endochitinases. HLDs from avocado and banana inhibited binding of IgE to prohevein (Hev b 6.01) in 59% and 38% of patients, respectively, whereas corresponding percentages for 31-kd endochitinases were 17% and 20%, respectively. Isolated HLDs of wheat germ agglutinin and 18-kd wheat germ agglutinin did not significantly inhibit IgE binding to hevein . CONCLUSION: The isolated HLD molecules alone, but not when linked to endochitinases, seem to be responsible for IgE-mediated clinical reactions in latex-fruit syndrome. Careful selection of relevant allergens in their proper molecular form is therefore crucial in forming a reliable diagnosis of latex-fruit syndrome.

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[120] - 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

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[121] - Asero R, Mistrello G, Roncarolo D, Amato S, Zanoni D, Barocci F, et al. Detection of clinical markers of sensitization to profilin in patients allergic to plant-derived foods. J Allergy Clin Immunol 2003;112:427-432

BACKGROUND: A proper classification of patients allergic to plant-derived foods is of pivotal importance because the clinical features of allergic reactions to fruits and vegetables depend on the nature and characteristics of proteins responsible for sensitization. However, in normal clinical settings this is presently impossible . OBJECTIVE: We sought to detect clinical markers of sensitization to profilin . METHODS: Seventy-one patients allergic to fruits and vegetables but not sensitized to lipid transfer protein or natural rubber latex were studied. Food allergy was ascertained on the basis of clinical history and positive skin prick test responses with fresh foods, commercial extracts, or both. Allergies to foods that had caused less than 2 adverse reactions were confirmed by means of open oral challenge. IgE reactivity to rBet v 1/rBet v 2 and to natural Phleum species profilin were detected. Moreover, IgE to the 30- to 40-kd and 60- to 90-kd birch pollen-enriched fractions, which also can be involved in cross-reactivity phenomena, were measured in sera from 52 patients by means of ELISA . RESULTS: On the basis of in vitro tests, 24, 18, and 25 patients turned out to be sensitized to Bet v 1, Bet v 2, or both, respectively. Four patients had negative test results for both allergens. Hypersensitivity to Bet v 2 was strongly associated with clinical allergy to citrus fruits (39% in patients monosensitized to Bet v 2 vs 4% in patients monosensitized to Bet v 1, P <.025), melon or watermelon (67% vs 0%, P <.001), banana (66% vs 8%, P <.001), and tomato (33% vs 0%, P <.05), whereas Bet v 1 sensitivity was associated with clinical allergy to apple (100% vs 39%, P <.001) and hazelnut (56% vs 0%, P <.001). The sensitivity of a history of allergy to gourd fruits, citrus fruits, tomato, banana, or a combination thereof as a means to detect profilin-hypersensitive patients was 85% (41/48). The specificity of an allergy to any of these fruits exceeded 85%, with positive predictive values ranging between 68% and 91% . CONCLUSION: In clinical settings in which laboratory investigations are not easily accessible, allergy to melon, watermelon, citrus fruits, tomato, and banana can be used as a marker of profilin hypersensitivity once a sensitization to natural rubber latex and lipid transfer protein is ruled out.

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[122] - 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.

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[123] - Asero R, Mistrello G, Roncarolo D, Amato S, Caldironi G, Barocci F, et al. Immunological cross-reactivity between lipid transfer proteins from botanically unrelated plant-derived foods: a clinical study. Allergy 2002;57:900-906

