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Sensitization and allergy to pineapple and coconut juice in patients followed up for allergic diseases in Parakou, Benin
Abstract
Objectives
Little is known about adverse food reactions. The aim of this study was to investigate the sensitization and allergy to two tropical fruits, pineapple ( Ananas comosus ) and coconut ( Cocos nucifera ), among patients followed up for allergic disease in Borgou Teaching Hospital in Parakou, Benin.
Materials and Methods
A prospective cross-sectional study was conducted in 2021. Adult patients (≥18 years) who were followed up for allergic asthma, rhinitis, or conjunctivitis were included in the study. Information on clinical manifestations following pineapple juice or coconut water drinking was collected, and skin prick testing was carried out.
Results
Overall, 101 patients were enrolled, male-female ratio of 0.4:1 and mean age of 33.4 (±14.4) years. Clinical manifestations were triggered by pineapple in 53.5%, mainly mouth and lip pruritus (38.6%). The prevalence of sensitization was 36.6%. Allergy was diagnosed in 24.8% (or 46.3% of those who complained) and was associated with mouth and lip pruritus (odds ratio [OR] = 4.1; 95% confidence interval [CI] = 1.6–10.6; P = 0.003), bronchospasm (OR = 3.7;95%CI = 1.1–12.7; P = 0.031), allergic rhinitis (OR = 3.5; 95%CI = 1.2–10.4; P = 0.020), and conjunctivitis (OR = 4.4; 95%CI = 1.6–12.5; P = 0.007). Clinical manifestations after ingestion of coconut water reportedly occurred in 18.8% and were mostly bronchospasm (8.9%). The prevalence of sensitization was 20.8%. Allergies were diagnosed in 6.9% (or 33.3% of those who complained), with no association found with demographic or clinical characteristics.
Conclusion
Pineapple is a common cause of food allergy among patients who are followed up in Borgou Teaching Hospital, while coconut is less responsible for this disorder. More studies are required to improve knowledge of allergic diseases in Sub-Saharan Africa, which is facing an epidemiological transition.
Food allergy is an aberrant immunological response to food antigen, which can result in potentially life-threatening reactions. It is often challenging to differentiate food allergy from other adverse reactions to food because their presentations can be indistinguishable. The purpose of this article is to give an overview of the classification, evaluation, and management of adverse food reactions, key differentiating features of food allergy, roles and limitations of various food allergy testing, and promising areas of emerging research. Case studies are used to highlight some of the clinical pearls in diagnosing and managing food-related diseases.
Foods can induce adverse reactions by a variety of mechanisms. An understanding of the characteristic signs and symptoms and the related mechanisms of adverse food reactions allows the clinician to efficiently diagnose and treat patients. Adverse reactions to foods can be classified based on whether there is a nonimmunologic or immunologic basis for symptoms. Food intolerance, or a nonimmunologic reaction, includes a range of responses to foods that result primarily from an individual’s intrinsic inability to metabolize a component of the food, e.g. , lactose sugar in dairy products. Other nonimmunologic adverse reactions may be attributed to food toxins or pharmacologic properties pharmacologic properties of foods themselves. Immunologic adverse reactions, in contrast, involve immune responses to food and are termed food allergy. Food allergy may further be categorized based on the underlying immunopathophysiology as immunoglobulin E (IgE) mediated, non‐IgE mediated, or cell mediated. Some chronic allergic responses involve a combination of immune mechanisms. This review provides a general classification system for adverse food reactions and describes specific conditions.
