Sunflower seed allergy

Food-Pollen Cross-Reactivity and its Molecular Diagnosis in China

PURPOSE OF REVIEW

Plant-derived foods are one of the most common causative sources of food allergy in China, with a significant relationship to pollinosis. This review aims to provide a comprehensive overview of this food-pollen allergy syndrome and its molecular allergen diagnosis to better understand the cross-reactive basis.

RECENT FINDINGS

Food-pollen cross-reactivity has been mainly reported in Northern China, Artemisia pollen is the major related inhalant source, followed by tree pollen (Betula), while grass pollen plays a minor role. Pollen allergy is relatively low in Southern China, with allergies to grass pollen being more important than weed and tree pollens. Rosaceae fruits and legume seeds stand out as major related allergenic foods. Non-specific lipid transfer protein (nsLTP) has been found to be the most clinically relevant cross-reacting allergenic component, able to induce severe reactions. PR-10, profilin, defensin, chitinase, and gibberellin-regulated proteins are other important cross-reactive allergen molecules. Artemisia pollen can induce allergenic cross-reactions with a wide range of plant-derived foods in China, and spring tree pollens (Betula) are also important. nsLTP found in both pollen and plant-derived food is considered the most significant allergen in food pollen cross-reactivity. Component-resolved diagnosis with potential allergenic proteins is recommended to improve diagnostic accuracy and predict the potential risk of causing allergic symptoms.

New light on an old syndrome: Role of Api g 7 in mugwort pollen-related celery allergy

BACKGROUND

Celery root is known to cause severe allergic reactions in patients sensitized to mugwort pollen.

OBJECTIVE

We studied clinically well-characterized patients with celery allergy by IgE testing with a comprehensive panel of celery allergens to disentangle the molecular basis of what is known as the celery-mugwort syndrome.

METHODS

Patients with suspected food allergy to celery underwent a standardized interview. Main inclusion criteria were a positive food challenge with celery or an unambiguous case history of severe anaphylaxis. IgE to celery allergens (rApi g 1.01, rApi g 1.02, rApi g 2, rApi g 4, nApi g 5, rApi g 6, rApi g 7) and to mugwort allergens (rArt v 1, rArt v 3, rArt v 4) were determined. IgE levels ≥0.35 kUA/L were regarded positive.

RESULTS

Seventy-nine patients with allergy to celery were included. Thirty patients had mild oral or rhinoconjunctival symptoms, and 49 had systemic reactions. Sixty-eight percent had IgE to celery extract, 80% to birch pollen, and 77% to mugwort pollen. A combination of Api g 1.01, 1.02, 4, 5, and 7 increased the diagnostic sensitivity for celery allergy to 92%. The lipid transfer proteins Api g 2 and Api g 6 were not relevant in our celery-allergic population. IgE to Api g 7, detected in 52% of patients, correlated closely (r = 0.86) to Art v 1 from mugwort pollen. Eleven of 12 patients with monosensitization to Api g 7 were IgE negative to celery extract. The odds ratio for developing a severe anaphylactic reaction rather than only mild oral symptoms was about 6 times greater (odds ratio, 5.87; 95% confidence interval, 1.08-32.0; P = .0410) for Api g 7-sensitized versus -nonsensitized subjects.

CONCLUSION

There is an urgent need for routine diagnostic tests to assess sensitization to Api g 7, not only to increase test sensitivity but also to identify patients at risk of a severe allergic reaction to celery.

Characterization and Incidence of Sunflower Seed Allergy in a Pediatric Allergy Clinic

BACKGROUND

Sunflower seeds are a popular allergen-free peanut alternative.

OBJECTIVE

To describe sunflower seed allergy incidence and characteristics.

METHODS

We conducted a retrospective cohort study of patients with sunflower seed allergy from 1995 to 2021 in a pediatric allergy clinic. We described demographic characteristics, testing results, atopic comorbidities, and reaction histories of patients with sunflower seed allergy and calculated the annual cumulative incidence of the allergy. Logistic regression was used to estimate the increase in odds of sunflower seed allergy diagnosis for each year from 1995 to 2021.

RESULTS

From 1995 to 2021, we identified 235 patients with sunflower seed allergy. Among patients with sunflower seed allergy, the median age at diagnosis was 3.9 years. More than three-quarters of patients had another atopic condition. Half of the reactions consisted of mild urticaria or rash, and a quarter met criteria for anaphylaxis. The cumulative incidence ranged from 0% (1995-1999, 2001-2004, and 2006) to 0.38% (2021). From 1995 to 2021, the odds of sunflower seed allergy diagnosis increased annually by 21% (odds ratio, 1.21; 95% CI, 1.17-1.25).