BACKGROUND: Lipid transfer proteins (LTP) are highly conserved and widely distributed throughout the plant kingdom. Recent studies demonstrated immunological cross-reactivity between LTP from many botanically unrelated fruits and vegetables and concluded that LTP are pan-allergens. This study aimed to evaluate the clinical relevance of such cross-reactivity in a group of subjects monosensitized to LTP . METHODS: Twenty LTP-hypersensitive patients were selected from a population of about 600 subjects with history of Rosaceae allergy by means of: 1) negative skin prick test (SPT) with a commercial birch pollen extract; 2) positive SPT with a commercial plum extract, rich in LTP but virtually lacking both Bet v 1-like proteins and profilin; 3) in-vitro IgE reactivity to the 9-10 kDa fraction of peach peel or immunoblot with peach peel showing a single band at 10 kDa; and 4) total inhibition of reactivity to whole peach extract (containing Bet v 1-related allergen, profilin, and LTP) by purified peach LTP on enzyme-linked immunoassay (ELISA). Allergy to foods other than Rosaceae was ascertained by careful interview and analysis of medical recordings. SPT with a large series of plant-derived foods were carried out as well. The cross reactivity between LTPs from botanically unrelated plant-derived foods was assessed by ELISA inhibition tests using walnut and peanut extracts as substrate, and peach LTP as inhibitor . RESULTS: All patients reported allergic reactions after the ingestion of at least one from a large number of vegetable foods other than Rosaceae, and in several cases clinical reactions were very severe (anaphylaxis, asthma, urticaria/angioedema). Nuts and peanuts were the most frequently reported causes of allergic reactions (80% and 40% of patients, respectively). All patients showed positive SPT to several non-Rosaceae food extracts. SPT with nuts, peanut, legumes, celery, rice, and corn were positive in the majority of patients. In ELISA inhibition studies, absorption of sera with peach LTP caused complete inhibition of IgE reactivity to walnut and peanut in all cases . CONCLUSION: LTP is a clinically relevant pan-allergen. Most Rosaceae-allergic, LTP-hypersensitive patients experience adverse reactions after ingestion of botanically unrelated plant-derived foods as well. In view of the high prevalence and severity of the allergic reactions induced, hazelnut, walnut, and peanut should be regarded as potentially hazardous for these patients.

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[124] - 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.

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

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

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[126] - Mari A, Scala E, D’Ambrosio C, Breiteneder H, Wagner S. Latex Allergy within a Cohort of Not-at-Risk Subjects with Respiratory Symptoms: Prevalence of Latex Sensitization and Assessment of Diagnostic Tools. Int Arch Allergy Immunol 2007;143:135-143

BACKGROUND: Immunoglobluin E (IgE)-mediated hypersensitivity to natural rubber latex (NRL) is a major problem in allergy practice. Currently, the use of skin prick tests (SPTs) with latex extracts and specific IgE detection for the diagnosis of NRL allergy in suspected patients is directed to identification of risk factors. Many cases of NRL allergy remain undiagnosed due to misreporting of symptoms by the patients or lack of proper questions asked by the physician. MATERIALS AND METHODS: A total of 6,126 subjects referred for respiratory symptoms underwent SPTs with NRL. Positive subjects were resurveyed for exposure to NRL, and specific IgE for NRL extracts and recombinant molecules was determined. Immunoblots of NRL extracts were performed to identify IgE patterns . RESULTS: Forty-six of 3,930 sensitized subjects had a positive SPT with NRL, displaying a prevalence of NRL sensitization of 0.75% for the general and 1.2% for the sensitized population. Eleven out of 46 (23.9%) subjects could be defined as NRL asymptomatic, whereas 35 (76.1%) developed symptoms upon exposure to NRL. Specific IgE to NRL was detected for 22 (75.86%) of 29 tested sera. Seventeen out of 22 (77%) sera displayed specific IgE to recombinant allergens with most reactions to Hev b 5, Hev b 6.01 and Hev b 6.02. Immunoblots of NRL extract fractions with patients' sera showed heterogeneous patterns . CONCLUSIONS: SPTs with NRL extract should be routinely performed in patients with respiratory symptoms. Hev b 5, Hev b 6.01 and Hev b 6.02 are the most important allergens, but further characterization of NRL extracts is needed to identify novel allergens and to clarify the role of crossreactive carbohydrate determinants.