Food allergy (FA) is currently a significant health care problem in the developing world. Widely varying study populations and methodologies, the use of surrogate markers such as self report or hospitalization rates due to anaphylaxis rather than objective methods, limits robust estimation of FA prevalence in low income settings. Also, allergy is under-recognized as a clinical specialty in the developing world which compromises the chance for accurate diagnosis. In this review, most published data on food allergens from developing or low income countries are displayed. The diagnostic challenges and limitations of treatment options are discussed. It seems that FA is an under-appreciated health care issue in the developing world, and accurate determination of its burden in low-income settings represents an important unmet need. Multicenter surveillance studies, using standardized methodologies, are, therefore, needed to reveal the true extent of the problem and provide epidemiological clues for prevention. Preventive strategies should be tailored to fit local circumstances in different geographic regions. In addition, studying the gene environment interactions and impact of early life microbiota on the expression of FA in developing communities would be worthwhile. Efforts and resources should be directed toward public health education and training of health care providers dealing with food allergic patients. Keywords: Food allergy, Developing countries, Low income, Allergens, Diagnosis, Treatment, Unmet needs
Background:
Oral allergy syndrome (OAS) is an immediate allergy caused by a cross-reaction of highly homologous common antigens (pan-allergens) contained in fruits/vegetables and pollen.
Methods:
A questionnaire was provided to 6824 outpatient visitors and serum levels of specific IgEs against crude antigens and pan-allergen components were measured to study the relationship between the prevalence of OAS and pollinosis in the Fukui Prefecture where there is almost no dispersal of birch pollen.
Results:
The prevalence of OAS was 10.8%. The rate of pollinosis complication in the OAS group was 67.4%, and OAS was observed in 16.8% of pollinosis patients. Causative foods in order of frequency were melon, pineapple, kiwi fruit, peach, and apple. A significantly higher number of patients from the OAS group were positive for birch, alder, and timothy grass-specific IgE. The rate of positivity for anti-component IgE corresponding to pollen in OAS group was also significantly higher. Of 34 patients with OAS caused by eating apples, 28 (82.4%) were positive for Mal d1-specific IgE. Of the 52 patients with peach-induced OAS, 41 (78.8%) were positive for Pur p1-specific IgE. The concordance rates between crude antigen-specific IgE and anti-PR-10 component-specific IgE were 87.1% and 93.3% for apple and peach respectively.
Conclusions:
In regions where birch pollen is not dispersed, OAS patients have a significant association with the onset of Bet v1-associated allergy. Anti-PR-10 component IgE was useful in diagnosing OAS, and crude antigen-specific IgE was also associated with apple and peach allergies.
Pineapple is the third most important tropical fruit in the world. It is known as the queen of fruits due to its excellent flavor and taste. It is good for the digestive system and helps in maintaining ideal weight and balanced nutrition. Processed pineapples are consumed worldwide and processing industries are trying out or using new technologies to retain the nutritional quality of the pineapple fruit. This is to meet the demand of consumers who want healthy, nutritious and natural products. The main objective of processing technique is to convert perishable fruits into stable products with longer life. Main purpose of processing is to minimize the qualitative and quantitative deterioration of the produce after harvest. Major export products include dried and preserved vegetables, jams, fruit juice, candy, wine. Moreover, some of these preserved products such as canned pineapple, fruit juices, dehydrated products and frozen fruits are gaining popularity in the foreign market and are good foreign exchange earners. In India only 2.2% of the total produce is processed as compared to 40 to 83% in developed countries.
Purpose:
Pollen-food allergy syndrome (PFAS) is an immunoglobulin E (IgE)-mediated allergy in pollinosis patients caused by raw fruits and vegetables and is the most common food allergy in adults. However, there has been no nationwide study on PFAS in Korea. In this study, we investigated the prevalence and clinical characteristics of PFAS in Korea.
Methods:
Twenty-two investigators participated in this study, in which patients with allergic rhinoconjunctivitis and/or bronchial asthma with pollen allergy were enrolled. The questionnaires included demographic characteristics, a list of fruits and vegetables, and clinical manifestations of food allergy. Pollen allergy was diagnosed by skin prick test and/or measurement of the serum level of specific IgE.
