Abstract
BackgroundApple allergy manifests as two main groups of clinical entities reflecting different patterns of allergen sensitization: oral allergy syndrome (OAS) and generalized symptoms (GS).ObjectiveWe analysed the sensitization profile to a wide panel of different components of food allergens (rMal d 1, Mal d 2, rMal d 3, rMal d 4, rPru p 3, rBet v 1 and Pho d 2) for a population of Mediterranean patients with OAS and GS to apple.MethodsPatients (N = 81) with a history of apple allergy that could be confirmed by positive prick-prick test and/or double-blind-placebo-controlled food challenge (DBPCFC), were included. Skin prick test (SPT) and ELISA were performed using a panel of inhalant, fruit and nut allergens. ELISA and ELISA inhibition studies were performed in order to analyse the sensitization patterns.ResultsThirty-five cases (43.2%) had OAS and 46 (56.8%) GS. SPT showed a significantly higher number of positive results with peach, cherry and hazelnut in those with GS. ELISA showed a significantly high percentage of positive cases to rMal d 3, rMal d 4, rPru p 3 and Pho d 2 in patients with OAS and GS compared to controls, and to rBet v 1 in patients with OAS vs controls and between OAS and GS patients. Three different patterns of recognition were detected: positive to LTP (rMal d 3 or rPru p 3), positive to profilin (rMal d 4 and Pho d 2), or positive to both. There were also patients with rMal d 1 recognition who showed cross-reactivity to rBet v 1.ConclusionIn an apple allergy population with a high incidence of pollinosis different patterns of sensitization may occur. LTP is most often involved in those with GS. Profilin, though more prevalent in patients with OAS, has been shown to sensitise patients with both types of symptoms.
Highlights
In adults and older children Rosacea fruits are the plant foods most often responsible for allergic reactions [1,2,3]
Patients and controls Patients referred to the Allergy Unit of Malaga Hospital with a history of apple allergy that could be confirmed by positive prick-prick test and/or double-blindplacebo-controlled food challenge (DBPCFC), were included
Patients were classified according to symptoms: oral allergy syndrome (OAS) when they were restricted to the skin or mucosal sites of direct contact with the allergen, and generalized symptoms (GS) when reactions involved organs far from the site of initial contact with the food accompanied or not to OAS
Summary
In adults and older children Rosacea fruits are the plant foods most often responsible for allergic reactions [1,2,3]. In Southern European countries, apple allergic patients more frequently have GS, no association with Betula sensitization and cross-reactions to other fruits, especially peach [1,6,7,12]. In this situation peach LTP, Pru p 3, is the strongest candidate for these sensitizations [1,6,7,12]. Atopic patients allergic to peach and apple may have OAS in an environment where the prevalence of Betula pollen sensitization is low In this situation, profilin is an important sensitizer [13,14,15]. Apple allergy manifests as two main groups of clinical entities reflecting different patterns of allergen sensitization: oral allergy syndrome (OAS) and generalized symptoms (GS)
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