Insect Allergens Research Articles

Insect (food) allergy and allergens

Insects represent an alternative for meat and fish in satisfying the increasing demand for sustainable sources of nutrition. Approximately two billion people globally consume insects. They are particularly popular in Asia, Latin America, and Africa. Most research on insect allergy has focussed on occupational or inhalation allergy. Research on insect food safety, including allergenicity, is therefore of great importance. The objective of this review is to provide an overview of cases reporting allergy following insect ingestion, studies on food allergy to insects, proteins involved in insect allergy including cross-reactive proteins, and the possibility to alter the allergenic potential of insects by food processing and digestion. Food allergy to insects has been described for silkworm, mealworm, caterpillars, Bruchus lentis, sago worm, locust, grasshopper, cicada, bee, Clanis bilineata, and the food additive carmine, which is derived from female Dactylopius coccus insects. For cockroaches, which are also edible insects, only studies on inhalation allergy have been described. Various insect allergens have been identified including tropomyosin and arginine kinase, which are both pan-allergens known for their cross-reactivity with homologous proteins in crustaceans and house dust mite. Cross-reactivity and/or co-sensitization of insect tropomyosin and arginine kinase has been demonstrated in house dust mite and seafood (e.g. prawn, shrimp) allergic patients. In addition, many other (allergenic) species (various non-edible insects, arachnids, mites, seafoods, mammals, nematoda, trematoda, plants, and fungi) have been identified with sequence alignment analysis to show potential cross-reactivity with allergens of edible insects. It was also shown that thermal processing and digestion did not eliminate insect protein allergenicity. Although purified natural allergens are scarce and yields are low, recombinant allergens from cockroach, silkworm, and Indian mealmoth are readily available, giving opportunities for future research on diagnostic allergy tests and vaccine candidates.

The presence of aeroallergens in food products: a potential risk for the patient with allergic rhinitis

Abstract Clinical entities of food allergy in allergic rhinitis patients due to IgE-sensitization to cross-reactive aeroallergen and food allergen components are well described, but less data are available regarding allergic reactions to foods containing aeroallergens, either due to food contamination, such as oral mite anaphylaxis, or due to their natural presence in the edible products, such as pollen grains in honey and bee products. There are some potential risks for allergic rhinitis subjects due to ingestion of food products containing domestic mite, insect, fungal and pollen allergens. The knowledge of these risks is useful for the allergists and ENT specialists, especially in the context of climate changes with warmer periods facilitating mite growth in flours, and of increase use of phytotherapy and apitherapy products containing pollen grains.

Climate change and allergy in Australia: an innovative, high-income country, at potential risk.

The impacts of climate change on allergens and allergic diseases are important and potentially serious in Australia. Australia is highly vulnerable to such impacts because of its very high prevalence of allergic diseases such as asthma and allergic rhinitis, and allergic sensitisation to environmental allergens such as certain pollens and fungal spores. This article aims to review published research on the impacts of climate change on allergens and allergic diseases from an Australian perspective. Research on climate change, allergens and allergy was reviewed. Recent global assessments of the topic were consulted, and supplemented with database searches to identify research published since the assessments were done, as well as research with an Australian focus. The databases used were Web of Science and Scopus. Only research published since the year 2000 was included. The impacts of climate change on allergens and allergic diseases are many and varied. Impacts on pollen include effects on pollen production and atmospheric pollen concentration, pollen seasonality, pollen allergenicity, and the dispersion and spatial distribution of pollen. Similarly, there is evidence for effects on fungal spore production, seasonality and allergenicity. There are also likely effects on indoor moisture and mould growth. Beyond these respiratory allergens, climate change may also affect food allergens, stinging insect allergens and contact allergens. All these changes could affect allergic diseases, in particular allergic respiratory diseases such as allergic asthma and allergic rhinitis. A large and sophisticated body of research exists from which to gauge both current and potential future impacts of climate change on allergens and allergic diseases. However, most, if not all, of this is from outside Australia. Australian-focused research is therefore urgently needed. Australia's vulnerability to the adverse effects of climate change on allergic diseases is compounded by the precarious nature of aeroallergen monitoring, reporting and forecasting in this country. But Australia has an impressive wealth of relevant experience and expertise, and has the potential to address the challenge of both current and future impacts of climate change on allergens and allergic diseases.

Comparison of serum concentrations of environmental allergen-specific IgE in atopic and healthy (nonatopic) horses.

