Pollen-associated Food Allergy Research Articles

Vegan diet - alternative protein sources as potential allergy risk

ZusammenfassungBackground: As a vegan diet is per definition a plant-based diet, consumers rely on plant protein sources in order to substitute animal proteins. Plant protein sources commonly used in this context are the following: cereals, like wheat (Triticum aestivum, Triticum durum), oat flakes; pseudo cereals like quinoa; nuts and oil seeds like cashew (Anacardium occidentale), hazelnut (Corylus avellana), walnut (Juglans regia); seeds like psyllium seeds (Plantago ovata), sesame (Sesamum indicum), and chia seed (Salvia hispanica).Methods: In order to assess the allergy risk posed by vegan diet, a literature search focusing on the composition of this particular diet and whether the respective foods are potentially allergenic was performed.Results: At first glance, it is evident for allergologists that these protein sources are well-known allergen sources. Particularly nuts and legumes harbour storage proteins, oleosins, and lipid trans- fer proteins that as such are associated with severe allergic reactions to food. In addition, there is increasing evidence that the simultaneous consumption of several of these foods may produce a summation effect where many single allergens of high allergenic potential sum up, thereby inducing anaphylaxis. Furthermore, food processing - or the lack of it - puts patients with pollen-associated food allergy at risk to react to some of the plant foods used in vegan diets.Conclusion: Therefore, individuals with a history of atopy should be educated regarding the allergy risk of a vegan diet.Cite this as Jappe U. Vegan diet - alternative protein sources as potential allergy risk. Allergo J Int 2023;32:251-7https://doi.org/10.1007/s40629-023-00248-7

Vegan diet—alternative protein sources as potential allergy risk

Abstract Background As a vegan diet is per definition a plant-based diet, consumers rely on plant protein sources in order to substitute animal proteins. Plant protein sources commonly used in this context are the following: cereals, like wheat (Triticum aestivum, Triticum durum), oat flakes; pseudo cereals like quinoa; nuts and oil seeds like cashew (Anacardium occidentale), hazelnut (Corylus avellana), walnut (Juglans regia); seeds like psyllium seeds (Plantago ovata), sesame (Sesamum indicum), and chia seed (Salvia hispanica). Methods In order to assess the allergy risk posed by vegan diet, a literature search focusing on the composition of this particular diet and whether the respective foods are potentially allergenic was performed. Results At first glance, it is evident for allergologists that these protein sources are well-known allergen sources. Particularly nuts and legumes harbour storage proteins, oleosins, and lipid transfer proteins that as such are associated with severe allergic reactions to food. In addition, there is increasing evidence that the simultaneous consumption of several of these foods may produce a summation effect where many single allergens of high allergenic potential sum up, thereby inducing anaphylaxis. Furthermore, food processing—or the lack of it—puts patients with pollen-associated food allergy at risk to react to some of the plant foods used in vegan diets. Conclusion Therefore, individuals with a history of atopy should be educated regarding the allergy risk of a vegan diet.

Real-life evaluation of molecular multiplex IgE test methods in the diagnosis of pollen associated food allergy.

Diagnosis of food allergies is challenging, as combining information from specific IgE (sIgE)-sensitization pattern and skin prick tests (SPTs) with clinical history is necessary for a personalized management of allergic patients. The aim of this study was to compare two molecular tests, the ImmunoCAP ISAC (ISAC) and the Allergy Explorer, version 2 (ALEX2 ) in the context of pollen food syndrome (PFS) diagnosis in a real-life scenario, to assess the benefit of multiplex testing in PFS patients. Diagnosis of food allergy was performed in 53 patients. Allergen-sIgE concentrations were measured with ISAC and ALEX2 . Results for sIgE were statistically compared with each other, with SPT results and with clinical presentation of the patients. Using ISAC as reference test for sIgE measurements, the average sensitivity of ALEX2 for PR-10 allergens was 83.2% and the average specificity 88.0%. If only low sIgE concentrations were included, the sensitivity was 60.8% and the specificity 91.1%. Apple and hazelnut sensitizations were confirmed in most patients by concordance of sIgE and SPT results. Significant correlations were shown between clinical symptoms and Mal d 1- and Gly m 4-sIgE levels measured by both tests and for Cor a 1-sIgE levels measured by ALEX2 . In eight patients, profilin related symptoms were supported by Hev b 8-sensitization. Multiplex testing is beneficial to understand patient-specific individual sensitization profiles and to providing personalized management recommendations. In the future, custom-designed test kits might enable reducing costs of multiplex testing for specific patient groups without compromising the diagnostic value.

