Foods, Drugs and Environmental Factors: Novel Kounis Syndrome Offenders

Kounis syndrome is hypersensitivity coronary disorder induced by various types of environmental exposures, drugs, conditions and stents. Allergic, hypersensitivity, anaphylactic and anaphylactoid reactions are associated with this syndrome. The disorder manifests as coronary spasms, acute myocardial infarction and stent thrombosis and affects the cerebral and mesenteric as well as coronary arteries. Importantly, its manifestations are broad and its etiology is continuously increasing. Recently, a variety of unusual etiologies have been reported including Anisakis simplex, scombroid syndrome, the use of Gelofusin or ultrasound contrast agents, kiwifruit, fly bites, and bee stings. Furthermore, losartan and the paradox of corticosteroid allergy have been implicated as possible causes. Although not rare, Kounis syndrome is infrequently diagnosed. Therefore, awareness of its etiology, manifestations and pathophysiology is important for providing the proper diagnosis and treatment and determining prognosis.

Allergy to kiwi: is component-resolved diagnosis in routine clinical practice really impossible?

BACKGROUND

Kiwi allergy is frequent and can be the result of sensitization to a number of allergens showing different physicochemical characteristics. Component-resolved diagnosis of kiwi allergy is still unavailable in routine clinical practice.

OBJECTIVE

To investigate whether component resolved-diagnosis of kiwi allergy can be, at least in part, carried out by a proper combination of routinely available diagnostic tools.

METHODS

63 adults with plant food allergy were studied 36 were kiwi-allergic while 27 were kiwi-tolerant and served as controls. Patients and controls underwent SPT with commercial peach and kiwi extracts, and with aprofilin-enriched date palm pollen extract (all by ALK-Abellò), and the measurement of IgE to birch, kiwi, and natural rubber latex.

RESULTS

The in-vitro test showed poor sensitivity and specificity, as it scored positive in about 50% of patients and controls irrespective of clinical allergy to kiwi. The kiwi SPT showed overall poor sensitivity; however, it scored negative in all subjects with pollen food-allergy syndrome, was weakly positive in some lipid transfer protein-hypersensitive/kiwi tolerant subjects and in one latex-sensitized subject, and strongly positive in all subjects with primary kiwi sensitization.

CONCLUSION

SPT with this commercial kiwi extract sensitively and specifically detects patients reacting to specific kiwi allergens. This can be useful to detect patients that are at risk of potentially severe reactions, particularly in case of co-sensitization to labile allergens, while we wait that the whole spectrum of kiwi allergens becomes available for routine in-vitro testing.

Kiwifruit Act d 11 is the first member of the ripening-related protein family identified as an allergen

BACKGROUND

Kiwifruit is an important cause of food allergy. A high amount of a protein with a molecular mass compatible with that of Bet v 1 was observed in the kiwifruit extract.

OBJECTIVE

To identify and characterize kirola, the 17-kDa protein of green kiwifruit (Act d 11).

METHODS

Act d 11 was purified from green kiwifruit. Its primary structure was obtained by direct protein sequencing. The IgE binding was investigated by skin testing, immunoblotting, inhibition tests, and detection by the ISAC microarray in an Italian cohort and in selected Bet v 1-sensitized Austrian patients. A clinical evaluation of kiwi allergy was carried out.

RESULTS

Act d 11 was identified as a member of the major latex protein/ripening-related protein (MLP/RRP) family. IgE binding to Act d 11 was shown by all the applied testing. Patients tested positive for Act d 11 and reporting symptoms on kiwifruit exposure were found within the Bet v 1-positive subset rather than within the population selected for highly reliable history of allergic reactions to kiwifruit. Epidemiology of Act d 11 IgE reactivity was documented in the two cohorts. IgE co-recognition of Act d 11 within the Bet v 1-like molecules is documented using the microarray IgE inhibition assay.

CONCLUSIONS

Act d 11 is the first member of the MLP/RRP protein family to be described as an allergen. It displays IgE co-recognition with allergens belonging to the PR-10 family, including Bet v 1.

Radionuclide concentration in tea, cabbage, orange, kiwi and soil and lifetime cancer risk due to gamma radioactivity in Rize, Turkey

BACKGROUND

In this study, the activity concentrations of (232) Th, (238) U, (40) K and (137) Cs were measured in tea, cabbage, orange, kiwi and soil samples collected from different stations using gamma spectrometry with a high-purity germanium detector.

RESULTS

The average activity concentrations of (232) Th, (238) U, (40) K and (137) Cs were found to be 8.2 ± 1.8, 17.3 ± 3.3, 465.8 ± 11.8 and 20.9 ± 3.8 Bq kg(-1) in food samples, and 72.4 ± 9.8, 51.1 ± 8.3, 229.3 ± 14.7 and 312.9 ± 11.5 Bq kg(-1) in farm soils, respectively. The internal effective dose to individuals and excess lifetime cancer risk from the consumption of the food type radioactivity ranged between 11.7 and 53.6 µSv y(-1) and between 0.05 × 10(-3) and 0.24 × 10(-3) , respectively. The annual external gamma effective dose and excess lifetime cancer risk in the farms due to soil radioactivity ranged between 94.1 and 139.8 µSv y(-1) and between 0.43 × 10(-3) and 0.64 × 10(-3) , respectively. The mean transfer factors of (232) Th, (238) U, (40) K and (137) Cs, from the soil to vegetables and fruit were 0.57, 0.32, 2.12 and 0.04, respectively.

