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Aytekin Guvenir F, Sengul Emeksiz Z, Buyuk Yaytokgil S, Toyran M, Dibek Misirlioglu E. Fruit allergy and anaphylaxis in children: Culprit fruits and clinical findings. Allergy Asthma Proc 2024; 45:e31-e37. [PMID: 38982605 DOI: 10.2500/aap.2024.45.240027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Background: Fruit allergy usually presents with mild-to-moderate symptoms but serious systemic reactions, e.g., anaphylaxis, may also occur. Objective: This study aimed to examine the clinical and laboratory characteristics of patients with fruit allergy and fruit-induced anaphylaxis. Methods: Patients diagnosed with fruit allergy at Dışkapı Hematology and Oncology Hospital and Bilkent City Hospital between January 2017 and January 2023 were included in the study. The diagnosis of anaphylaxis was made according to the European Allergy and Clinical Immunology Anaphylaxis Guideline. Results: During the study period, skin-prick tests with food allergens were performed on 9432 patients in our clinic, and fruit allergy was detected in 78 patients (0.82%). Five patients with inaccessible medical records were excluded from the study. 40 (54.8%) were boys. The median (interquartile range) age at the onset of symptoms was 72 months (12.5-144 months). Sixty-eight of the patients (93.2%) had a concomitant allergic disease, the most common of which was allergic rhinitis (n = 48 [65.8%]). The 73 patients had a history of reaction to 126 fruits. Twenty-five patients (19.8%) were allergic to multiple fruits. The most common fruit allergen was banana (22/126 [17.4%]), followed by peach (18/126 [14.2%]) and kiwi (17/126 [13.5%]). Mucocutaneous findings were observed most frequently after fruit consumption (120/126 [95.2%]). Anaphylaxis occurred in 17 patients (23.2%) with 21 fruits.The fruits most commonly associated with anaphylaxis were banana (6/21 [28.6%]) and kiwi (6/21 [28.6%]). Conclusion: Fruit allergy generally presents with mild symptoms, e.g., oral allergy syndrome, but severe systemic symptoms, e.g., anaphylaxis, can also be observed. Kiwi and banana are the fruits that most commonly cause anaphylaxis. Although more comprehensive studies are needed to comment on the development of tolerance, especially in patients with anaphylaxis, responsible fruit avoidance is still the most important strategy.
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Affiliation(s)
- Funda Aytekin Guvenir
- From the Department of Pediatric Allergy/Immunology, Ankara Bilkent City Hospital, Ankara, Turkey, and
| | - Zeynep Sengul Emeksiz
- From the Department of Pediatric Allergy/Immunology, Ankara Bilkent City Hospital, Ankara, Turkey, and
| | - Sule Buyuk Yaytokgil
- From the Department of Pediatric Allergy/Immunology, Ankara Bilkent City Hospital, Ankara, Turkey, and
| | - Muge Toyran
- From the Department of Pediatric Allergy/Immunology, Ankara Bilkent City Hospital, Ankara, Turkey, and
| | - Emine Dibek Misirlioglu
- From the Department of Pediatric Allergy/Immunology, Ankara Bilkent City Hospital, Ankara, Turkey, and
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Đurašinović T, Lopandić Z, Protić-Rosić I, Nešić A, Trbojević-Ivić J, Jappe U, Gavrović-Jankulović M. Identification of S-adenosyl-l-homocysteine hydrolase from banana fruit as a novel plant panallergen. Food Chem 2024; 437:137782. [PMID: 37871426 DOI: 10.1016/j.foodchem.2023.137782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 10/25/2023]
Abstract
Banana allergy is often associated with the pollen and latex allergies, which led us to the hypothesis that some yet unidentified banana allergen could provide a basis of the latex-pollen-fruit syndrome. S-adenosyl-l-homocysteine hydrolase (SAHH) was recently identified in the literature as a novel plant allergen. This study aimed to assess the allergenic potential of the naturally occurring banana SAHH (nSAHH) and its recombinant homolog produced in E. coli (rSAHH). nSAHH showed IgE reactivity with a serum pool of twelve banana-allergic persons, while rSAHH displayed IgE reactivity in ten out of the twelve tested patients. Five linear B-cell epitopes were identified on the rSAHH surface, exhibiting ≥ 90 % sequence homology with relevant plant SAHH allergens. Our findings have elucidated SAHH as a novel plant panallergen, underlying the cross-reactivity between plant-derived food and respiratory allergens, confirming our initial hypothesis.