Targeted micronutrition for allergic patients—possible applications of a food for special medical purposes

SummaryA novel and recently launched food for special medical purposes was discussed by a multidisciplinary expert panel as an option for allergic patients. The newly developed lozenge contains the whey protein beta-lactoglobulin (BLG) as well as the micronutrients iron, zinc and vitamin A. BLG loaded with ligands (holo-BLG) is discussed as one factor of the allergy-protective farm effect in numerous scientific studies. Further studies reveal that holo-BLG shuttles its ligands specifically to immune cells, where it balances the specific nutrient demand and can thus lead to immune resilience. Based on the scientific background, the experts see a broad range of possible applications for holo-BLG in the form of a lozenge, for example in patients suffering from multiple allergies, with sensitisation to rare allergens (including occupational allergens), tree pollen-associated food allergies or in general difficult treatment situations (e.g. allergies to animal dander or refusal of allergen immunotherapy). The expert panel describes the holo-BLG lozenge as an innovative and additional option for allergic patients.

花粉症患者にみられる食物アレルギー：花粉-食物アレルギー症候群

花粉症患者にみられる食物アレルギー：花粉-食物アレルギー症候群

Fecal Eosinophil Cationic Protein Is a Diagnostic and Predictive Biomarker in Young Adults with Inflammatory Bowel Disease.

Background and Aims: Fecal biomarkers are important non-invasive markers monitoring disease activity in inflammatory bowel disease (IBD). We compared the significance of fecal eosinophil cationic protein (fECP) and fecal calprotectin (fCal). Methods: fECP and fCal were measured in patients with Crohn’s disease (CD, n = 97), ulcerative colitis (UC, n = 53), Clostridioides difficile infection (CDI, n = 9), primary food allergy (PFA, n = 11), pollen-associated food allergy (n = 25) and non-inflammatory controls (n = 78). Results were correlated with clinical and endoscopic IBD activity scores. Results: fECP was significantly elevated in CD, UC, CDI and PFA compared to controls. fCal was significantly increased in CD, UC and CDI. fECP had lower diagnostic accuracy than fCal (area under the curve (AUC) = 0.88) in differentiating between endoscopically active and inactive patients with IBD (AUC = 0.77, ROC analysis). In contrast to fCal, fECP correlated negatively with age and levels were also elevated in clinically and endoscopically inactive patients with IBD <45 years (endoscopically inactive IBD vs controls; AUC for fECP = 0.86; AUC for fCal = 0.62). However, in those patients with low inflammatory activity (fCal <250 mg/kg), high fECP indicated the need for treatment modification or surgery (fECP <200 µg/kg = 22%; 200–600 µg/kg = 44%; >600 µg/kg = 82%) at month 48 of follow-up. Conclusions: fECP is a diagnostic and prognostic marker in young patients with IBD in remission.

What Is Oral Allergy Syndrome?

What Is Oral Allergy Syndrome?

A Study on Pollen-associated Food Allergy Syndrome with the Genus Alnus Antigen

A Study on Pollen-associated Food Allergy Syndrome with the Genus Alnus Antigen

ハンノキ属陽性例における食物アレルギーの検討

ハンノキ属陽性例における食物アレルギーの検討

Measurement of health-related quality of life in adult patients with birch pollen-associated food allergy.