Results:
A total of 648 pollinosis patients were enrolled. The prevalence of PFAS was 41.7% (n = 270). PFAS patients exhibited cutaneous (43.0%), respiratory (20.0%), cardiovascular (3.7%) or neurologic symptoms (4.8%) in addition to oropharyngeal symptoms. Anaphylaxis was noted in 8.9% of the PFAS patients. Seventy types of foods were linked to PFAS; e.g., peach (48.5%), apple (46.7%), kiwi (30.4%), peanut (17.4%), plum (16.3%), chestnut (14.8%), pineapple (13.7%), walnut (14.1%), Korean melon (12.6%), tomato (11.9%), melon (11.5%) and apricot (10.7%). Korean foods such as taro/taro stem (8.9%), ginseong (8.2%), perilla leaf (4.4%), bellflower root (4.4%), crown daisy (3.0%), deodeok (3.3%), kudzu root (3.0%) and lotus root (2.6%) were also linked to PFAS.
Conclusions:
This was the first nationwide study of PFAS in Korea. The prevalence of PFAS was 41.7%, and 8.9% of the PFAS patients had anaphylaxis. These results will provide clinically useful information to physicians.
Despite concerns voiced often by food-allergic patients, allergy to coconut is rare, not directly associated with nut allergy and few cases are reported so far in the literature. We present an interesting case of coconut allergy in a child that was previously tolerant to coconut and regularly exposed via both the skin and gastrointestinal route.
Introduction:
The oral allergy syndrome (OAS) is a particular type of food allergy rarely explored in the paediatric population that is already considered an adult problem.
Objective:
Identify the prevalence of OAS, symptoms and pollen species associated with its presence in children affected by allergic diseases.
Methods:
A cross-sectional study was conducted. Consecutive sampling included children from 6 to 14 years who needed allergy treatment for the first time. A structured questionnaire was carried out to collect demographic and clinical data and history of OAS. Besides sensitisation to various allergens, the skin prick-by-prick test was performed to corroborate sensitisation to food related to OAS. Prevalence of OAS and its association with pollens was established following the covariate adjusted logistic regression.
Results:
267 subjects were included. Overall prevalence of OAS was 8.9% (95%CI 6.1-13.1%). Prevalence of OAS for allergic rhinitis and asthma were 8.8% and 9.1%, respectively. In patients sensitised to pollen, the prevalence ranged from 9.6% to 12.2% depending on the type of pollen. 62.5% of children with OAS were sensitive to pineapple. After adjusting for gender and family history of atopic disease, trees from the Quercus species showed an association with OAS (OR=2.7, 95%CI 1.2-6.2).
Conclusions:
OAS is not uncommon in our environment. Pineapple, a typical fruit from the region, was the main food related. Quercus sp., but not birch nor olive, was the pollen associated with this syndrome.
Coconut pollen, one of the major palm pollen grains is an important constituent amongst vectors of inhalant allergens in India and a major sensitizer for respiratory allergy in susceptible patients. To gain insight into its allergenic components, pollen proteins were analysed by two-dimensional electrophoresis, immunoblotted with coconut pollen sensitive patient sera followed by mass spectrometry of IgE reactive proteins. Coconut being largely unsequenced, a proteomic workflow has been devised that combines the conventional database dependent analysis of tandem mass spectral data and manual de novo sequencing followed by a homology-based search for identifying the allergenic proteins. N-terminal acetylation helped to distinguish 'b' ions from others, facilitating reliable sequencing. This led to the identification of 12 allergenic proteins. Cluster analysis with individual patient sera recognised vicilin-like protein as a major allergen which was purified to assess its in-vitro allergenicity and partially sequenced. Other IgE-sensitive spots showed significant homology with well known allergenic proteins such as 11S globulin, enolase, isoflavone reductase along with a few which are reported as novel allergens. The allergens identified can be used as potential candidates for hypoallergenic vaccine development, design specific immunotherapy trials and enrich the repertoire of existing IgE reactive proteins.