Allergic responses in humans, horses and other species are mediated by immunoglobulin E (IgE) antibodies. Serum testing to detect allergen-specific IgE antibodies has been developed for dogs, cats and horses; this allows for the identification of allergens and determination of appropriate allergen- specific immunotherapies. This study compared serum allergen-specific IgE concentrations in atopic and healthy horses. The study was performed on Malopolski breed atopic (n=21) and nonatopic (n=21) clinically healthy horses. Allergen-specific IgE serum concentrations were measured in summer seasons of 2008-2015 using a monoclonal anti-IgE antibody. A Northern and Central European allergen panel containing mite, insect, mould and plant pollen allergens, including 15 tests of individual allergens and 5 tests of allergen mixtures was used. The mean allergen-specific IgE concentrations in the atopic and normal horse populations were compared. Among the atopic horses, the strongest positive reactions occurred against the storage mites Tyrophagus putrescentiae and the domestic mite Dermatophagoides farinae. The atopic horses also demonstrated high IgE concentrations against insects, particularly Tabanus sp., the plant pollens colza, cultivated rye and the mould pollen mixture Aspergillus/Penicillium. No horses in the atopic group were IgE-negative. Among all mite, insect, mould and some plant allergen groups the differences in mean specific IgE concentrations between allergic and healthy horses were significant. The mean IgE concentrations for most allergen groups were significantly higher in the atopic horses than in the healthy animals. However, a high incidence of positive reactions was observed in both healthy and allergic horses. Our results showed a high frequency of polysensitization in atopic horses.

Allergenic extracts to diagnose and treat sensitivity to insect venoms and inhaled allergens

ObjectiveTo review allergenic extracts used to diagnose or treat insect allergies, including how the extracts are manufactured and their measurements of potency or concentration. Data SourcesPeer-reviewed articles derived from searching PubMed (National Center for Biotechnology Information) about insect allergies and extract preparation. Encyclopedia of Life (http://www.eol.org/) and http://allergome.org/ were also referenced for background information on insects and associated allergens. Study SelectionsSearch terms used for the PubMed searches included insect allergens and allergies, Apidae, Vespidae, fire ants, cockroach allergies, insect allergen extract preparation, and standardization. ResultsHumans may be sensitized to insect allergens by inhalation or through stings. Cockroaches and moths are predominantly responsible for inhalation insect allergy and are a major indoor allergen in urban settings. Bees, fire ants, and wasps are responsible for sting allergy. In the United States, there are multiple insect allergen products commercially available that are regulated by the US Food and Drug Administration. Of those extracts, honeybee venom and insect venom proteins are standardized with measurements of potency. The remaining insect allergen extracts are nonstandardized products that do not have potency measurements. ConclusionSensitization to inhalational and stinging insect allergens is reported worldwide. Crude insect allergen extracts are used for diagnosis and specific immunotherapy. A variety of source materials are used by different manufacturers to prepare these extracts, which may result in qualitative differences that are not reflected in measurements of potency or protein concentration.

Pattern of Allergen Sensitivity among Patients with Bronchial Asthma and/or Allergic Rhinosinusitis in a Tertiary Care Centre of Southern India.

The distribution of aeroallergens varies among various geographical areas of India and the knowledge of allergen sensitivity pattern in this part of Southern Indian (Karnataka) is limited. This data can provide clinically useful information and better understanding of common allergies prevalent in this area. To study the pattern of allergen sensitivity among patients with bronchial asthma and/or allergic rhinosinusitis. In this retrospective study, patients diagnosed with bronchial asthma and/or allergic rhinitis who underwent skin prick testing, were included in the study. Patients who had taken drugs that could affect the test results, within one week prior to testing were excluded. Also, patients on long-acting oral antihistamines within four weeks of testing and pregnant women were excluded. A total of 64 antigens were used which included eight types of pollens, eight types of dusts, six types of fungi, eight types of insects, two types of danders, wool and 31 types of food items. Skin prick testing was done as per standard protocol. Out of 2219 patients, 1193 (53.8%) were males and 1026 (46.2%) were females. The mean age of the subjects was 41.47 (±14) years. There were 740 (33.3%) patients diagnosed with bronchial asthma, 357 (16.1%) allergic rhinitis and 1122 (50.6%) had both bronchial asthma and allergic rhinitis. Overall the highest percentage of skin-prick test positivity was found among insect allergens (24.45%) followed by dust (24.21%), grass and tree pollen (20.57%), fungus (13.92%) and food allergens (9.28%), in that order. Among the individual allergens, the highest percentage of skin-prick test positivity was present in rice grain dust allergen (33.30%) and the least common was chicken allergen (4.40%). Among the allergen groups, insects and dusts elicited the highest percentage of skin-prick test positive results. Whereas, among all the individual allergens rice grain dust elicited highest percentage of positives.