The "Food Allergy Quality of Life Questionnaire - Adult Form" (FAQLQ-AF) is the first freely available questionnaire for the assessment of health-related quality of life (HRQL) in adults with food allergy (FA). We present validation data for the German version as well as data on HRQL in patients with birch pollen-associated FA. The Dutch FAQLQ-AF (scale from 1-7, no impairment - maximum impairment) was translated into German. Subsequently, 73 consecutive patients with a history of birch pollen-associated FA (52 women, median age 43 years) were surveyed using questions regarding triggers and symptoms of their FA as well as questions contained in the FAQLQ-AF. Construct validity, internal consistency, and discriminative ability were analyzed. The foods most frequently reported to elicit allergic reactions included apple (78%), hazelnut (75%), soy drinks (55%), and carrot (52%). Thirty percent of patients exclusively reported symptoms consistent with oral allergy syndrome (OAS). Sixty-four percent reported OAS combined with systemic symptoms, and only 6% were exclusively affected by non-OAS symptoms. The German FAQLQ-AF showed good construct validity (correlation with the food allergy-independent measure: r = 0.81; p < 0.001) and excellent internal consistency (Cronbachs α = 0.98). The mean overall FAQLQ-AF score was 3.7. Women, elderly individuals, and those with multiple relevant food allergies showed a greater impairment of HRQL. The German FAQLQ-AF questionnaire is a reliable and valid tool for measuring HRQL in patients with birch pollen-associated food allergy.

Enlarging the toolbox for allergen epitope definition with an allergen-type model protein.

BackgroundBirch pollen-allergic subjects produce polyclonal cross-reactive IgE antibodies that mediate pollen-associated food allergies. The major allergen Bet v 1 and its homologs in plant foods bind IgE in their native protein conformation. Information on location, number and clinical relevance of IgE epitopes is limited. We addressed the use of an allergen-related protein model to identify amino acids critical for IgE binding of PR-10 allergens.Method Norcoclaurine synthase (NCS) from meadow rue is structurally homologous to Bet v 1 but does not bind Bet v 1-reactive IgE. NCS was used as the template for epitope grafting. NCS variants were tested with sera from 70 birch pollen allergic subjects and with monoclonal antibody BV16 reported to compete with IgE binding to Bet v 1.ResultsWe generated an NCS variant (Δ29NCSN57/I58E/D60N/V63P/D68K) harboring an IgE epitope of Bet v 1. Bet v 1-type protein folding of the NCS variant was evaluated by 1H-15N-HSQC NMR spectroscopy. BV16 bound the NCS variant and 71% (50/70 sera) of our study population showed significant IgE binding. We observed IgE and BV16 cross-reactivity to the epitope presented by the NCS variant in a subgroup of Bet v 1-related allergens. Moreover BV16 blocked IgE binding to the NCS variant. Antibody cross-reactivity depended on a defined orientation of amino acids within the Bet v 1-type conformation.ConclusionOur system allows the evaluation of patient-specific epitope profiles and will facilitate both the identification of clinically relevant epitopes as biomarkers and the monitoring of therapeutic outcomes to improve diagnosis, prognosis, and therapy of allergies caused by PR-10 proteins.

History of food allergy.

In this chapter we will first consider whether there is real evidence on the basis of literature for early descriptions in antiquity of pathogenic reactions after food intake that could be comparable to allergy, for instance in the scriptures of Hippocrates or Lucretius. On this topic we are skeptical, which is in agreement with the medical historian Hans Schadewaldt. We also assert that it is unlikely that King Richard III was the first food-allergic individual in medical literature. Most probably it was not a well-planned poisoning ('allergy') with strawberries, but rather a birth defect ('… his harm was ever such since his birth') that allowed the Lord Protector to bring Mylord of Ely to the scaffold in the Tower, as we can read in The History of King Richard III by Thomas More (1478-1535; published by his son-in-law, Rastell, in 1557). In 1912, the American pediatrician Oscar Menderson Schloss (1882-1952) was probably the first to describe scratch tests in the diagnosis of food allergy. Milestones in the practical diagnosis of food allergy are further discussed, including scratch tests, intradermal tests, modified prick tests and prick-to-prick tests. False-negative results can be attributed to the phenomenon of a 'catamnestic reaction' according to Max Werner (1911-1987), or to the fermentative degradation of food products. Prior to the discovery of immunoglobulin E, which marked a turning point in allergy diagnosis, and the introduction of the radioallergosorbent test in 1967, several more or less reliable techniques were used in the diagnosis of food allergy, such as pulse rate increase after food intake according to Coca, the leukopenic index, drop in basophils or drastic platelet decrease. The 'leukocytotoxic test' (Bryan's test), today called the 'ALCAT' test, shows no scientific evidence. The double-blind placebo-controlled food challenge test remains the gold standard in the diagnosis of food allergy. For the future, component-resolved diagnostics with the use of recombinant molecular allergens or chip arrays, such as the ISAC technique, hold a lot of promise. With regard to the clinical situation, a subjective selection is given, touching on the pollen-associated food allergies ('birch-mugwort-celery-spice syndrome'), as well as the new phenomenon of lethal food allergies that have appeared since the 1980s. Finally, rare ways of elicitation of a 'derivative allergy', first described by Erich Fuchs (1921-2008), for example by kissing, as well as 'oral allergy syndrome' and oral hyposensitization are considered.