In the African continent, the sensitization pattern and clinical profile are unknown in patients with rhinitis/rhinosinusitis attending the outpatient ear, nose, and throat (ENT) clinics. We therefore aimed to analyze the clinical characteristics of rhinitis/rhinosinusitis patients in Democratic Republic of Congo (DRC), classify allergic rhinitis (AR) according to the Allergic Rhinitis and Its Impact on Asthma criteria, and evaluate the sensitization profile and its associated factors. From January to May 2009, 423 patients with rhinitis symptoms attending the Outpatient ENT clinic of the University Hospital and Saint Joseph Hospital of Kinshasa were evaluated for allergy symptoms, severity, and duration of symptoms and underwent skin-prick tests (SPTs) for a panel of 15 allergens. Of 423 patients 35.2% had positive SPT results, with 40.9% showing polysensitization. Dermatophagoides pteronyssinus (DPT) (68.5%) and cockroach (36.2%) were the most common allergens among sensitized patients. Patients with rhinitis/rhinosinusitis mainly presented in decreasing order with sneezing, facial pain/pressure, nasal obstruction, postnasal discharge, nose itching, clear nasal discharge, and eye itching. Persistent and moderate/severe AR represented 61.4 and 69.3%, respectively. Sensitization was independently associated with younger age, rhinoconjunctivitis, and reaction to nonspecific trigger factors. In conclusion, 35.2% of patients attending the ENT Outpatient Clinic in DRC for rhinitis problems had a positive SPT to at least one allergen, with mainly DPT and cockroach allergens being involved; and a substantial portion showed persistent and moderate/severe AR. Therefore, allergy should not be neglected as an etiologic factor in rhinologic disease in the African continent.
A review of case reports of anaphylactic shock and lethal anaphylaxis caused by food consumption occurring in China was conducted. Case reports published in Chinese medical journals from 1980 to 2007 were considered in the review. According to these reports, the most common allergenic offenders were pineapple, soft-shelled turtle and crab.
Coconut, Cocos nucifera L., is a tree that is cultivated for its multiple utilities, mainly for its nutritional and medicinal values. The various products of coconut include tender coconut water, copra, coconut oil, raw kernel, coconut cake, coconut toddy, coconut shell and wood based products, coconut leaves, coir pith etc. Its all parts are used in someway or another in the daily life of the people in the traditional coconut growing areas. It is the unique source of various natural products for the development of medicines against various diseases and also for the development of industrial products. The parts of its fruit like coconut kernel and tender coconut water have numerous medicinal properties such as antibacterial, antifungal, antiviral, antiparasitic, antidermatophytic, antioxidant, hypoglycemic, hepatoprotective, immunostimulant. Coconut water and coconut kernel contain microminerals and nutrients, which are essential to human health, and hence coconut is used as food by the peoples in the globe, mainly in the tropical countries. The coconut palm is, therefore, eulogised as 'Kalpavriksha' (the all giving tree) in Indian classics, and thus the current review describes the facts and phenomena related to its use in health and disease prevention.
Coconut water (coconut liquid endosperm), with its many applications, is one of the world's most versatile natural product. This refreshing beverage is consumed worldwide as it is nutritious and beneficial for health. There is increasing scientific evidence that supports the role of coconut water in health and medicinal applications. Coconut water is traditionally used as a growth supplement in plant tissue culture/micropropagation. The wide applications of coconut water can be justified by its unique chemical composition of sugars, vitamins, minerals, amino acids and phytohormones. This review attempts to summarise and evaluate the chemical composition and biological properties of coconut water.
Pineapple (Ananas comosus) is a tropical fruit that is highly relished for its unique aroma and sweet taste. It is renowned as a flavourful fruit since it contains a number of volatile compounds in small amounts and complex mixtures. Pineapple is also a rich source of minerals and vitamins that offer a number of health benefits. Ranked third behind banana and citrus, the demand for pineapple has greatly increased within the international market. The growth of the pineapple industry in the utilisation of pineapple food-based processing products as well as waste processing has progressed rapidly worldwide. This review discusses the nutritional values, physicochemical composition and volatile compounds, as well as health benefits of pineapples. Pineapple contains considerable amounts of bioactive compounds, dietary fiber, minerals, and nutrients. In addition, pineapple has been proven to have various health benefits including anti-inflammatory, antioxidant activity, monitoring nervous system function, and healing bowel movement. The potential of food products and waste processing of pineapples are also highlighted. The future perspectives and challenges with regard to the potential uses of pineapple are critically addressed. From the review, it is proven that pineapples have various health benefits and are a potential breakthrough in the agricultural and food industries.