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Affiliation(s)
- Tatjana Đurašinović
- Institute of Medical Biochemistry, Military Medical Academy, 11000 Belgrade, Serbia
| | - Zorana Lopandić
- University of Belgrade, Faculty of Chemistry, 11000 Belgrade, Serbia
| | | | - Andrijana Nešić
- University of Belgrade, Faculty of Chemistry, 11000 Belgrade, Serbia
| | | | - Uta Jappe
- Division of Clinical and Molecular Allergology, Priority Area Asthma and Allergy, Research Center Borstel, German Center for Lung Research (DZL), Airway Research Center North (ARCN), Borstel, Germany; Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Luebeck, Luebeck, Germany
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Krikeerati T, Rodsaward P, Nawiboonwong J, Pinyopornpanish K, Phusawang S, Sompornrattanaphan M. Revisiting Fruit Allergy: Prevalence across the Globe, Diagnosis, and Current Management. Foods 2023; 12:4083. [PMID: 38002141 PMCID: PMC10670478 DOI: 10.3390/foods12224083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Fruit allergies manifest with a diverse array of clinical presentations, ranging from localized contact allergies and oral allergy syndrome to the potential for severe systemic reactions including anaphylaxis. The scope of population-level prevalence studies remains limited, largely derived from single-center or hospital-based investigations. In this comprehensive review, we conducted a systematic literature search spanning the years 2009 to 2023, with full acknowledgment of potential analytical biases, to provide a global overview of fruit allergy prevalence. The primary mechanistic underpinning of fruit allergies stems from cross-reactivity between aeroallergens and food allergens, a consequence of structurally similar epitopes-a phenomenon recognized as pollen food allergy syndrome (PFAS). In the era of molecular allergology, numerous studies have dissected allergen components with substantial clinical relevance. Within this review, we explore important allergenic molecules found in plant-based foods, scrutinize pertinent cross-reactivity patterns, and offer insights into management recommendations. Additionally, we compare guideline recommendations to enhance clinical understanding and inform decision making.
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Affiliation(s)
- Thanachit Krikeerati
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
- Faculty of Medicine Siriraj Hospital, Center of Research Excellence in Allergy and Immunology, Mahidol University, Bangkok 10700, Thailand
| | - Pongsawat Rodsaward
- Division of Immunology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Jutamard Nawiboonwong
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Kanokkarn Pinyopornpanish
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chiangmai University, Chiangmai 50200, Thailand;
| | - Songwut Phusawang
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Mongkhon Sompornrattanaphan
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
- Faculty of Medicine Siriraj Hospital, Center of Research Excellence in Allergy and Immunology, Mahidol University, Bangkok 10700, Thailand
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Julanon N, Thiravetyan B, Unhapipatpong C, Xanthavanij N, Krikeerati T, Thongngarm T, Wongsa C, Songnuan W, Naiyanetr P, Sompornrattanaphan M. Not Just a Banana: The Extent of Fruit Cross-Reactivity and Reaction Severity in Adults with Banana Allergy. Foods 2023; 12:2456. [PMID: 37444194 DOI: 10.3390/foods12132456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
This cross-sectional study aimed to investigate the prevalence and clinical characteristics of cross-reactivity and co-allergy to other plant foods among adult patients with IgE-mediated banana allergy in Thailand. A structured questionnaire was used to assess clinical reactivity, and cross-reactivity diagnoses were based on reactions occurring within 2 years of banana allergy onset, within 3 h of intake, and confirmed by allergists. Among the 133 participants, the most commonly associated plant foods with clinical reactions were kiwi (83.5%), avocado (71.1%), persimmon (58.8%), grapes (44.0%), and durian (43.6%). Notably, 26.5% of the reported reactions to other plant foods were classified as severe. These findings highlight the common occurrence of cross-reactivity/co-allergy to other plant foods in banana-allergic patients, with a significant proportion experiencing severe reactions. Travelers to tropical regions should be aware of this risk and advised to avoid specific banana cultivars and plant foods with reported high cross-reactivity. The inclusion of self-injectable epinephrine in the management plan for patients with primary banana allergy should be considered due to the substantial proportion of reported severe reactions and the wide range of clinical cross-reactivity and co-allergy observed.