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[127] - Rihs HP, Rueff F, Lundberg M, Rozynek P, Barber D, Scheurer S, et al. Relevance of the recombinant lipid transfer protein of Hevea brasiliensis: IgE-binding reactivity in fruit-allergic adults. Ann Allergy Asthma Immunol 2006;97:643-649

BACKGROUND: Lipid transfer proteins (LTPs) are relevant allergens in certain plants. The role of the LTP of Hevea brasiliensis in the latex-fruit syndrome is widely unknown. OBJECTIVE: To study IgE reactivity with recombinant Hevea LTP in sera of fruit-allergic adults with and without natural rubber latex (NRL) allergy. METHODS: An LTP-specific complementary DNA of H brasiliensis leaves was amplified, subcloned into the pMAL expression system, and analyzed. The recombinant protein was coupled to ImmunoCAP, and the IgE-binding properties were studied in sera of 10 NRL-allergic patients without symptoms to fruit and 48 atopic patients with fruit allergy. Eleven of these 48 patients were also allergic to NRL, 14 displayed sensitization to NRL without symptoms on NRL exposure so far, and 23 had neither symptoms nor IgE antibodies to NRL. RESULTS: After expression in Escherichia coli, a soluble maltose-binding protein-rHev b 12 fusion protein was isolated and coupled to ImmunoCAP to determine rHev b 12 specific IgE reactivity. rHev b 12 specific IgE binding was found in 3 fruit-allergic patients with NRL sensitization (0.68, 0.88, and 0.96 kU/L) and in 3 fruit-allergic patients without NRL sensitization (1.58, 2.25, and 2.27 kU/L). The remaining 52 serum samples and all maltose-binding protein control test results were negative (< 0.35 kU/L). CONCLUSIONS: In these patients, rHev b 12 specific IgE reactivity seems to result from common cross-reactive epitopes with some of the fruit LTPs tested and underscores only an involvement in co-recognition. No clinical relevance of IgE binding to the LTP of H brasiliensis in association with NRL allergy was detected.

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[128] - Ghunaim N, Grönlund H, Kronqvist M, Grönneberg R, Söderström L, Ahlstedt S, et al. Antibody profiles and self-reported symptoms to pollen-related food allergens in grass pollen-allergic patients from northern Europe. Allergy 2005;60:185-191

BACKGROUND: Most studies on pollen-related food allergy have so far focused on the association of birch/weed pollen allergens and plant food allergy. The aim of this study was to elucidate the allergen spectrum among a group of grass pollen-allergic patients from northern Europe and to relate the results to clinical histories of pollen-related food allergy . METHODS: Fifty-eight grass pollen-allergic patients answered a questionnaire regarding allergy to foods. Blood samples were taken to test IgE-reactivity to a large panel of pollen allergens and pollen- and nonpollen-related food allergens using crude allergen extracts and recombinant and native allergens . RESULTS: Three different groups of grass pollen-allergic patients were identified according to their IgE antibody profile: a grass pollen group only (19%), a grass and tree pollen group (29%) and a grass, tree and compositae (pan-) pollen group (48%). No sensitization to Bet v 1 as well as almost no IgE to plant food was observed in the grass pollen group. In contrast, nearly all patients in the two tree-related groups had IgE to Bet v 1, which reflected the high frequency of adverse reactions to typical birch-related food in these groups. Only four patients belonging to the pan-pollen group displayed IgE to profilin Phl p 12/Bet v 2. Patients in the pan-pollen group reported significantly more symptoms to food allergens compared with patients in the two other groups. The most frequently reported symptom was the oral allergy syndrome . CONCLUSIONS: Sensitization to grass pollen alone is rare among grass pollen-allergic patients from northern Europe. The majority of patients are in addition sensitized to birch (Bet v 1), which seems to be closely related to their pollen-derived food allergy. The study highlights the advantage of using well-defined allergen molecules for the diagnosis of cross-reactivity between pollen and food allergens.