CONCLUSIONS

In our single-center cohort of children with sunflower seed allergy, most children were diagnosed in early childhood, had high rates of comorbid atopic conditions, and had high rates of cutaneous reactions to sunflower seed products. Moreover, in our cohort, incidence of sunflower seed allergy increased.

The use of inhibition assay in Api g 7 suspected allergy in a female patient with anaphylaxis: A case report

The symptoms of celery allergy are mainly presented as oral allergy symptom, but there are several case reports of patients who experienced anaphylaxis. Defensin (Api g 7), as a novel allergen in celery root, was described in 2022 r. The female patient had a history of several episodes of dyspnea and cough, associated with ingestion of spice mixes containing dried celery. Up to the point of hospitalization, there were no objective tests, either sIgE or skin prick tests, that would confirm celery sensitization. During hospitalization, patient had a positive double-blind placebo-controlled food challenge with cooked celery. The patient was sensitized to mugwort defensin Art v 1. An inhibition assay with celery allergen extract was performed to prove cross-sensitization between Art v 1 and celery allergen responsible for symptoms in the patient. In conclusion, Api g 7 is an important celery allergen that can be responsible for severe reactions. Its cross-reactivity with Art v 1 is characteristic. Negative diagnostic tests with celery do not exclude Api g 7 sensitization.

The Role of Defensins as Pollen and Food Allergens

PURPOSE OF REVIEW

Defensin-polyproline-linked proteins are relevant allergens in Asteraceae pollen. Depending on their prevalence and amount in the pollen source, they are potent allergens, as shown for the major mugwort pollen allergen Art v 1. Only a few allergenic defensins have been identified in plant foods, such as peanut and celery. This review provides an overview of structural and immunological features, IgE cross-reactivity, and diagnostic and therapeutic options regarding allergenic defensins.

RECENT FINDINGS

We present and critically review the allergenic relevance of pollen and food defensins. The recently identified Api g 7 from celeriac and other allergens potentially involved in Artemisia pollen-related food allergies are discussed and related to clinical severity and allergen stability. To specify Artemisia pollen-related food allergies, we propose the term "defensin-related food allergies" to account for defensin-polyproline-linked protein-associated food syndromes. There is increasing evidence that defensins are the causative molecules in several mugwort pollen-associated food allergies. A small number of studies have shown IgE cross-reactivity of Art v 1 with celeriac, horse chestnut, mango, and sunflower seed defensins, while the underlying allergenic molecule remains unknown in other mugwort pollen-associated food allergies. As these food allergies can cause severe allergic reactions, identification of allergenic food defensins and further clinical studies with larger patient cohorts are required. This will allow molecule-based allergy diagnosis and a better understanding of defensin-related food allergies to raise awareness of potentially severe food allergies due to primary sensitization to Artemisia pollen.

Clinical Use of the ImmunoCAP Inhibition Test in the Diagnosis of Meat Allergy Caused by a Tick Bite in an Adult Male with No Previous Atopic History

(1) Background: alpha-gal syndrome (AGS) is a serious, potentially life-threatening allergic reaction. This is a type of food allergy to red meat and other mammalian products (e.g., gelatin). In Poland, this problem seems to be rare or, more likely, very underdiagnosed. The diagnosis of AGS is difficult. It seems that the knowledge about this syndrome is insufficient. There are no effective diagnostic tools able to clearly diagnose this cross-reactive allergy. This paper presents the clinical application of a non-standard method in the diagnosis of a cross-reactive allergy using the example of AGS. (2) Methods: standard tests for in vitro allergy diagnostics and the non-standard ImmunoCAP inhibition test(IT) were carried out for serum collected from a patient with a red meat allergy. (3) Results: the serum concentration of anti-α-Gal IgE was very high (302 kUA/L), and IgE antibodies toanti-mammalian-meat allergens were found. The level of IgE antibodies to mammalian meat allergens decreased after blocking on α-GAL-CAP. The concentration of anti-α-Gal IgE decreased after blocking on CAPs coated with various mammalian meat allergens. Blocking with allergens of poultry meat did not affect the concentration of anti-α-Gal IgE. (4) Conclusions: the ImmunoCAP ITseems to be a useful tool in the diagnosis of cross-reactive allergies. Based on their clinical history and test results, the patient was diagnosed with AGS caused by a primary sensitization to α-Gal after a tick bite. This is the second case of AGS described in Poland and the first in Pomerania.

