1
|
Rojo Gutiérrez MI, Ballesteros González D. [Oral allergy syndrome (OAS)]. REVISTA ALERGIA MÉXICO 2023; 70:306-312. [PMID: 38506877 DOI: 10.29262/ram.v70i4.1315] [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] [Indexed: 03/21/2024] Open
Abstract
The pollen-food allergy syndrome, also known as oral allergy syndrome, is characterized by local reactions in the mouth and throat after consuming certain raw plant foods in individuals sensitized to pollen from grass, weeds, and trees. Birch-apple is the prototype of this syndrome, with apple, pear, and plum being the most commonly associated foods. Symptoms are usually limited to the oral cavity but can include systemic reactions, including anaphylaxis. Sensitization to pollen allergens, such as lipid transfer proteins, profilin, and PR-10 proteins, triggers this syndrome. Its prevalence varies by geographic region and the predominant pollen type, affecting between 30% and 60% of food allergies. Diagnosis involves a clinical history, skin tests, and, in ambiguous cases, double-blind, placebo-controlled oral food challenges. Treatment primarily involves avoiding trigger foods.
Collapse
Affiliation(s)
- María Isabel Rojo Gutiérrez
- Pediatra, Alergóloga e Inmunóloga; profesora de Alergia pediátrica, Facultad de Medicina; Presidenta electa de la Sociedad Latinoamericana de Alergia, Asma e Inmunología (SLAAI) Montevideo,
| | - Diego Ballesteros González
- Médico Cirujano y Partero, Escuela Superior de Medicina, Instituto Politécnico Nacional; Aler-gólogo e inmunólogo clínico, Hospital Juárez de México, Ciudad de México
| |
Collapse
|
2
|
Balas WM, Strzelecka J, Godyńska A, Sybilski AJ. Carrot-Induced Systemic Reaction: A Unique Presentation of Pollen-Food Allergy Syndrome in a Young Boy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1817. [PMID: 38002908 PMCID: PMC10670796 DOI: 10.3390/children10111817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
Pollen-food allergy syndrome (PFAS) is a common IgE-mediated allergic condition resulting from cross-reactions between pollen and plant food allergens, primarily those in the PR-10 subfamily. Mostly symptoms are limited to the mouth and throat causing oral allergy syndrome (OAS). Systemic reactions are extremely rare. We report an 11-year-old boy who experienced a unique anaphylactic reaction after consuming raw carrot juice. The patient exhibited symptoms within one minute, including abdominal pain, facial and eyelid swelling, dyspnea, a macular rash, choking sensation and drowsiness. Desloratadine alleviated these symptoms, and as his overall condition improved rapidly, there was no need for adrenaline administration. Carrot-specific IgE levels in the patient's serum were as follows: Dau c: 40.63 kUA/L and Dau c1: 31.5 kUA/L. He had previously been diagnosed with seasonal allergic rhinoconjunctivitis. The high degree of similarity among allergen components within the PR-10 subfamily contributed to cross-reactivity between birch pollen and carrots. It is important to remember that PFAS can manifest systemically, with symptoms ranging from mild skin itching to potentially fatal consequences. This highlights the need for healthcare professionals to be extra cautious and aware of this possibility, especially since carrots are commonly found in a wide range of dishes and snacks.
Collapse
Affiliation(s)
- Weronika M. Balas
- Department of Paediatrics and Allergology, The National Institute of Medicine of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland (A.G.); (A.J.S.)
| | - Joanna Strzelecka
- Department of Paediatrics and Allergology, The National Institute of Medicine of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland (A.G.); (A.J.S.)
| | - Aleksandra Godyńska
- Department of Paediatrics and Allergology, The National Institute of Medicine of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland (A.G.); (A.J.S.)
| | - Adam J. Sybilski
- Department of Paediatrics and Allergology, The National Institute of Medicine of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland (A.G.); (A.J.S.)