CONCLUSION

Annual effective gamma doses were found to be higher than the world's average in soil samples. The excess lifetime cancer risks were only found higher than the world's average in soil samples.

Evaluation of IgE binding to proteins of hardy (Actinidia arguta), gold (Actinidia chinensis) and green (Actinidia deliciosa) kiwifruits and processed hardy kiwifruit concentrate, using sera of individuals with food allergies to green kiwifruit

BACKGROUND

Allergy to green kiwifruit has become common since the fruit was introduced in North America and Europe 30 years ago. Gold kiwifruit, more recently introduced commercially, has been shown to bind IgE from some individuals allergic to green kiwifruit. Hardy kiwifruit is a third species that is now cultivated in North America with potential application as a fresh fruit and in processed foods.

OBJECTIVE

To compare the IgE binding properties of proteins in hardy kiwifruit extract and processed hardy kiwifruit concentrate to each other and to extracts of green and gold kiwifruits to evaluate the potential for allergic cross-reactions.

METHODS

Sera from kiwifruit-allergic subjects and individuals without allergies to kiwifruit were assayed for IgE binding to soluble proteins in green, gold and hardy kiwifruits and heat-processed concentrate from hardy kiwifruit using immunoblots and direct enzyme-linked immunosorbent assay (ELISA).

RESULTS

Marked IgE binding to specific hardy kiwifruit proteins was identified. However, IgE binding to heat-processed hardy kiwifruit concentrate was remarkably lower than to the raw fruit extract.

CONCLUSIONS

These results suggest that some kiwifruit-allergic individuals may suffer allergic cross-reactions if they consume raw hardy kiwifruit. However, heat processing of the hardy kiwifruit alters allergenic protein structure, dramatically reducing in vitro IgE binding. Processing likely reduces the risk of eliciting an allergic response in those with allergies to raw kiwifruit.

Comparison of the allergenicity of Actinidia deliciosa (kiwi fruit) and Actinidia chinensis (gold kiwi)

Actinidia chinensis (gold kiwi) is a newly available fruit which has been shown to have in vitro immunoglobulin E (IgE) cross-reactivity with green kiwi. This is the first study to investigate clinical reactivity of gold kiwi. Five patients clinically allergic to green kiwi were investigated by skin test and double-blind placebo controlled food challenge (DBPCFC) with gold kiwi fruit. IgE-binding patterns of individual sera from the five challenged patients and a pool of sera from a further nine patients with kiwi allergy were compared in the two fruits by Western blotting. Cross reactivity of proteins in the two fruits was assessed by inhibition of immunoblots and by IgE enzyme-linked immunosorbent assay (ELISA) inhibition. Four of the five patients had a positive DBPCFC to gold kiwi. Western blotting showed marked differences in the allergen patterns of green and gold kiwi. However, inhibition of the immunoblots and ELISA assay reveals extensive inhibition of IgE binding to proteins in each fruit by the alternative species. Gold kiwi fruit is allergenic and patients allergic to green kiwi are at risk of reacting to the gold kiwi fruit. Despite having different protein profiles and IgE-binding patterns, the two species have proteins that extensively cross-inhibit the binding to IgE.

Tolerance of heat-treated kiwi by children with kiwifruit allergy

Kiwifruit allergy is increasing among children but whether heating affects clinical tolerance to kiwifruit is unknown. To assess tolerance to heated kiwifruit in children allergic to fresh kiwifruit. In this prospective trial, 20 children (median age 9.4 yr) with a history of immediate allergic reactions to fresh kiwifruit underwent double-blind placebo-controlled food challenges with steam-cooked (100 degrees C for 5') and industrially homogenised kiwifruit. Skin prick tests with a commercial kiwifruit allergen, raw kiwifruit and double-blind placebo-controlled food challenge with 25 g of fresh kiwifruit were used to confirm the history. Specific kiwifruit IgE to native and homogenized fruit were identified by immunoblotting. Fresh kiwifruit induced positive skin prick wheals in all children (confirmed during challenge in 19 patients). Commercial skin prick test elicited a positive response in five children, steam-cooked kiwifruit in five, and the homogenised kiwifruit preparation in none. UniCAP determinations were positive for kiwifruit in three patients. All children's sera showed specific IgE at immunoblotting with raw kiwifruit and one with the homogenised preparation (major allergens identified: Act c 1 and Act c 2). There was no clinical reactivity following challenge with homogenised kiwifruit but one child reacted to cooked kiwifruit challenge. Industrial heat treatment and homogenisation can make kiwifruit safe for children who are allergic to this increasingly popular fruit. This has dietary implications for children who are allergic to several fruit and vegetable proteins.

Allergy to kiwi

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.

METHODS

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.

RESULTS

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.

Kiwi fruit allergy: a review

Allergy to kiwi fruit was first described in 1981, and there have since been reports of the allergy presenting with a wide range of symptoms from localized oral allergy syndrome (OAS) to life-threatening anaphylaxis. The article reviews the available information concerning the clinical features of kiwi fruit allergy and the role of clinical investigations for diagnosis. Work identifying the major allergens in kiwi fruit has resulted in conflicting results, the possible reasons for which are discussed. The clinical associations of kiwi fruit allergy with allergies to pollens or latex are reviewed.