The Two-Sided Experimental Model of ImmunoCAP Inhibition Test as a Useful Tool for the Examination of Allergens Cross-Reactivity on the Example of α-Gal and Mammalian Meat Sensitization-A Preliminary Study

Cross-reactivity of allergens is the cause of various, sometimes unexpected, clinical reactions. There are no standard methods to investigate cross-reactivity. We present an experimental model of a two-sided inhibition test (IT) on ImmunoCAP membranes (CAP). We constructed the described model based on the known cross-allergy syndrome to red meat developing in people bitten by ticks (α-Gal syndrome; AGS). Some individuals who are bitten by ticks develop IgE antibodies specific to the carbohydrate determinant, galactose-α-1,3-galactose (α-Gal), present in the tick's saliva. These antibodies can cross-react with α-Gal molecules expressed on mammalian meat proteins. The well-known property of anti-α-Gal IgE antibodies binding by various sources of this allergen was used by us in the proposed model of the two-sided inhibition test on ImmunoCAP membranes. We expected that anti-α-Gal IgE antibodies bind allergens from mammalian meat and blocking them abolishes this reactivity, and the two-sided inhibition test model we proposed on ImmunoCAP membranes allowed us to observe such a relationship. We conducted the experiment three times on biological material from people with different clinical manifestations of allergy to α-Gal, each time obtaining similar results. In conclusion, the model of bilateral inhibition on ImmunoCAP membranes proposed by us seems to be an attractive, simple tool for direct testing of allergic cross-reactivity.

Feasibility of the ALEX multiplex platform in the diagnosis of nut allergy from a Mediterranean population

BACKGROUND

ALEX multiplex platform has been recently commercialized but its clinical utility as quantitative technique respect to ImmunoCAP-singleplex as the reference method has not yet been confirmed on patients suffering from nut allergy and co-sensitization to different nuts.

METHODS

58 serum samples from patients with nut allergy from a Mediterranean population were assayed in parallel by ALEX-multiplex and ImmunoCAP-singleplex techniques. Patients were diagnosed based on clinical symptoms and positive skin prick tests (SPTs). The following whole extracts were compared between both techniques: walnut, hazelnut, peanut, almond, pistachio and sunflower seed; besides the recombinant Pru p 3. A qualitative and quantitative study was carried out.

RESULTS

Both techniques had similar sensitivities respect to whole extracts from walnut, hazelnut and peanut as well as to Pru p 3 (p > 0.05). However for whole extracts from almond, pistachio and sunflower seed the sensitivity obtained by ALEX was much lower than ImmunoCAP (9.09 % vs 88.63 %; 14.81 vs 70.37 %; and 8.51 % vs 88.88 %; respectively). The concordance between both techniques showed only a substantial agreement for Pru p 3 (k = 0.791); moderate agreement for hazelnut and peanut (k = 0.550 and k = 0.544, respectively); fair agreement for walnut (k = 0.386) and poor agreement for almond, pistachio and sunflower seed (k < 0.2). Quantitative analysis showed that ImmunoCAP for walnut, peanut and sunflower seed had higher mean values than ALEX. Relationships were significant for all specific IgE levels except to for almond, pistachio and sunflower seed.

CONCLUSIONS

ALEX platform is a suitable technique to patients with nut allergy from the Mediterranean area except to for those suffering from allergy to almond, pistachio and sunflower seed.

Experimental Research Models to Assess the Cross-Reactivity between Can f 5 and Human PSA—Two Different Perspectives

The similarity in antigenic structures, including the degree of correspondence between the amino acid sequence and the spatial structure, is not always reflected in the actual cross-reactivity of allergens. Inhibition tests appear to be an invaluable tool for assessing potential cross-reactivity between allergens under natural conditions. In this publication, we present two experimental models of inhibition tests: solid phase (SP-IT) and liquid phase (LP-IT). As an exemplary research model, we used the cross-reactivity between human PSA and anti-Can f 5 IgE antibodies. We performed an SP-IT model using a microplate coated with human PSA. The LP-IT model was based on mixing anti-Can f 5 IgE positive serum with a material containing human PSA. Anti-Can f 5 IgE and PSA concentrations before and after inhibition were measured to evaluate inhibition effectiveness. The results of the performed experiments showed that both proposed models of inhibition tests are an effective tools for studying cross-reactive relationships between antigens. In the SP-IT, the concentration of anti-Can f 5 decreased by 21.6% and, in the LP-IT, it decreased by 34.51%. In turn, the PSA concentration in the SP-IT decreased by 11.25% and, in the LP-IT, it decreased by 15.49%. In conclusion, both the SP-IT and the LP-IT seem to be effective tools for assessing the actual cross-reactivity between different allergens.