- 2nd Department of Paediatrics, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| |
Collapse
|
3
|
Chong AC, Izadi N, Chwa WJ, Tam JS. Fruitful or unfruitful: strawberry and tomato specific immunoglobulin E testing at a tertiary pediatric center. FRONTIERS IN ALLERGY 2023; 4:1277631. [PMID: 37908373 PMCID: PMC10613731 DOI: 10.3389/falgy.2023.1277631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
Background Suspected strawberry and tomato (S/T) food allergy (FA) can be evaluated using specific immunoglobulin E (sIgE) testing despite its low specificity and positive predictive value. Objective This study aims to understand ordering patterns for S/T sIgE testing and identify relevant factors to clinical decision-making. Methods We retrospectively reviewed 814 patients with sIgE testing available for strawberries (651), tomatoes (276), or both (113) from January 2012 to May 2022 at a tertiary pediatric hospital. Patient demographics, provider specialty, and reasons for testing were collected. Student's t-test and multiple regression analyses were performed to test the association between the S/T sIgE level and clinically relevant outcome (CRO) status. Fisher's exact test and general linear models were used to evaluate and compare potential predictive factors for CRO status. Results Allergy and immunology, gastroenterology, and general pediatrics ordered most S/T sIgE testing. Testing was ordered most frequently for non-IgE-mediated gastrointestinal symptoms, mild possible IgE-mediated reactions, and eczema. Testing was most often ordered for infants and school-age children. Mean sIgE levels were higher for S/T tests resulting in a CRO when controlling for other predictor variables (p = 0.015; p = 0.002 for S/T, respectively). Only 2.2% and 5.4% of tests resulted in a CRO for S/T, and severe allergy was rare. Testing for non-IgE-mediated GI symptoms or eczema, or in non-atopic patients, yielded no CROs. Exposure and reaction history of present illness (ERH) was associated with CROs (p < 0.001; p = 0.04) with a high negative predictive value (99.5%; 100%) and low positive predictive value (11.5%; 15.0%). ERH (p < 0.001, η2 = 0.073; p = 0.009, η2 = 0.123) was a more significant predictor than the sIgE level (p = 0.002, η2 = 0.037; p = 0.212, η2 = 0.030) for CRO status. Conclusion The diagnosis of S/T food allergy is made primarily based on clinical history. S/T sIgE testing for children and adolescents should be avoided for patients without an ERH and in the workup of non-IgE-mediated GI symptoms. Testing for eczema and non-atopic patients is likely low-yield.
Collapse
Affiliation(s)
- Albert C. Chong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Neema Izadi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Clinical Immunology and Allergy, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Won Jong Chwa
- Saint Louis University School of Medicine, Saint Louis University, Saint Louis, MO, United States
| | - Jonathan S. Tam
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Clinical Immunology and Allergy, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
4
|
Suriyamoorthy P, Madhuri A, Tangirala S, Michael KR, Sivanandham V, Rawson A, Anandharaj A. Comprehensive Review on Banana Fruit Allergy: Pathogenesis, Diagnosis, Management, and Potential Modification of Allergens through Food Processing. PLANT FOODS FOR HUMAN NUTRITION (DORDRECHT, NETHERLANDS) 2022; 77:159-171. [PMID: 35661960 DOI: 10.1007/s11130-022-00976-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
The pulp of the banana fruit is rich in bioactive compounds like dietary fibers, low glycemic carbohydrates, natural sugars, vitamins, minerals and antioxidants. These beneficial compounds are responsible for the proper functioning of immune system and enhance prevention against various deadly diseases like cancer, diabetes and heart diseases. Despite having, positive effects, the fruit are recognized as an important source for causing allergy to 0.6% of people in general population and up to 67 and 46% for people with asthma or atopic dermatitis. Fruit allergy is one of the most common food allergies witnessed worldwide. Banana fruit allergy results from the abnormal immune response to the banana proteins soon after its consumption. Symptoms range from oral allergy syndrome (OAS) to the life-threatening anaphylaxis. IgE reactivity of banana is associated with different proteins of which six proteins have been identified as major allergens, viz., Mus a1 (Profilin-actin binding protein), Mus a 2 (Class 1 chitinase), Mus a 3 (Nonspecific lipid transfer protein), Mus a 4 (Thaumatin like protein), Mus a 5 (Beta 1,3 glucanase) and Mus a 6 (Ascorbate peroxidase). This review focuses on pathogenesis, clinical features, diagnosis, and different food processing methods to mitigate the allergenicity of banana fruit.