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[129] - Beaudouin E, Renaudin JM, Jacquenet S, Moneret-Vautrin DA. Intérêt diagnostique des IgE spécifiques aux allergènes recombinants du latex. Alim'Inter 2007;12:219-225

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[130] - Ganglberger E, Radauer C, Wagner S, O'Riordain G, Beezhold DH, Brehler R, et al. Hev b 8, the Hevea brasiliensis latex profilin, is a cross-reactive allergen of latex, plant foods and pollen. Int Arch Allergy Immunol 2001;125:216-227

BACKGROUND: Plant profilins are important pan-allergens. They are responsible for a significant percentage of pollen-related allergies. Limited information is available about their involvement in the latex-fruit syndrome and the cross-reactivities between latex and pollen. We aimed to clone and express the Hevea brasiliensis latex profilin to investigate its allergological significance and serological cross-reactivities to profilins from plant foods and pollens . METHODS: A DNA complementary to messenger RNA (cDNA) coding for the Hevea latex profilin, Hev b 8, was amplified by polymerase chain reaction from latex RNA. Recombinant (r)Hev b 8 was produced in Escherichia coli and used to screen sera from 50 latex- allergic health care workers (HCWs) with well-documented histories of food and pollen allergy and 34 latex-allergic spina bifida (SB) patients. The cross-reactivity of natural Hev b 8 and rHev b 8 with other plant profilins was determined by ELISA inhibition assays. A three-dimensional homology model of Hev b 8 was constructed based on known profilin structures . RESULTS: The cDNA of Hev b 8 encoded a protein of 131 amino acids with a predicted molecular mass of 14 kD. Twelve of the 50 HCWs and 2 of the 34 SB patients were sensitized to Hev b 8. All Hev b 8-sensitized patients showed allergic symptoms to pollen or plant foods. Cross-reactivities between profilins of latex, pollen and plant food were illustrated by their ability to inhibit IgE binding to rHev b 8. Homology modeling of Hev b 8 yielded a structure highly similar to Bet v 2, the birch pollen profilin, with the most distinct differences located at the N-terminus . CONCLUSIONS: We conclude that primary sensitization to latex profilin in the majority of cases takes place via pollen or food profilins. Additionally, pollinosis and food-allergic patients with profilin-specific IgE can be at risk of developing latex allergy

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[131] - Vallier P, Balland S, Harf R, Valenta R, Deviller P. Identification of profilin as an IgE-binding component in latex from Hevea brasiliensis: clinical implications. Clin Exp Allergy 1995;25:332-339

Considering the high occurrence of profilin as an allergen in many plant species, the assumption was made that profilin might be an allergen in Hevea brasiliensis, a member of the latex producing Euphorbiaceae family Using IgE-binding inhibition by purified profilins we demonstrated that profilin is an IgE-binding component in the cytosolic fraction of natural latex and, to a lower extent, in the rubber fraction. Thirty-five out of 36 sera containing IgE to ragweed-profilin reacted with profilin from latex, indicating structural homologies between profilins from latex and ragweed. A large percentage (59%) of these sera were found to be positive in CAP latex assay. The preincubation of these sera with purified ragweed profilin greatly inhibited the CAP latex. Because profilin is also present in banana extract, it is likely to be involved in cross-sensitivity to banana and latex. In a group of 19 individuals allergic to latex only two had anti-profilin IgE antibodies. Profilin was barely detectable on glove extract immunoblots, whereas some sera from patients allergic to latex reacted with a 15 kDa allergen which was not profilin. Consequently, IgE antibodies to latex-profilin is a questionable factor for sensitization of occupationally-exposed patients; however, sensitization to profilin should be taken into account when interpreting the results of latex IgE antibody assays.