Nutritional Protocol for Asthma

Asthma is characterized by hypersensitivity of the bronchioles, leading to bronchospasm, oedema of the mucosa and increased secretion of mucous, usually more viscous. This leads to a deficiency in ventilation. There are several factors that are involved, including the release of inflammatory mediators from mast cells (particularly leukotrienes), pollution, stress, pollen, insect and food allergens/ sensitivities, animal hair/fur/dander, food additives, obesity, and genetically modified plants (leading to increased allergens in foods).

Allergens stimulate store-operated calcium entry and cytokine production in airway epithelial cells.

Aberrant immune responses to environmental allergens including insect allergens from house dust mites and cockroaches contribute to allergic inflammatory diseases such as asthma in susceptible individuals. Airway epithelial cells (AECs) play a critical role in this process by sensing the proteolytic activity of allergens via protease-activated receptors (PAR2) to initiate inflammatory and immune responses in the airway. Elevation of cytosolic Ca2+ is an important signaling event in this process, yet the fundamental mechanism by which allergens induce Ca2+ elevations in AECs remains poorly understood. Here we find that extracts from dust mite and cockroach induce sustained Ca2+ elevations in AECs through the activation of Ca2+ release-activated Ca2+ (CRAC) channels encoded by Orai1 and STIM1. CRAC channel activation occurs, at least in part, through allergen mediated stimulation of PAR2 receptors. The ensuing Ca2+ entry then activates NFAT/calcineurin signaling to induce transcriptional production of the proinflammatory cytokines IL-6 and IL-8. These findings highlight a key role for CRAC channels as regulators of allergen induced inflammatory responses in the airway.

Allergens might trigger migraine attacks.

Migraine is a common primary headache disorder. The mechanisms underlying the onset of a migraine attack are not completely understood. Environmental changes and a number of other factors could induce migraine attacks. The aim of this study was to investigate the relationship between the frequency of migraine attacks and allergens. Migraine patients without aura, and healthy individuals similar in age and gender without a history of headache and allergy were prospectively included in the study. The duration of migraine, the frequency of migraine attacks, the medication history, and the symptoms during attacks were questioned. Migraine disability assessment score (MIDAS) and visual analog scale (VAS) scores were obtained. Allergen extracts including dust, fungi, insect, animal epithelium, pollens, and food allergens were applied for allergy tests. 49 migraine patients and 49 healthy individuals were enrolled in the study. There was no significant difference in terms of age and gender. The median migraine disease duration, the number of attacks in a month, and the duration of attacks were, respectively, 5.5years (1-44), 4 (1-10) day/month, and 24 (4-72)h. The mean MIDAS grade was 2.45±0.14 (1-4), and mean VAS score was 7.89±0.27 (4-10). The positivity of allergy tests was 55.1% (27/49) in the migraine group and 32.7% (16/49) in the control group (p<0.05). The allergy tests were positive for house dust, red birch, hazel tree, olive tree, nettle, and wheat. The frequency of migraine attacks was higher in allergy-test-positive patients than in negative ones in the migraine group (p=0.001). The migraine patients who had frequent attacks should be examined for allergies.

Identification of common allergens for united airway disease by skin prick test

Objective: Identification of common allergens by skin prick test in patients of united airway disease. Materials and Methods: Skin prick test was performed in 60 patients of United Airway Disease to identify the common allergens. A total of 62 allergens consisting of 36 types of pollen, 5 fungi, 4 insects, 8 type of dusts, 4 dander, 3 fabrics, Dust mite and Parthenium leaves were tested. Result: Most common allergens were Dust mite (60%) followed by Parthenium leaves (45%), insects (18.75%), pollen (14.81%), dust allergens (8.51%), fabrics (8.33%), fungi (5.66%), dander (5%). Most common insect allergens were cockroach (female) (30%), cockroach (male) (23.33%). Common pollens were Ricinus communis (28.33%), Amaranthus spinosus (28.33%), Parthenium hysterophorus (26.66%), Eucalyptus tereticornis (26.66%) and Cynodon dactylon (25%). Common dust allergens were house dust (21.66%), paper dust (11.66%) and cotton mill dust (10%). Among fabrics kapok cotton (13.33%) showed maximum positivity. Among fungi Aspergillus fumigatus (10%) followed by A. niger (6.66%) were most common. In animal dander group common ones were cat dander followed by dog dander. Conclusion: In conclusion it can be said that the knowledge drawn by above study will help to treat patients by immunotherapy or avoidance strategy.