Collapse
Affiliation(s)
- Priyanga Suriyamoorthy
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Alluru Madhuri
- Academics and Human Resources Department, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Srikanth Tangirala
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
- Centre of Excellence in Non-Thermal Processing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Karunai Raj Michael
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Vignesh Sivanandham
- Academics and Human Resources Department, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India
| | - Ashish Rawson
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India.
- Centre of Excellence in Non-Thermal Processing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India.
| | - Arunkumar Anandharaj
- Department of Food Safety and Quality Testing, National Institute of Food Technology, Entrepreneurship and Management (NIFTEM), Thanjavur, Tamil Nadu, 613005, India.
| |
Collapse
|
5
|
Elghoudi A, Narchi H. Food allergy in children—the current status and the way forward. World J Clin Pediatr 2022; 11:253-269. [PMID: 35663006 PMCID: PMC9134150 DOI: 10.5409/wjcp.v11.i3.253] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/16/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Food allergy in children is a major health concern, and its prevalence is rising. It is often over-diagnosed by parents, resulting occasionally in unnecessary exclusion of some important food. It also causes stress, anxiety, and even depression in parents and affects the family’s quality of life. Current diagnostic tests are useful when interpreted in the context of the clinical history, although cross-sensitivity and inability to predict the severity of the allergic reactions remain major limitations. Although the oral food challenge is the current gold standard for making the diagnosis, it is only available to a small number of patients because of its requirement in time and medical personnel. New diagnostic methods have recently emerged, such as the Component Resolved Diagnostics and the Basophil Activation Test, but their use is still limited, and the latter lacks standardisation. Currently, there is no definite treatment available to induce life-long natural tolerance and cure for food allergy. Presently available treatments only aim to decrease the occurrence of anaphylaxis by enabling the child to tolerate small amounts of the offending food, usually taken by accident. New evidence supports the early introduction of the allergenic food to infants to decrease the incidence of food allergy. If standardised and widely implemented, this may result in decreasing the prevalence of food allergy.
Collapse
Affiliation(s)
- Ahmed Elghoudi
- Paediatric Department, Sheikh Khalifa Medical City, Abu Dhabi NA, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, Abu Dhabi, United Arab Emirates
| | - Hassib Narchi
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, Abu Dhabi, United Arab Emirates
| |
Collapse
|
6
|
Identification of Allergens in White- and Red-Fleshed Pitaya (Selenicereus undatus and Selenicereus costaricensis) Seeds Using Bottom-Up Proteomics Coupled with Immunoinformatics. Nutrients 2022; 14:nu14091962. [PMID: 35565931 PMCID: PMC9134757 DOI: 10.3390/nu14091962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023] Open
Abstract
White-fleshed pitaya (Selenicereus undatus) and red-fleshed pitaya (Selenicereus costaricensis) are becoming increasingly popular because of their nutritional and medicinal benefits. However, in addition to their beneficial properties, allergy to pitaya fruits has occurred in daily life. In this study, we investigated the protein profile of pitaya fruit seeds and focused on the most reactive proteins against immunoglobulin E (IgE) in sera from allergic patients by immunoblotting. A protein band of approximately 20 kDa displayed a clear reaction with the serum IgE. The protein bands of interest were excised, in-gel digested, and analyzed using liquid chromatography–tandem mass spectrometry (LC–MS/MS), followed by data searching against a restricted database (Caryophyllales in UniProtKB) for protein identification. Immunoinformatic tools were used to predict protein allergenicity. The potential allergens included cupin_1 and heat shock protein 70 (HSP70) in white-fleshed pitaya seeds, and cupin_1, heat shock protein 70, and heat shock protein sti1-like in red-fleshed pitaya seeds are potential allergens. The expression of potential allergens was further verified at the transcriptional level in the species of S. undatus and S. costaricensis.
Collapse
|
7
|
Kim JH. Insights into pediatric pollen food allergy syndrome. Clin Exp Pediatr 2020; 63:483-484. [PMID: 32475107 PMCID: PMC7738767 DOI: 10.3345/cep.2019.01179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/21/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jeong Hee Kim
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| |
Collapse
|