Cor a 1–reactive T cells and IgE are predominantly cross-reactive to Bet v 1 in patients with birch pollen–associated food allergy to hazelnut

IgE- and T-cell cross-reactivity contribute to the birch pollen-food syndrome. We performed a comprehensive analysis of T-cell cross-reactivity in primary cell cultures, facilitating the identification of allergen-specific T-cell subpopulations from individual patients. Patients with birch pollen allergy and associated food allergy to hazelnuts, carrots, or both were analyzed for IgE cross-reactivity, T-cell responses, and T-cell cross-reactivity to recombinant Bet v 1.0101 (Bet v 1; birch), Cor a 1.0401 (Cor a 1; hazelnut), and Dau c 1.0104 (Dau c 1; carrot). A novel flow cytometry-based method using a 2-step staining process with fluorescent dyes was established to identify subpopulations of cross-reactive T cells. IgE-binding inhibition tests of individual sera revealed that the vast majority of Cor a 1-reactive IgE was cross-reactive to Bet v 1, whereas Bet v 1-reactive IgE was only partially inhibited by preincubation with Cor a 1. Primary stimulation of T cells with Bet v 1 or Cor a 1 resulted in a significant increase in specific responses to Cor a 1 or Bet v 1 after secondary stimulation, respectively, indicating T-cell cross-reactivity between birch and hazelnut allergens in all patients of the study cohort. Preactivation with Dau c 1 induced less pronounced effects. A novel flow cytometry-based proliferation assay identified a predominant Cor a 1/Bet v 1-cross-reactive T-cell subpopulation within highly Bet v 1/Cor a 1-responsive T cells. Analysis of primary allergen-specific T cells combined with flow cytometry-based proliferation assays facilitates investigation of allergen-specific T-cell subpopulations in subjects and might be helpful to evaluate the effect of birch-specific immunotherapy on pollen-associated food allergies.

Colonoscopic allergen provocation test with rBet v 1 in patients with pollen‐associated food allergy

After consumption of fruits, nuts, and vegetables, several patients with pollen allergy experience gastrointestinal (GI) tract symptoms that are possibly caused by pollen-associated food allergy. The aim of this study was to evaluate the colonoscopic allergen provocation (COLAP) test using the recombinant birch pollen allergen Bet v 1 (rBet v 1) for in vivo diagnosis of pollen-associated food allergy manifesting in the GI tract. Thirty-four patients with a history of adverse reactions to food, GI tract symptoms, and birch pollen pollinosis and five healthy controls underwent COLAP test. Twenty minutes after endoscopic challenge of the cecal mucosa with rBet v 1, the mucosal wheal and flare reaction was registered semiquantitatively, and tissue biopsy specimens were examined for eosinophil mucosal activation. The mucosal reaction to rBet v 1 was correlated with the presence of pollinosis (P=0.004), history of adverse reaction to Bet v 1-associated food allergens (P=0.001), and tissue eosinophils' activation (P<0.001). A wheal and flare reaction in the COLAP test was observed in 13 of 16 patients (81%) with a history of GI tract symptoms associated with the ingestion of Bet v 1-related foods and in four of 18 (22%) patients with a negative history (P<0.001). The control group did not develop visible mucosal reactions to rBet v 1. Systemic anaphylactic reactions did not occur. The mucosal administration of rBet v 1 by COLAP test provides a new diagnostic tool that might support the diagnosis of Bet v 1-associated food allergy manifesting in the GI tract.

