Allergenic relationship between taxonomically diverse pollens

Immunoglobulin E-Mediated Autoimmunity

The study of autoimmunity mediated by immunoglobulin E (IgE) autoantibodies, which may be termed autoallergy, is in its infancy. It is now recognized that systemic lupus erythematosus, bullous pemphigoid (BP), and chronic urticaria, both spontaneous and inducible, are most likely to be mediated, at least in part, by IgE autoantibodies. The situation in other conditions, such as autoimmune uveitis, rheumatoid arthritis, hyperthyroid Graves’ disease, autoimmune pancreatitis, and even asthma, is far less clear but evidence for autoallergy is accumulating. To be certain of an autoallergic mechanism, it is necessary to identify both IgE autoantibodies and their targets as has been done with the transmembrane protein BP180 and the intracellular protein BP230 in BP and IL-24 in chronic spontaneous urticaria. Also, IgE-targeted therapies, such as anti-IgE, must have been shown to be of benefit to patients as has been done with both of these conditions. This comprehensive review of the literature on IgE-mediated autoallergy focuses on three related questions. What do we know about the prevalence of IgE autoantibodies and their targets in different diseases? What do we know about the relevance of IgE autoantibodies in different diseases? What do we know about the cellular and molecular effects of IgE autoantibodies? In addition to providing answers to these questions, based on a broad review of the literature, we outline the current gaps of knowledge in our understanding of IgE autoantibodies and describe approaches to address them.

Skin prick test reactivity to common aeroallergens among allergic rhinitis patients in Iran

BACKGROUND

Allergic rhinitis is the most common allergic disease with negative impacts on patients' quality of life. The prevalence and pattern of sensitisation vary between different countries and populations. Identification of the most prevalent aeroallergens in each area has a very important role in diagnosis and treatment of allergic rhinitis. Iran is a fairly large country with different geo-climatic conditions and there are no data about the most prevalent aeroallergen in Mashhad City, which is the second largest city in Iran, with a semiarid climate. The aim of this study was to evaluate the prevalence of positive skin test to various common aeroallergens among allergic rhinitis patients in the city of Mashhad.

MATERIALS AND METHODS

Skin prick tests were performed with 27 common regional aeroallergens including grass, weed, tree, mite and mould in 311 patients with allergic rhinitis.

RESULTS

The overall rate of sensitisation to any allergen was 81 %. 76 % of patients were poly-sensitised and weed and grass were the most prevalent allergens (77 % and 62 % respectively). Salsola Kali and mould were the most and the least prevalent individual allergens (72.5 % and 6.5 % respectively). Mean total IgE in patients with positive skin prick test was significantly higher than in patients without any positive skin prick test (308 vs 128 IU/mL, P = 0.016). 97 % of atopic patients were sensitised to Salsola kali and or Fraxinus americana.

CONCLUSIONS

Our work showed the importance of weeds, especially the Amaranthaceae and Chenopodiaceae families. Diagnosis of pollen allergy can be simplified by using a combination of a few common aeroallergens.

A clinically relevant major cross-reactive allergen from mesquite tree pollen

BACKGROUND

Prosopis juliflora (mesquite) is one of the major sources of pollinosis in tropical and semi-arid countries of the world. The present study was undertaken to purify and characterize a major cross-reactive allergen from this tree species.

MATERIALS AND METHODS

Mesquite pollen extract was purified using reverse-phase chromatography. Allergen characterization was done by electrophoresis, enzyme-linked immunosorbent assay (ELISA) and Western blotting. Clinical relevance of the purified protein was analyzed by in vivo (skin tests) and in vitro experiments such as ELISA, histamine release, peripheral blood mononuclear cells (PBMC) proliferation and cytokine assays. Cross-reactivity of purified protein with allergenic tree species and lima bean (food) was assessed by inhibition assays.

RESULTS

A 66-kDa protein was purified from mesquite pollen extract using octadecyl silica resin. Purified protein recognized 90% of mesquite-sensitized patients in skin test and ELISA. It induced significant histamine release in allergic patients' blood and interleukin-4 secretion in the PBMC culture supernatants. Inhibition assays suggested close allergenic relationship of this protein with Ailanthus excelsa, Cassia siamea, Salvadora persica pollen and Phaseolus lunatus (lima bean - an edible legume).

CONCLUSIONS

A 66-kDa major cross-reactive allergen was isolated from mesquite pollen using single-step purification procedure. The protein seems relevant for clinical applications in allergic disorders.

Immunotherapy with keyhole lampet hemocyanin-conjugated decapeptide vaccine in cypress pollen allergy

BACKGROUND

Cupressaceae pollen allergy is a world-wide pollinosis but immunotherapy has rarely been tested. Immunotherapy is usually allergen-specific but new forms may be targeted towards IgE.