The EATERS mnemonic is a novel method for taking an allergy focused clinical history. It provides a degree of certainty for diagnosing food allergy and can be used in both IgE and non IgE mediated reactions. EATERS will allow health care professionals to use their existing clinical skills to interpret the history of an allergic reaction, and by doing so will help to make sense of allergy test results.
Background: Food allergy is deemed to have a worldwide prevalence ranging from 2 to 10 %. Objective: To determine the frequency of skin reactivity to food allergens by age groups. Methods: Cross-sectional, descriptive, prolective, observational study. Patients aged from 2 to 64 years with symptoms consistent with allergic disease were included. Skin prick tests were carried out with food allergens. Frequencies and percentages were estimated. Results: One-hundred and ninety-one patients were included, out of which 63.4% were females. Mean age was 22.5 years; 19.3 % showed positive skin reactivity to at least one food. Distribution by age group was as follows: preschool children 13.5 %, schoolchildren 24.3 %, adolescents 2.7 % and adults 59.5 %. Diagnoses included allergic rhinitis in 84.3 %, asthma in 19.4 %, urticaria in 14.1 % and atopic dermatitis in 8.4 %. Positive skin reactivity frequency distribution in descending order was: soybeans with 5.2 %, peach with 4.7 %, grapes, orange and apple with 3.6 %, nuts with 3.1 %, pineapple, avocado, tomato and tuna with 2.6 %. Conclusion: The frequency of skin reactivity to food allergens was similar to that reported in the national and Latin American literature, but sensitization to each specific allergen varied for each age group.
The objective of this work was to identify the main allergenic proteins and to assess the influence of high hydrostatic pressure (HHP) on the potential allergenicity of HHP pineapple juice. Fresh pineapple juice was treated with different pressures and the allergenic proteins were extracted and analyzed by SDS-PAGE, Western bloting and LC-MS/MS. The main allergenic proteins were detected as 24-kDa and 14-kDa bands by serum of pineapple-allergic patients. LC-MS/MS analysis of these bands showed that they actually consisted of a mixture of several isotypes of cysteine proteinases. Among these, bromelain [Ananas comosus] is a known allergen named Ana c 2 and it is highly homologous to other cysteine proteinases. ELISA assay of HHP pineapple juice carried out at ambient temperature (18-22℃) showed that the higher the pressure, the higher the reduction in allergenicity, yielding a maximum reduction of about 20% under 500MPa. However, in the case of 400MPa and 50℃, the reduction rate of allergenicity was higher, up to 50% compared to that of the sample at 20℃ without HHP treatment. Taken together, the results suggested that high pressure treatment could alter the potential allergenicity of pineapple juice allergens and identified Ana c 2 and a few other related cysteine proteinases as the main allergens.
Accurately diagnosing a patient with a possible food allergy is important to avoid unnecessary dietary restrictions and prevent life-threatening reactions. Routine testing modalities have limited accuracy, and an oral food challenge is often required to make a definitive diagnosis. Given that they are labor intensive and risk inducing an allergic reaction, several alternative diagnostic modalities have been investigated. Testing for IgE antibodies to particular protein components in foods has shown promise to improve diagnostics and has entered clinical practice. Additional modalities show potential, including epitope binding, T-cell studies, and basophil activation.
Copyright © 2015 Elsevier Inc. All rights reserved.
Fruit bromelain was extracted from the fruit of pineapples. Crude enzyme extract was subjected to heat treatment at 40-80°C for 0-60 min. The temperature stability profiles as a function of different time intervals showed higher retention of enzyme activity at low temperature. Incubation at 40°C showed no loss of fruit bromelain activity up to 60 min, whereas at 50°C almost 83% of activity remained. Incubation at 80°C for 8 min caused almost complete activity loss. Thermal inactivation of fruit bromelain in the temperature range 40-80°C was described by a first-order model. The calculated activation energy (Ea) value for fruit bromelain was 313.18 ± 57.44 kJ/mol.