Diagnostic Value of Component Allergen, Pru p 1 in the Korean Adult Patients with Birch Pollen-Associated Food Allergy

Diagnostic Value of Component Allergen, Pru p 1 in the Korean Adult Patients with Birch Pollen-Associated Food Allergy

Schwere Soforttypallergie nach Verzehr roher Paprika

We report on a patient with rare anaphylaxis after ingestion of raw bell pepper. A complex cluster of sensitization including grass and birch pointed out a possible pollen-associated food allergy. We suggest that the severe reaction is due to cross-reactivity towards Bet v 1. Western blot showed binding of the patient's serum to an 11 kDa protein, which has not been described yet and might be a new allergenic structure of the bell pepper plant or a fragment of the Bet v 1-homologous bell pepper protein.

Unverträglichkeit als Folge einer Hyperreaktivität

Many patients complain about hyperreactivity of the skin or mucosal membranes, whereby rather harmless "triggers" lead to exaggerated reactions like running nose, bronchospasm, urticaria, etc. Most of these hyperreactivities have an underlying inflammation. It is important not to focus only on the triggers, but to look for the agent causing the inflammation and to avoid/treat it: elimination of the cause also eliminates the hyperreactivity. Four examples are presented where this cause--trigger model of hyperreactivity is illustrated (exercise induced asthma, pollen associated food allergy, flare-up reactions in drug allergy and hyperreactivity in chronic urticaria).

Soja – ein unterschätztes Pollen assoziiertes Nahrungsmittelallergen!?

Einhergehend mit einem steigenden Konsum wurden in den letzten Jahren in Deutschland zunehmend teils schwere allergische Reaktionen auf Sojaprodukte, insbesondere auf Sojagetränke, beobachtet. Birkenpollenallergiker haben ein besonderes Risiko, eine solche Reaktion zu erleiden, denn das Hauptallergen der Birke Bet v 1 zeigt eine hohe Homologie mit dem Soja-Allergen Gly m 4. Hierdurch kann es bei entsprechend Sensibilisierten zu einer immunologischen Kreuzreaktion im Sinne einer Pollen assoziierten Nahrungsmittelallergie kommen. Genaue Daten zur Prävalenz dieses Krankheitsbildes sind nicht bekannt. In Deutschland könnten allerdings bei geschätzten 5 – 10 % (4 – 8 Mio.) Birkenpollenallergikern bis zu 2,9 Mio. Menschen von einer Kreuzsensibilisierung auf Soja betroffen sein. Eine sichere Allergenmeidung ist schwierig, da Soja vielfach versteckt in Nahrungsmitteln enthalten sein kann. Besondere Hinweise für Birkenpollenallergiker, die insbesondere vor dem Verzehr proteinreicher, nicht-fermentierter Sojaprodukte (z. B. Drinks) gewarnt werden sollten, scheinen gerechtfertigt. Inwieweit auch durch eine spezifische Immuntherapie gegen Bet v 1 die Birken assoziierte Sojaallergie beeinflusst werden kann, ist nicht bekannt.