Allergens in veterinary medicine.

Allergic diseases in animals are increasingly gaining importance in veterinary practice and as research models. For intradermal testing and allergen immunotherapy, a good knowledge of relevant allergens for the individual species is of great importance. Currently, the knowledge about relevant veterinary allergens is based on sensitization rates identified by intradermal testing or serum testing for allergen‐specific IgE; crude extracts are the basis for most evaluations. Only a few studies provide evidence about the molecular structure of (particularly) dust mite, insect and mould allergens in dogs and horses, respectively. In those species, some major allergens differ from those in humans. This position paper summarizes the current knowledge about relevant allergens in dogs, cats and horses.

Animal allergens: common protein characteristics featuring their allergenicity.

Animal allergens: common protein characteristics featuring their allergenicity.

Assessment of serum levels of allergen-specific immunoglobulin E in different seasons and breeds in healthy horses.

The present study was designed to asses specific IgE towards environment allergens in 42 healthy horses. Determination of this immunoglobulin in serum serve as diagnostic tools in allergic diseases to improve efficacy of the treatment and proper allergen selection to specific immunotherapy. Serum levels of allergen specific IgE were measured with equine monoclonal antibody, using 15 individual and 5 mix allergens in North European Panel. The study revealed season dependent increased levels of allergen specific IgE in normal horses. It is noteworthy that healthy horses show high percentage of positive reactions, most commonly towards to domestic mites D. farinae (80%), D. pteronyssinus (35.71%) and storage mites T. putrenscentiae (42.86%), Acarus siro (40.48%). These allergens play an important role in equine, canine and feline atopic dermatitis. We also demonstrated high IgE levels in the group of horse specific insect allergens. Tabanus sp. (35.71%), Culicoides sp. (28.57%) and Simulium sp. (26.19%) were the most frequent insect positive reaction allergens. No positive reactions in all groups of allergens were found in winter season, low and merely detectable levels of antibodies have been found relating to D. farianae and T. putrescentiae allergen. We observed elevated mould-IgE levels in horses that live in stables, while outdoor living horses showed very low levels. Amongst all positive reactions we observed only weak and moderate reactions but no strong positive reactions were found. No significant differences were observed between three breeds of horses with the exception of moulds and D. pteronyssinus allergens.

Allergen‐specific immunotherapy in horses with insect bite hypersensitivity: a double‐blind, randomized, placebo‐controlled study

Insect bite hypersensitivity (IBH) is a common cause of pruritus in horses, but there are few controlled studies on the efficacy of allergen-specific immunotherapy (ASIT). Atopic dermatitis and IBH can present with overlapping clinical signs; multiple insect and environmental allergens could be indicated in these horses to achieve effective hyposensitization. Although the success of ASIT using Culicoides spp. whole-body extracts is controversial, there are no controlled studies published that clearly show benefit from this form of therapy. The objective was to evaluate the efficacy of ASIT in horses with IBH using commercially available extracts and tests. Twenty horses with seasonal pruritus and positive intradermal reactions to a whole Culicoides extract. An enzyme-linked immunosorbent assay test (Allercept(®) ) was used to detect concurrent allergen-specific IgE for other insects and environmental allergens. The ASIT was formulated by adding the relevant serologically positive allergens to the Culicoides extract. After randomization, 10 horses received ASIT and the rest a placebo solution. Clinical response was assessed every 4 months during 1 year using a clinical scoring system based on the severity of four clinical signs at 10 different body regions. Horses were not stabled and, to minimize dropouts, an insect repellent was used weekly in both groups. Differences in clinical scores between groups were nonsignificant at any re-evaluation, while both groups improved to a similar extent, probably due to the insecticide treatment. Using commercially available extracts and tests, we could not demonstrate a beneficial effect of 1 year multiple ASIT in nonstabled horses with IBH.