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[132] - Enberg RN, Leickly FE, McCullough J, Bailey J, Ownby DR. Watermelon and ragweed share allergens. J Allergy Clin Immunol 1987;79:867-875

A biotin-avidin amplified ELISA was used to measure antigen-specific IgE for ragweed, representative members of the gourd family (watermelon, cantaloupe, honeydew melon, zucchini, and cucumber), and banana in the sera of 192 allergic patients, each with an IgE greater than or equal to 180 microns/ml. Sixty-three percent (120/192) of the sera contained antiragweed IgE, and of these patients, 28% to 50% contained IgE specific for any single gourd family member. In contrast, no greater than 11% of the sera positive for a given gourd or banana were negative for ragweed. Correlations between ragweed and gourd-specific IgE levels were significant (p less than 0.001), and correlation coefficients between any two gourds exceeded 0.79. In an ELISA system, the extracts of watermelon and ragweed inhibited each other in a dose-dependent manner; the resulting nonparallel inhibition curves indicate that some, but not all, of the allergens in the two extracts are cross-reactive. Isoelectric focusing of watermelon and ragweed extracts in narrow range gel (pH 4 to 6) followed by immunoblotting demonstrated six watermelon allergen bands with isoelectric points identical to those of ragweed allergens. Several remaining bands in the two extracts had differing isoelectric points, however. Six of 26 patients interviewed with watermelon-specific IgE reported developing oropharyngeal symptoms (itching and/or swelling of the lips, tongue, or throat) after ingesting at least one of the study foods, whereas only one of 25 patients interviewed without detectable watermelon-specific IgE reported similar symptoms (p = 0.05)

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[133] - Guinnepain MT, Guilloux L, Laurent J. Buckwheat allergy: an additional cross-reactivity between latex and food. Rev Fr Allergol Immunol Clin 1997;37:1218

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[134] - de Maat Bleeker F, Stapel SO. Cross-reactivity between buckwheat and latex. Allergy 1998;53:538-539

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

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

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

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

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[137] - Asero R, Mistrello G, Roncarolo D, Amato S, Zanoni D, Barocci F, et al. Detection of clinical markers of sensitization to profilin in patients allergic to plant-derived foods. J Allergy Clin Immunol 2003;112:427-432

BACKGROUND: A proper classification of patients allergic to plant-derived foods is of pivotal importance because the clinical features of allergic reactions to fruits and vegetables depend on the nature and characteristics of proteins responsible for sensitization. However, in normal clinical settings this is presently impossible . OBJECTIVE: We sought to detect clinical markers of sensitization to profilin . METHODS: Seventy-one patients allergic to fruits and vegetables but not sensitized to lipid transfer protein or natural rubber latex were studied. Food allergy was ascertained on the basis of clinical history and positive skin prick test responses with fresh foods, commercial extracts, or both. Allergies to foods that had caused less than 2 adverse reactions were confirmed by means of open oral challenge. IgE reactivity to rBet v 1/rBet v 2 and to natural Phleum species profilin were detected. Moreover, IgE to the 30- to 40-kd and 60- to 90-kd birch pollen-enriched fractions, which also can be involved in cross-reactivity phenomena, were measured in sera from 52 patients by means of ELISA . RESULTS: On the basis of in vitro tests, 24, 18, and 25 patients turned out to be sensitized to Bet v 1, Bet v 2, or both, respectively. Four patients had negative test results for both allergens. Hypersensitivity to Bet v 2 was strongly associated with clinical allergy to citrus fruits (39% in patients monosensitized to Bet v 2 vs 4% in patients monosensitized to Bet v 1, P <.025), melon or watermelon (67% vs 0%, P <.001), banana (66% vs 8%, P <.001), and tomato (33% vs 0%, P <.05), whereas Bet v 1 sensitivity was associated with clinical allergy to apple (100% vs 39%, P <.001) and hazelnut (56% vs 0%, P <.001). The sensitivity of a history of allergy to gourd fruits, citrus fruits, tomato, banana, or a combination thereof as a means to detect profilin-hypersensitive patients was 85% (41/48). The specificity of an allergy to any of these fruits exceeded 85%, with positive predictive values ranging between 68% and 91% . CONCLUSION: In clinical settings in which laboratory investigations are not easily accessible, allergy to melon, watermelon, citrus fruits, tomato, and banana can be used as a marker of profilin hypersensitivity once a sensitization to natural rubber latex and lipid transfer protein is ruled out.