RationaleAllergy to coconut (Coccus Nucifera, Arecaceae's family) it is a very uncommon entity. A few published reports sign out immunologic cross-reactivity between coconut and nuts, soybean and legumes.MethodsA 64 year-old woman, with hypertension and autoimmune thyroiditis, referred a few minutes after eating a coconut biscuit, a generalized urticaria, facial and uvula edema, dysphagia and dyspnea. A similar second episode was followed by bronchoconstriction, hypotension (100/60) and hypoxemia (PaO2:58) minutes after eating a Spanish sweet containing coconut, almond, sugar, milk, cocoa and yolk. It subsided in a few hours after symptomatic therapy in the emergency room. Next, she tolerated almond, milk, egg, sugar, cocoa, date, other nuts and legumes.ResultsSkin prick tests (SPT) were strongly positive to coconut pulp (19×10 mm) and coconut milk (13×10 mm), with a late skin reaction 4-6 hours later (edema and erithema). SPT were negative to palmate, date, palm pollen, peanut, almond, pistachio nut, walnut, hazelnut, sweet chestnut, soybean, cocoa, chickpea, lentil, mustard and latex. Specific Ig E (CAP Pharmacia™) to coconut measured 20,8 KU/L and was negative to nuts, legumes and soybean. Multiple specific Ig E reacting bands to coconut milk and coconut pulp as well as to dry commercial coconut powder were revealed by immunoblotting. The most prominent had an apparent molecular weight of 18, 22 and 28 kD.Conclusions
We report an IgE-mediated anaphylaxis to coconut, demonstrated by SPT, specific Ig E and immunoblotting. No clinical or immunological cross-reactivity was found with other related fruits. The main allergens measured 18, 22, and 28 kD.
Adverse reactions to foods are classified according to the presence or absence of involvement of the immune system, which may or may not include the production of immunoglobulin E (IgE) antibodies. This review focuses on the epidemiology, diagnosis, and management of adverse food reactions, primarily in adults, and excluding celiac disease and lactose intolerance. Reported reactions to foods are often believed to be manifestations of a food allergy; however, IgE-mediated food allergy only affects 1% to 4% of adults, with seafood, tree nuts, peanuts, fruits, and vegetables being the most common triggers. Diagnosis is challenging and most commonly achieved through careful evaluation of clinical history followed by elimination and reintroduction or challenge with the suspected offending food. With acute-onset allergic reactions, estimation of food-specific IgE antibodies is frequently used to confirm or refute the diagnosis. Recent developments, such as single allergen assays, enhance the diagnosis of IgE-mediated food allergy, but the gold standard remains oral food challenge. Despite recent advances in the management of food allergy, including the promotion of oral tolerance, the mainstay of management is still the avoidance of food triggers. Dietary management can be compromised by nutritional inadequacy, accidental exposure, food labeling, and quality of life or adherence issues. It is essential that adults with confirmed food allergy receive optimal nutrition and dietetic support to enable them to manage their condition.
Epidemiological data on food allergy are scarce in African countries. We studied the prevalence of food sensitization in Ghanaian schoolchildren.
Children (5-16 years; n = 1,714) from 9 Ghanaian schools were given parental consent to participate in the study. Adverse reactions and food consumption were determined by a questionnaire and atopy by skin prick testing (SPT) to peanut and 6 fruits. Subjects with positive SPTs were considered cases (n = 43) and matched with at least 1 control (n = 84), using age, sex, and school as matching criteria. Serum samples from case-control sets were analyzed for specific IgE (sIgE) to foods that elicited a positive SPT response in cases.