A practical focus on sesame allergy and a brief review of other seed allergies

Although seed allergies are relatively rare, sesame allergy has been increasing worldwide and is typically persistent in most patients. Because allergen labeling laws, until just recently, have not required the declaration of sesame as a major allergen, there is a clear need to better understand and potentially treat this food allergy. Although blood and skin prick testing for sesame have limited predictive value, this improves with the use of component diagnostics and skin-prick test with fresh sesame. A thorough history and oral food challenge should be used to diagnose sesame allergy. Treatment of sesame allergy with oral immunotherapy has been demonstrated to be safe and effective in case reports, and in at least one controlled study with a published sesame oral immunotherapy protocol. There is minimum literature with regard to management of other seed allergies.

The realm of plant proteins with focus on their application in developing new bakery products

Plant proteins are spreading due to growing environmental, health and ethical concerns related to animal proteins. Proteins deriving from cereals, oilseeds, and pulses are witnessing a sharp growth showing a wide spectrum of applications from meat and fish analogues to infant formulations. Bakery products are one of the biggest markets of alternative protein applications for functional and nutritional motives. Fortifying bakery products with proteins can secure a better amino-acids profile and a higher protein intake. Conventional plant proteins (i.e., wheat and soy) dominate the bakery industry, but emerging sources (i.e., pea, chickpea, and faba) are also gaining traction. Each protein brings specific functional properties and nutritional value. Therefore, this chapter gives an overview of the main features of plant proteins and discusses their impact on the quality of bakery products.

Oilseed Cakes in the Food Industry; A Review on Applications, Challenges, and Future Perspectives

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By-products from the food sector now have a wide range of applications. Low-cost raw materials, followed by low-cost goods, are regarded as one of the sectors’ top goals. Because of its economic relevance, reduced price, and nutrients such as protein, fiber, carbs, and antioxidants, oilseed cakes (OCs) have found a desirable place in livestock and poultry feed. Furthermore, because the cake has the same desirable nutrients, its usage in the food business is unavoidable. However, its use in this sector is not simply for nutritious purposes and has it has different impacts on flavor, texture, color, and antioxidant qualities. Therefore, as a result of its desirable qualities, the cake can be more useful in extensive applications in the food business, as well as in the manufacture of supplements and novel foods. The current review looks at the reapplications of byproducts obtained from oilseeds (soybean, sunflower, sesame, canola, palm kernel, peanut, mustard, and almond) in the food sector in the future. Furthermore, allergenicity, toxicity, antinutritional compounds, and techniques of extracting cakes from oilseeds have been discussed.

Sensitization Potency of Sunflower Seed Protein in a Mouse Model: Identification of 2S-Albumins More Allergenic Than SFA-8

SCOPE

Food allergy to sunflower seed (SFS) protein is not frequent and only non-specific lipid transfert protein (nsLTP) Hel a 3 is officially recognized as a food allergen. Out of the eleven seed storage 2S-albumins (SESA) detected in SFS, only SFA-8 allergenicity has been investigated so far. The study aimed then to evaluate SFS protein allergenicity and particularly, to compare the sensitization potency of SESA in a mouse model.

METHODS AND RESULTS

The most abundant SESA and nsLTP were isolated from SFS through a combination of chromatographic methods. Purified proteins were then used to measure specific IgG1 and IgE responses in BALB/c mice orally sensitized to different SFS protein isolates. The study, thus, confirmed the allergenicity of SFA-8 and Hel a 3 but mice were also highly sensitized to other SESA such as SESA2-1 or SESA20-2. Furthermore, competitive inhibition of IgE-binding revealed that SFA-8 IgE-reactivity was due to cross-reactivity with other SESA. 11S-globulins were weakly immunogenic and were rapidly degraded in an in vitro model of gastroduodenal digestion. In contrast, Hel a 3, SESA2-1 and SFA-8 were more resistant to proteolysis and gastroduodenal digestion did not affect their IgE-reactivity.

CONCLUSIONS

SESA2-1 or SESA20-2 were more potent allergens than SFA-8 in this mouse model. Allergenicity of SESA must be now confirmed in SFS-allergic patients.