OBJECTIVES

A randomized, double-blind, placebo-controlled trial was carried out to assess the efficacy of a vaccine made of keyhole lampet hemocyanin (KLH)-conjugated decapeptide from the Fc(epsilon4) domain of the IgE in cypress pollinosis.

METHODS

Sixty patients with cypress pollen allergy were studied. They were included on a suggestive clinical history, positive skin tests and nasal challenge to cypress pollen extract. Three intramuscular injections of the vaccine (250 microg) or placebo were administered monthly with a booster injection 5 to 8 weeks later. The primary end-point criterion was the threshold dose inducing a positive nasal challenge. The secondary end-point was the symptom-medication scores measured when cypress pollen grains were over 50 grains/m3.

RESULTS

Nasal challenge before treatment was non-significantly different between the placebo and vaccine groups. After treatment there was no significant difference between the two groups. Pollen counts were over 50 grains/m3 for 8 weeks during the trial. There was no significant difference in total symptom scores between the placebo and vaccine groups. The vaccine was safe.

CONCLUSIONS

The KLH-conjugated decapeptide vaccine was not effective in cypress pollen allergy.

Adverse reactions associated with echinacea: the Australian experience

BACKGROUND

Fifty percent of Australians use complementary and alternative medicines (other than vitamins) in any 12-month period, of which echinacea-containing products are increasingly popular. Recent reports have highlighted the risk of allergic reactions to complementary medicines in atopic patients.

OBJECTIVE

To determine the characteristics of adverse reactions linked to use of the popular herbal remedy echinacea.

METHODS

Five privately referred patients were evaluated by the authors in their office practice via skin prick testing (SPT) on the volar aspect of the forearm and radioallergosorbent test after adverse reactions to echinacea. As there was little published information on adverse reactions to echinacea, reports to the Australian Adverse Drug Reactions Advisory Committee were reviewed. Those suggestive of possible allergic reactions were evaluated in greater detail by anonymously surveying the healthcare professionals who had reported the cases and from one unreported case. Serum was collected for further analysis where possible.

RESULTS

Five cases of adverse reactions to echinacea were personally evaluated by the authors. Two patients suffered anaphylaxis and a third had an acute asthma attack 10 minutes after their first ever dose of echinacea. The fourth patient suffered recurrent episodes of mild asthma each time echinacea was ingested, and the fifth developed a maculopapular rash within 2 days of ingestion which recurred when rechallenged. Three of the patients had positive SPT results. Three reported repeated spontaneous "challenges" and symptoms after further ingestion of echinacea. Fifty-one Australian adverse drug reports implicating echinacea were also reviewed. There were 26 cases suggestive of possible immunoglobulin E-mediated hypersensitivity (4 anaphylaxis, 12 acute asthma, 10 urticaria/angioedema). Of these 26 patients, age ranged from 2 to 58 years, 78% were female and >50% were known to be atopic. Four were hospitalized, 4 reacted after their first known exposure, and 1 patient suffered multiple progressive systemic reactions. Twenty percent of 100 atopic subjects who had never taken echinacea also had positive SPT results to this substance when tested by one of the authors in his office practice.

CONCLUSION

Some atopic subjects have positive SPT results to echinacea in the absence of known exposure. Atopic subjects are also overrepresented in those experiencing reactions to echinacea. The possibility that cross-reactivity between echinacea and other environmental allergens may trigger allergic reactions in "echinacea-naïve" subjects is supported by the Australian data. Given its widespread (and largely unsupervised) community use, even rare adverse events become inevitable. Atopic patients should be cautioned appropriately.

Clinical and immunologic evaluation of Cedrus deodara pollen: a new allergen from India

BACKGROUND

Allergy to pollen from gymnosperms is well documented in the West. However, many allergenic species are native to the Himalayan region of India, and Cedrus deodara (Pinaceae) was selected for allergologic investigation. The objective was to define the allergologic and immunochemical aspects of C. deodara pollen.

METHODS

Pollen antigen from C. deodara (CD) was prepared and characterized by biochemical and biologic assays. Specific IgE binding was determined by means of ELISA and immunoblotting.

RESULTS

CD pollen antigen caused marked skin sensitivity in 7.5% of an atopic population. A significantly elevated level of CD-specific IgE antibodies was observed in 65.8% of the skin-positive patients. Immunoblotting showed protein fractions of 37, 44, 58, and 78 kDa with 100% binding with the patients' sera suspected to be due to carbohydrate moieties.