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Affiliation(s)
- Narachai Julanon
- Division of Dermatology, Department of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Ben Thiravetyan
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chanita Unhapipatpong
- Division of Clinical Nutrition, Department of Medicine, Khon Kaen Hospital, Khon Kaen 40000, Thailand
| | - Nutchapon Xanthavanij
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thanachit Krikeerati
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Faculty of Medicine Siriraj Hospital, Center of Research Excellence in Allergy and Immunology, Mahidol University, Bangkok 10700, Thailand
| | - Torpong Thongngarm
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Faculty of Medicine Siriraj Hospital, Center of Research Excellence in Allergy and Immunology, Mahidol University, Bangkok 10700, Thailand
| | - Chamard Wongsa
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Faculty of Medicine Siriraj Hospital, Center of Research Excellence in Allergy and Immunology, Mahidol University, Bangkok 10700, Thailand
| | - Wisuwat Songnuan
- Systems Biology of Diseases Research Unit, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
- Center of Excellence on Environmental Health and Toxicology (EHT), OPS, MHESI, Bangkok 10400, Thailand
- Department of Plant Science, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Phornnop Naiyanetr
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Mongkhon Sompornrattanaphan
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Faculty of Medicine Siriraj Hospital, Center of Research Excellence in Allergy and Immunology, Mahidol University, Bangkok 10700, Thailand
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Reinhold L, Lynch S, Lauter CB, Dixon SR, Aneese A. A Heart Gone Bananas: Allergy-Induced Coronary Vasospasm due to Banana (Kounis Syndrome). Case Reports Immunol 2023; 2023:5987123. [PMID: 37397346 PMCID: PMC10313452 DOI: 10.1155/2023/5987123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/04/2023] Open
Abstract
Kounis syndrome encompasses a variety of cardiovascular signs and symptoms associated with mast cell activation in the setting of allergic or hypersensitivity and anaphylactic or anaphylactoid insults. It can manifest as coronary vasospasm, coronary, or in-stent thrombosis, and acute myocardial infarction with plaque rupture. Various medications as well as foods including fish, shellfish, mushroom, kiwi, and rice pudding have been implicated as causal agents. We present what we believe to be the first documented case of Kounis syndrome manifesting as coronary vasospasm as the result of an allergy to banana. This case highlights the importance of considering allergic causes of angina and allergy referral in a patient with known atopy and an otherwise negative cardiovascular workup. It also emphasizes to consider food allergy, especially banana, as a cause of Kounis syndrome.
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Affiliation(s)
| | - Stephen Lynch
- William Beaumont University Hospital, Royal Oak, MI, USA
| | - Carl B. Lauter
- William Beaumont University Hospital, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Simon R. Dixon
- William Beaumont University Hospital, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Andrew Aneese
- William Beaumont University Hospital, Royal Oak, MI, USA
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López-Pedrouso M, Lorenzo JM, Alché JDD, Moreira R, Franco D. Advanced Proteomic and Bioinformatic Tools for Predictive Analysis of Allergens in Novel Foods. BIOLOGY 2023; 12:biology12050714. [PMID: 37237526 DOI: 10.3390/biology12050714] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
In recent years, novel food is becoming an emerging trend increasingly more demanding in developed countries. Food proteins from vegetables (pulses, legumes, cereals), fungi, bacteria and insects are being researched to introduce them in meat alternatives, beverages, baked products and others. One of the most complex challenges for introducing novel foods on the market is to ensure food safety. New alimentary scenarios drive the detection of novel allergens that need to be identified and quantified with the aim of appropriate labelling. Allergenic reactions are mostly caused by proteins of great abundance in foods, most frequently of small molecular mass, glycosylated, water-soluble and with high stability to proteolysis. The most relevant plant and animal food allergens, such as lipid transfer proteins, profilins, seed storage proteins, lactoglobulins, caseins, tropomyosins and parvalbumins from fruits, vegetables, nuts, milk, eggs, shellfish and fish, have been investigated. New methods for massive screening in search of potential allergens must be developed, particularly concerning protein databases and other online tools. Moreover, several bioinformatic tools based on sequence alignment, motif identification or 3-D structure predictions should be implemented as well. Finally, targeted proteomics will become a powerful technology for the quantification of these hazardous proteins. The ultimate objective is to build an effective and resilient surveillance network with this cutting-edge technology.
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Affiliation(s)
- María López-Pedrouso
- Department of Zoology, Genetics and Physical Anthropology, Universidade de Santiago de Compostela, Santiago de Compostela, 15872 A Coruña, Spain
| | - José M Lorenzo
- Centro Tecnolóxico da Carne de Galicia, Rúa Galicia Nº 4, Parque Tecnológico de Galicia, San Cibrao das Viñas, 32900 Ourense, Spain
| | - Juan de Dios Alché
- Plant Reproductive Biology and Advanced Microscopy Laboratory, Department of Biochemistry, Cell and Molecular Biology of Plants, Estación Experimental del Zaidín, Spanish National Research Council (CSIC), Profesor Albareda 1, 18008 Granada, Spain
| | - Ramón Moreira
- Department of Chemical Engineering, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Daniel Franco
- Department of Chemical Engineering, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
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