Oral food desensitization

The common treatment of IgE-mediated food allergy is to avoid the offending item and educating patients on appropriate emergency measures. Recently, attempts to gain food tolerance with oral administration of increasing doses of the offending food have become frequent. Desensitization procedures are risky and safety is a priority. Their success depends on the individual allergic characteristics and the modality of food administration. Most schedules adopted in the desensitization protocols are empiric and not regular, as requirements of safety would require. Some oral food desensitization schedules were compared in order to verify whether the increments between doses were regular. Through a mathematic formula adopted by the musicians to tune instruments in the 17th Century, including Bach, I describe a method to calculate an increment factor by which a schedule of food administration that ensures an absolutely constant increment between doses can be achieved. This method can prove useful for every situation in which a gradual dose increment is needed (food, drugs in an experimental setting, specific immunotherapy with inhalants or venom insect allergens). All calculations can be done also without a computer, and this is particularly important if modern technologies are not available, such as in developing countries.I propose calling this method 'Building an Allergen-augmentation Curve Harmoniously (BACH)'.

Extending the honey bee venome with the antimicrobial peptide apidaecin and a protein resembling wasp antigen 5

Honey bee venom is a complex mixture of toxic proteins and peptides. In the present study we tried to extend our knowledge of the venom composition using two different approaches. First, worker venom was analysed by liquid chromatography-mass spectrometry and this revealed the antimicrobial peptide apidaecin for the first time in such samples. Its expression in the venom gland was confirmed by reverse transcription PCR and by a peptidomic analysis of the venom apparatus tissue. Second, genome mining revealed a list of proteins with resemblance to known insect allergens or venom toxins, one of which showed homology to proteins of the antigen 5 (Ag5)/Sol i 3 cluster. It was demonstrated that the honey bee Ag5-like gene is expressed by venom gland tissue of winter bees but not of summer bees. Besides this seasonal variation, it shows an interesting spatial expression pattern with additional production in the hypopharyngeal glands, the brains and the midgut. Finally, our immunoblot study revealed that both synthetic apidaecin and the Ag5-like recombinant from bacteria evoke no humoral activity in beekeepers. Also, no IgG4-based cross-reactivity was detected between the honey bee Ag5-like protein and its yellow jacket paralogue Ves v 5.

Allergen‐derived proteinases: Isolation, characterization and signaling via proteinase‐activated receptors (PARs)

ObjectiveTo identify proteolytic enzymes in insect and mould asthma allergens and assess their ability to signal via the PARs.MethodsAllergen‐derived trypsin‐like enzymes known to contribute to lung inflammation were visualized (western blot) with serine proteinase activity‐based probes (ABP). Enzymes were purified using ion‐exchange chromatography and analyzed for their ABP reactivity &amp; substrate‐inhibitor kinetic profiles. Each enzyme was tested for its activation of PAR–dependent calcium signaling in PAR1 &amp; PAR2‐expressing KNRK cells. ABP‐labeled enzymes were isolated by avidin affinity chromatography and their peptide sequences determined (mass spectrometry).ResultsBoth allergens contained ABP‐labeled proteinases with MWs of 20–26 kDa. Each enzyme had distinct kinetic substrate (Km) and inhibitor (Ki) profiles. The enzymes all caused PAR2 calcium signaling, and differentially activated PAR1. Sequencing revealed that the allergen proteinases were homologous with previously described trypsin‐like enzymes.ConclusionsDiverse allergens contain multiple biochemically distinct trypsin‐like proteinases that are able to target PARs 1 and 2. Thus, PARs and their activating allergen proteinases may be attractive therapeutic targets for the treatment of allergen‐induced asthma.Support: Canadian Institutes of Health Research, NIH USA and Lung Association of Alberta &amp; NWT

Allergenicity and Cross-Reactivity of Booklice (Liposcelis bostrichophila): A Common Household Insect Pest in Japan