Incidence of Pollen-associated Food Allergies in Patients with Atopic Dermatitis

RATIONALE: The aim of our study was to analyze both the frequency and the clinical relevance of pollen-associated food allergies in patients hospitalized in 2007 due to severe atopic dermatitis (AD).METHODS: 536 patients (330 f, 206 m; mean 29 yrs) with AD haven been investigated by specific IgE, prick-to-prick tests (native food), prick tests (pollen), and oral provocation tests. As “positive” patients were diagnosed when specific IgE and positive skin test and a positive clinical reaction (or a clear positive personal history) were observed.RESULTS: 60.1% demonstrated a clinical relevant allergy caused by pollen-associated foodstuff. In 35% the diagnosis was newly established. 51.5% reacted to more than one allergen: hazelnut (42%), raw apple (29,5%) almonds (25.0%), walnut (23.7%) and carrots (14.4%). The strongest prick test reaction was observed for grass and rye pollen. Mean IgE level of all patients was 3,459 U/l (7-47,690 U/l). Specific IgE against pollen was clustered (Immuno CAP low: levels 1-3; high: 4-6): high sensitization was observed against grass (41.4%), rye (40.7%), mugwort (28.9%) and birch (27.4%), respectively. Sensitization against egg, peanut, soy, fish, wheat, and cow's milk was negligible.CONCLUSIONS: One explanation for the rather high rate of patients with a clinically relevant food allergy could be a selection due to severity of their skin disease. It is of great interest whether this subgroup would have a clinical benefit using SIT against pollen regarding both the severity of the skin disease and induction of tolerance against food allergens, respectively. RATIONALE: The aim of our study was to analyze both the frequency and the clinical relevance of pollen-associated food allergies in patients hospitalized in 2007 due to severe atopic dermatitis (AD). METHODS: 536 patients (330 f, 206 m; mean 29 yrs) with AD haven been investigated by specific IgE, prick-to-prick tests (native food), prick tests (pollen), and oral provocation tests. As “positive” patients were diagnosed when specific IgE and positive skin test and a positive clinical reaction (or a clear positive personal history) were observed. RESULTS: 60.1% demonstrated a clinical relevant allergy caused by pollen-associated foodstuff. In 35% the diagnosis was newly established. 51.5% reacted to more than one allergen: hazelnut (42%), raw apple (29,5%) almonds (25.0%), walnut (23.7%) and carrots (14.4%). The strongest prick test reaction was observed for grass and rye pollen. Mean IgE level of all patients was 3,459 U/l (7-47,690 U/l). Specific IgE against pollen was clustered (Immuno CAP low: levels 1-3; high: 4-6): high sensitization was observed against grass (41.4%), rye (40.7%), mugwort (28.9%) and birch (27.4%), respectively. Sensitization against egg, peanut, soy, fish, wheat, and cow's milk was negligible. CONCLUSIONS: One explanation for the rather high rate of patients with a clinically relevant food allergy could be a selection due to severity of their skin disease. It is of great interest whether this subgroup would have a clinical benefit using SIT against pollen regarding both the severity of the skin disease and induction of tolerance against food allergens, respectively.

Impact of native, heat‐processed and encapsulated hazelnuts on the allergic response in hazelnut‐allergic patients

Pollen-associated food allergy is common. However, systemic reactions or even life-threatening anaphylaxis are rare. The aim of this study was to investigate the clinical impact of native, heat-processed and encapsulated hazelnuts (HN) in patients with proven HN allergy. One hundred and thirty-two patients with a positive history of HN allergy were recruited. Sensitization was confirmed by a skin prick test (SPT) and sIgE against HN. After an HN-free diet, double-blind placebo-controlled challenges were performed with increasing amounts of native and roasted HN. A subset of patients were given HN capsules to circumvent the oral mucosa. Basophil activation was measured by flow cytometry before and after provocation but also ex vivo using native and roasted HN extracts. Three groups of HN-allergic patients were identified depending on their clinical reaction pattern. The dosages by which allergic reactions were elicitated varied for native HN from 0.01 to 2.0 g, with a median of 0.1 g, for roasted HN from 0.01 to 10.0 g, with a median of 0.23 g, and for encapsulated HN from 0.1 to 3.0 g, with a median of 0.3 g. Accordingly, the SPT was more frequently positive and resulted in greater weal reactions if native HN was used. This finding was confirmed by ex vivo basophil activation showing that significantly higher allergen extract concentrations (roasted>native) were necessary to induce 50% basophil activation. Our data show that heat processing of HN reduces its allergenicity. SPT but also the basophil activation test can be used to determine the reactivity of an allergen extract.