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[138] - 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.

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[139] - Vassilopoulou E, Zuidmeer L, Akkerdaas J, Tassios I, Rigby NR, Mills ENC, et al. Severe Immediate Allergic Reactions to Grapes: Part of a Lipid Transfer Protein-Associated Clinical Syndrome. Int Arch Allergy Immunol 2007;143:92-102

BACKGROUND: Grape allergy is considered rare; grape lipid transfer protein (LTP; Vit v 1), an endochitinase and a thaumatin-like protein (TLP) have been reported as grape allergens. A considerable number of patients have referred to our department for severe reactions to grapes, and several IgE binding proteins were detected . OBJECTIVES: The aim of this study was to identify and characterise the allergens involved in severe allergic reactions to grapes and describe the population in which they occur . METHODS: Patients with reported severe allergic reactions to grapes (n = 37) are described. Grape allergens were purified/fractionated by a combination of chromatographic techniques, identified by proteomic analysis and biochemically characterised. Immunoreactivity was assessed by blot (inhibitions) and RAST (inhibitions), and skin prick tests were performed with the isolated allergens . RESULTS: All subjects were polyallergic, sensitised and reactive to several additional foods and pollen. All patients were sensitised to grape LTP. A 28-kDa expansin, a 37.5-kDa polygalacturonase-inhibiting protein, a 39-kDa beta-1,3-glucanase and a 60-kDa protein were identified as minor grape allergens. Endochitinase and TLP did not play a role. Inhibition experiments revealed the possible cross-reactive role of LTP for clinical sensitivities to other LTP-containing plant foods, but also the involvement of cross-reactive carbohydrate determinants of minor allergens in IgE cross-reactivity . CONCLUSIONS: LTP is the major grape allergen, while additional minor allergens may contribute to clinical reactivity. Severe grape allergy presents in atopic patients who frequently react to other LTP-containing, plant-derived foods. The 'LTP syndrome' is the appropriate term to describe this condition.

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[140] - Miralles JC, Caravaca F, Guillén F, Lombardero M, Negro JM. Cross-reactivity between Platanus pollen and vegetables. Allergy 2002;57:146-149

Background: Several associations have been described between tree and plant pollens and certain foods. The objective of this study is to verify whether there is cross-reactivity between Platanus pollen and vegetable origin foods. Methods: We selected 56 patients allergic to vegetable foods and subjected them to cutaneous tests with aeroallergens and vegetable foods. A statistical analysis was performed to evaluate the association of Platanus pollen with foods and with other aeroallergens. Later, a specific IgE determination was performed as well as a RAST (radioallergosorbent) inhibition experiment, to verify the existence of cross-reactivity in vitro. Results: In the cutaneous tests we found a positive correlation between Platanus pollen and hazelnut, peanut, banana and celery. The results of the RAST inhibition experiment indicate an important cross-reactivity between the pollen of Platanus acerifolia and hazelnut and banana fruit, and an intermediate cross-reactivity with celery and peanut. Conclusion: We have described an association between the pollen of the Platanus tree and some vegetable foods such as hazelnut, banana, peanut and celery. This association could be explained by the in vitro IgE cross-reactivity detected.

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Les allergies aux "aliments latex" : prévalences et sévérité des réactions

Quels allergènes dans le latex sont responsables du syndrome latex-aliments ?

La trilogie latex / aliments / pollens

Aux frontières du syndrome "latex-aliments" : les aliments sans le latex ?

Rubriques

Dans la même rubrique

Autres "fruits exotiques"

La figue et autres Moracées

L’avocat

La banane

Le kiwi