Analysis of allergen profile in patients sensitized to canine allergen and potential Can f 5 cross-reactivity with human PSA

Can f 5 allergy and possible cross-reactivity with human semen in which there are significant amounts of prostate-specific antigen (PSA) are particularly interesting aspects of allergy to dog. The objective of the study was to confirm cross-reactivity between human PSA and Can f 5 in a study of canine sensitised women. A total of 100 women (aged 18-73, 41 on average) with a positive history of animal fur allergy or positive skin prick tests to canine allergens were selected. Levels of Immunoglobulin E (IgE) specific to Can f 1, Can f 2, Can f 3, Can f 5 were determined. Patients with increased concentration of sIgE Can f 5 were selected for further inhibition testing using polystyrene microplate ELISA test coated with human PSA. In the studied population, allergy to Can f 5 dominated (52.3% of patients with increased concentration of canine-specific IgE were allergic to this allergenic component). In all analyzed cases, the concentration of IgE Can f 5 decreased after incubation on the ELISA plate coated with human PSA. The minimum decrease in concentration was 10.44%, the maximum was 37.73%, the average decrease was 21.6%. No statistically significant influence of the presence or absence of allergenic sIgE Can f 5 in blood serum on the occurrence of symptoms after intercourse was found. The study confirmed the moderate ability of Can f 5 to cross-react with human PSA sIgE, which may be clinically significant in some women. At the same time, symptoms of an allergy to male semen do not constitute a typical clinical presentation of allergy to Can f 5.

Allergenicity of Fermented Foods: Emphasis on Seeds Protein-Based Products

Food allergy is an IgE-mediated abnormal response to otherwise harmless food proteins, affecting between 5% and 10% of the world preschool children population and 1% to 5% adults. Several physical, chemical, and biotechnological approaches have been used to reduce the allergenicity of food allergens. Fermentation processes that contribute to technological and desirable changes in taste, flavor, digestibility, and texture of food products constitute one of these approaches. Lactic acid bacteria (LAB), used as starter cultures in dairy products, are a subject of increasing interest in fermentation of plant proteins. However, the studies designed to assess the impact of LAB on reduction of allergenicity of seed proteins are at an early stage. This review presents the current knowledge on food fermentation, with a focus on seed proteins that are increasingly used as ingredients, and its impacts on food potential allergenicity.

Anaphylactic reaction in patient allergic to mango

Background

An allergy to mango is extremely rare. The antigenic composition of the fruit is not fully known. Profilin from mango has a structure similar to birch tree profiling: it is responsible for cross-reactions between mango and pear, apple, and peach. A panallergen with a structure similar to mugwort defensin (Art v 1) which cross-reacts with celery, carrot, peanuts, pepper, aniseed, and caraway has been previously described.

Case study

A female patient, 30 years old, was admitted in February 2017 because of recurrent allergic reactions following consumption of various foods. The most severe allergic reaction in the patient’s life occurred after eating a mango fruit. Within several minutes the patient developed a generalised urticaria, followed by facial oedema, strong stomach pain and watery diarrhoea. The diagnostics involved skin tests with a set of inhalatory and food allergens, including native skin tests. The patient also experienced symptoms of recurrent, generalized urticaria in connection with consumption of various types of food, especially complex dishes containing many different ingredients. Additionally, an interview revealed that the patient was experiencing symptoms of the oral allergy syndrome after ingesting various fruit and vegetables, especially during late summer and fall. Diagnostics was extended by determining the levels of IgE specific for allergen components, using the ImmunoCap ISAC method. In order to confirm the occurence of a cross-reaction between mugwort and mango allergens, we performed the inhibition test of IgE specific for mugwort using a mango allergen extract and ImmunoCap matrix.

Results

Skin prick tests (SPT) were positive for allergens of grass 7 mm; weeds 8 mm; cat’s fur 5 mm; mugwort 6 mm. SPT were also positive for mango. The level of specific IgE was increased for allergens of mugwort, grass, celery, pepper, carrot, mango, banana, peach, and apple. The ImmunoCap ISAC test demonstrated a high level of specific IgE rPhl p 1 (timothy grass) and Art v 1 (mugwort). We also performed the IgE inhibition test using both mango extract and ImmunoCap matrix and confirmed a cross-reaction with Art v 1 in the pathogenesis of symptoms observed in the patient.

Conclusions

An anaphylactic reaction to consumed mango, resulting from cross-allergy with mugwort Art v 1 was diagnosed in the patient. Acute urticarial in this case is a manifestation of IgE-mediated food allergy. During in vitro diagnostic procedures we found an elevated concentration of IgE specific to several food allergens (including celery, peppers, carrot, banana, peach, apple, shrimp). The elimination diet removing allergens the patient was allergic to was recommended. Considering the anaphylactic reaction the patient was instructed to carry a rescue set composed of an adrenaline autosyringe, steroids, and antihistamines.