Background: Booklice (Liposcelis bostrichophila) are a common household insect pest distributed worldwide. Particularly in Japan, they infest ‘tatami’ mats and are the most frequently detected insect among all detectable insects, present at a frequency of about 90% in dust samples. Although it has been hypothesized that they are an important indoor allergen, studies on their allergenicity have been limited. Methods: To clarify the allergenicity of booklice and the cross-reactivity of this insect allergen with allergens of other insects, patients sensitized to booklice were identified from 185 Japanese adults with allergic asthma using skin tests and IgE-ELISA. IgE-inhibition analysis, immunoblotting and immunoblotting-inhibition analysis were performed using sera from these patients. Allergenic proteins contributing to specific sensitization to booklice were identified by two-dimensional electrophoresis and two-dimensional immunoblotting. Results: The booklouse-specific IgE antibody was detected in sera from 41 patients (22% of studied patients). IgE inhibition analysis revealed that IgE reactivity to the booklouse allergen in the sera from one third of booklouse-sensitized patients was not inhibited by preincubation with extracts from any other environmental insects in this study. Immunoblotting identified a 26-kD protein from booklouse extract as the allergenic protein contributing to specific sensitization to booklice. The amino acid sequence of peptide fragments of this protein showed no homology to those of previously described allergenic proteins, indicating that this protein is a new allergen. Conclusions: Sensitization to booklice was relatively common and specific sensitization to this insect not related to insect panallergy was indicated in this population.

Mammalian lipocalin allergens – insights into their enigmatic allergenicity

Most of the important mammal-derived respiratory allergens, as well as a milk allergen and a few insect allergens, belong to the lipocalin protein family. As mammalian lipocalin allergens are found in dander, saliva and urine, they disperse effectively and are widely present in the indoor environments. Initially, lipocalins were characterized as transport proteins for small, principally hydrophobic molecules, but now they are known to be involved in many other biological functions. Although the amino acid identity between lipocalins is generally at the level of 20-30%, it can be considerably higher. Lipocalin allergens do not exhibit any known physicochemical, functional or structural property that would account for their allergenicity, that is, the capacity to induce T-helper type 2 immunity against them. A distinctive feature of mammalian lipocalin allergens is their poor capacity to stimulate the cellular arm of the human or murine immune system. Nevertheless, they induce IgE production in a large proportion of atopic individuals exposed to the allergen source. The poor capacity of mammalian lipocalin allergens to stimulate the cellular immune system does not appear to result from the function of regulatory T cells. Instead, the T cell epitopes of mammalian lipocalin allergens are few and those examined have proved to be suboptimal. Moreover, the frequency of mammalian lipocalin allergen-specific CD4(+) T cells is very low in the peripheral blood. Importantly, recent research suggests that the lipocalin allergen-specific T cell repertoires differ considerably between allergic and healthy subjects. These observations are compatible with our hypothesis that the way CD4(+) T-helper cells recognize the epitopes of mammalian lipocalin allergens may be implicated in their allergenicity. Indeed, as several lipocalins exhibit homologies of 40-60% over species, mammalian lipocalin allergens may be immunologically at the borderline of self and non-self, which would not allow a strong anti-allergenic immune response against them.

Association of sensitization to food and inhalant allergens in patients of asthma and rhinitis

Of 1860 patients screened, 1097 (58.9 %) gave history of food allergy. Of the history positive patients 470 were skin prick tested . 29.3 % (138/470) exhibited positive reactions to one or more food(s). Rice elicited SPT positive reaction in maximum ( 6.2 %) cases followed by blackgram (5.9 %), lentil (5.5 %), citrus fruits (5.3 %), pea (3.8 %), maize (3.8%) and banana (3.6 %). Among food sensitised cases 35.5% ( 49/138 ) of patients also showed positive skin reaction to one or more pollen extracts. A majority of the food sensitized patients (52.1 %) were skin test positive to insect allergens while only 14.7 % showed positivity with fungal extracts. Positive skin reaction with food co-existed with positive SPT to insects extracts. Sensitisation to food allergen (potential food allergy) was significantly associated with asthma (P=0.0065) whereas inhalant allergens (pollen, fungal and insects) were strongly related to rhinitis (P<0.01). However sensitisation with pollens was less common in patients of asthma with rhinitis. Sensitisation to food allergens was significantly associated with asthma alone ( P=0.0001). But food sensitivity is significantly less common in cases of asthma associated with rhinitis (P<0.028). Correlations between sensitisation to aeroallergens and ten common foods were analyzed. Conclusions The results suggest that concommittant sensitisations to food with pollen and insect may enhance the risk of asthma and rhinitis or contribute towards exacerbation of symptoms. The synergistic action of these factors may influence the development and progression of atopic manifestation.