CONCLUSIONS

Patients from the Himalayan region, where CD occurs naturally, were sensitized more than patients from distant places. The immunochemical characterization revealed multiple protein fractions from low to very high molecular mass (14-126 kDa) mostly in the acidic pI range. CD pollen has been recognized as a new allergen from India for the first time. The role of pollen as a causative agent of respiratory allergic disorders is very well established, as is evident from the recent increase of reports from across the world (1-4). India is blessed with the richest flora on the earth, from alpine tundra to Rajasthan desert. Consequently, it provides considerable variation in the quality and quantity of airborne pollen in different ecogeographic regions of the country (5-8). Although studies on the allergenic properties of airborne pollen from various species have been carried out by several workers in India (9-12), information on allergy to aerial pollen from Himalayan tree species has been completely

In vitro diagnosis of cypress pollen allergy by using cytofluorimetric analysis of basophils (Basotest)

BACKGROUND

Cupressaceae pollen allergy is a worldwide pollinosis, but its in vitro diagnosis is notoriously difficult. The Basotest is a newly available in vitro test for the detection of allergen-specific IgE based on the level of cellular activation of basophils by using flow cytometry.

OBJECTIVES

The Basotest was compared with the measurement of cypress pollen-specific IgE in highly selected patients.

METHODS

We analyzed 34 patients allergic to cypress pollen selected on the basis of a suggestive clinical history and positive skin test and nasal challenge responses to cypress pollen extract. We also analyzed 8 patients with positive skin test responses to cypress pollen extract who did not present symptoms during the pollen season (intermediate group) and 33 control subjects. Sensitivity, specificity, and efficiency of the Basotest and serum-specific IgE levels measured by using the CAP System were determined in patients allergic to cypress pollen. Histamine release was studied in a selected group of patients.

RESULTS

The Basotest was more sensitive (91.2%) than the CAP System (76%) for the in vitro diagnosis of cypress pollen allergy. A dose-response curve was observed in basophils obtained from patients allergic to cypress pollen. There were no false-positive results with either test (specificity 100%). The results of the Basotest or those of the CAP System did not correlate with the patients' in vivo threshold sensitivity assessed by skin tests and nasal challenge.

CONCLUSIONS

The Basotest was found to be an effective diagnostic test in patients allergic to cypress pollen.

How far can we simplify in vitro diagnostics for grass pollen allergy?: A study with 17 whole pollen extracts and purified natural and recombinant major allergens

BACKGROUND

Current diagnostics for grass pollen allergy are composed of mixtures of pollen of different grass species. Their complex composition hampers accurate standardization.

OBJECTIVE

The aim of the study was to investigate whether mixtures of grass pollen extracts can be replaced by a single pollen species and whether a single pollen species can be replaced by a limited number of purified natural or recombinant major allergens.

METHODS

Sera (n = 800) were selected on the basis of a general suspicion for inhalant allergy and tested in a RAST for IgE reactivity with pollen from 17 different grass species. Cross-reactivity of IgE responses was studied by means of RAST inhibition. Sera with positive test results for grass pollen were tested in a RAST for natural Lol p 1 and Lol p 5 and recombinant Phl p 1 and Phl p 5.

RESULTS

Specific IgE antibodies against one or more of the 17 pollen species were detected in 209 of 800 sera (26.1%). The highest responses were observed against Poa pratensis followed by Festuca rubra, Phleum pratense, and Dactylis glomerata. IgE responses were clearly lower (approximately by a factor of 5) against only three species (Phragmites communis, Cynodon dactylon, and Zea mays). With the exception of a few low-responder sera, no sera were found to have negative test results to the high responder species and positive results to any of the other species. Sera with positive test results for grass pollen (n = 154) were tested with purified Lol p 1 and Lol p 5. IgE anti-Lol p 1 and Lol p 5 accounted for an average of 81% +/- 7% of total anti-grass pollen IgE. For 14 sera (all with low anti-grass pollen IgE titers), a RAST with purified allergens resulted in a false-negative diagnosis for grass pollen allergy. With recombinant Phl p 1 and Phl p 5, the mean IgE reactivity was 57% +/- 6% of the anti-grass pollen IgE response (n = 141), with 13 false-negative results.

CONCLUSION

One grass species is sufficient for in vitro diagnosis of grass pollen allergy. With purified natural Lol p 1 and Lol p 5, greater than 90% of grass-positive sera is detected. Around 80% of the IgE response to grass pollen is directed to these major allergens. Recombinant allergens, produced in Escherichia coli, did not equal the IgE-binding capacity of their natural counterparts.

Allergenic relationship among four common and dominant airborne palm pollen grains from Eastern India

BACKGROUND

Palm pollen grains are predominant aeroallergens in the tropics including India. Evidence of allergenic crossreactivity had been reported from various parts of the world on different families, e.g. Poaceae, Asteraceae, etc. No such information is available about the palm pollen of tropical countries.

OBJECTIVES

The present study was undertaken to find out the allergenic relationship, if any, in four common and important palm pollen in India.

METHODS

A 2-year aerobiological survey was carried out at Madhyamgram situated at the suburban fringe of Calcutta Metropolis using Burkard volumetric sampler to know the seasonal variation of Areca catechu, Borassus flabellifer, Cocos nucifera and Phoenix sylvestris among others. Skin-prick tests (SPT) were performed with the relevant pollen extracts on the respiratory allergic patients. Sera from the subjects were tested directly by ELISA for estimating the allergen specific IgE. ELISA inhibitions and dot blotting were performed with pooled patients sera and four palm pollen extracts to detect the cross-reactivity.

RESULTS

Among 70 patients, Areca catechu exhibited the maximum percentage (48.5%) of positive responses followed by Cocos nucifera (45.7%), Phoenix sylvestris (42.85%) and Borassus flabellifer (38.5%). On an average, 30-50% of the patients showed positive skin reactions and enhanced specific IgE level to more than one palm pollen extract. Further evidence of allergenic crossreactivity among the four palm pollen grains were provided by dot blotting and ELISA inhibition studies. In ELISA inhibition, a distinct inhibition was obtained with comparable amounts of the pollen extracts.

CONCLUSION

The suburban aerobiological survey of Calcutta and SPT results confirmed that the relevant pollen types are significant contributors of aeroallergen load of the study area. ELISA inhibition studies with the pooled patients sera using antihuman IgE probe revealed the presence of shared allergenic components among the four palm pollen grains.

Limited genetic control of specific IgE responses to rye grass pollen allergens in Australian twins

BACKGROUND

Both genetic and environmental factors are thought to contribute to specific IgE responses, however, the relative contribution of each in the responses to individual ryegrass pollen allergens is largely unknown even though some responses to allergens have been linked to certain HLA complexes.

OBJECTIVE

Using a large group of monozygotic and dizygotic twins, this study was designed to investigate the IgE binding profiles of individual ryegrass pollen (Lolium perenne) components to assess the relative contribution of genetic and environmental factors in determining IgE responses to specific allergens.

METHODS

Ryegrass pollen proteins were separated by electrophoresis and immunoblotted with sera from 191 pairs of twins where at least one sibling had a SPT > 2 mm to perennial ryegrass. Concordance levels for individual ryegrass pollen components were compared between monozygotic and dizygotic twins in a subset group where both twins had SPT > 3 mm to perennial ryegrass.

RESULTS

Immunoblotting revealed 23 individual IgE-binding components from ryegrass pollen. Although there was a significantly greater proportion of monozygotic twins with SPT wheals greater than 3 mm when compared with the dizygotic twins, the mean case-wise concordance for the immunoblot components was similar for both groups of twins. The mean case-wise concordance when at least four pairs of sera were involved was 44% for the MZ twins (n=11 components) and 45% for the DZ twins (n=12 components). We found no significant differences in concordance levels for any of the 23 individual components including allergens previously associated with HLA.

CONCLUSION

Evidence for genetic control of allergen-specific IgE responses in a large population sample of twins to individual ryegrass allergens is limited, indicating that the IgE responses to specific ryegrass pollen allergens are determined largely by environmental factors.

Investigation of different recombinant isoforms of grass group-V allergens (timothy grass pollen) isolated by low-stringency cDNA hybridization--antibody binding capacity and allergenic activity

A cDNA library of timothy grass pollen was screened for homologous isoforms of major group-V allergens by low stringency hybridization with a Phl p 5 (Phleum pratense) probe. After restriction analysis of the 40 clones obtained, 17 were selected for cDNA sequencing. Of these clones, two were unrelated to group-V allergens, six showed high similarity but an incomplete open reading frame and nine had high similarity with a complete open reading frame. Comparison of deduced amino acids of ten complete cDNA clones confirmed the presence of two major isoforms, a and b. Within these two subgroups, only minor sequence variations were observed. Eight isoforms were expressed in Escherichia coli K12 and purified to homogeneity. Although the subgroups a and b could be distinguished by their molecular masses and by binding constants towards monoclonal antibodies, all isoforms turned out to be biochemically similar. Ribonuclease activity as a marker for the biological function of group-V allergens was shown to be in the same range for both subgroups. Analysis of allergenic B-cell responses towards the isoforms in 26 grass pollen allergic patients revealed that the IgE reactivities to the different isoforms were identical for each individual. IgE reactivities and allergenic activities of three isovariants and an allergen of a different group were compared in a selected group of four grass pollen allergic patients by immunoblot, histamine-release and skin-prick tests. The IgE reactivity does not necessarily mirror the allergenic activity of the single molecule, and the variability of allergenic activity between the isovariants does not, in every case, depend on the structural differences of these allergens. We conclude that group-V isoallergens in grass pollen, although they can be structurally different, induce a similar B-cell response but can show variable allergenic activity. Thus, the most allergenic isoform of each important group of allergens should be sufficient for the diagnosis of type-I allergy. Whether the isoallergenic variation has any significant influence on the outcome of immunotherapy in allergic disease still has to be elucidated.