Overall, 11% of 1,407 children reported adverse reactions to foods, and 5% of 1,431 children showed a positive SPT reaction mostly directed against peanut and pineapple (both 2%). Although there was a positive association between adverse reactions and SPT responses to any food allergen in the urban children (adjusted OR = 3.6, 95% CI 1.2-10.8), most of the reported adverse reactions were not in children showing an SPT reaction to the specific food item. sIgE sensitization was very variable for the different foods, ranging from 0 to 100% in cases, and from 0 to 25% among controls. High IgE levels for a food item significantly increased the risk of SPT positivity to any food item in the urban, but not in the rural, schoolchildren.
Specific foods were identified to be allergenic in Ghana. We show a good association between SPT and sIgE in urban, but not in rural, schoolchildren. However, there was no clear association between reported adverse reactions to food and SPT or sIgE.
rising prevalence of food hypersensitivity (FHS) and severe allergic reactions to foods have been reported in the last decade. However, little is known on the prevalence in young adults. This study estimated the prevalence of FHS to the most common allergenic foods in an unselected population of young adults. We investigated a cohort of 1272 young adults 22 years of age by questionnaire, skin prick test (SPT) and histamin release (HR) followed by oral challenge to the most common allergenic foods. FHS was divided into primary and secondary FHS. Primary FHS was defined as being independent of pollen sensitization, whereas secondary FHS was defined as reactions to pollen related fruits and vegetables in pollen allergic patients. The questionnaire was returned by 77.1%. Primary FHS was reported by 19.6% and secondary FHS by 16.7% of the participants. Confirmed primary FHS by oral challenge was 1.7% [1.1% - 2.95%]. In primary FHS, the most common allergenic food was peanut (0.6%) followed by additives (0.5%), shrimp (0.2%), codfish (0.1%), cow's milk (0.1%), octopus (0.1%) and soy (0.1%). In secondary FHS, kiwi allergy was reported by 7.8% of the participants followed by hazelnut (6.6%), pineapple (4.4%), apple (4.3%), orange (4.2%), tomato (3.8%), peach (3.0%) and brazil nut (2.7%). This study found a 1.7% [1.1% - 2.95%] prevalence of primary FHS confirmed by oral challenge to the most common allergenic foods in an unselected population of young adults.
After a short description of the uses of pineapple as folk medicine by the natives of the tropics, the more important new pharmaceutical applications of bromelain, reported between 1975 and 1978, are presented. Although the exact chemical structure of all active components of bromelain is not fully determined, this substance has shown distinct pharmacological promise. Its properties include: (1) interference with growth of malignant cells; (2) inhibition of platelet aggregation; (3) fibrinolytic activity; (4) anti-inflammatory action; (5) skin debridement properties. These biological functions of bromelain, a non-toxic compound, have therapeutic values in modulating: (a) tumor growth; (b) blood coagulation; (c) inflammatory changes; (d) debridement of third degree burns; (e) enhancement of absorption of drugs. The mechanism of action of bromelain affecting these varied biological effects relates in part to its modulation of the arachidonate cascade.
An association between allergies to latex proteins and to various foods has been reported and confirmed by RAST and immunoblotting inhibition. However, no significant data had been collected on the frequency of specific IgE antibodies to fruits in these patients and the frequency of a history of fruit intolerance. Serum samples of 136 patients with well-documented, clinically relevant, immediate-type hypersensitivity against latex proteins were analyzed for IgE antibodies against a panel of different fruits. Patient history of food intolerance was documented by a standardized questionnaire. Fruit-specific IgE antibodies were detected in 69.1% of serum samples. Cross-reacting IgE antibodies recognizing latex and fruit allergens (papaya, avocado, banana, chestnut, passion fruit, fig, melon, mango, kiwi, pineapple, peach, and tomato) were demonstrated by RAST-inhibition tests. Of our patients, 42.5% reported allergic symptoms after ingestion of these fruits and a total of 112 intolerance reactions were recorded. However, fruit-specific IgE antibodies were detected only in serum samples from 32.1% of the patients who perceived symptoms due to these fruits. Thus, serologic tests seem to be of low significance for prediction o food allergy in latex-allergic patients.
There have been reports of increased prevalence of certain food allergies in patients with Type I latex allergy (LA). A detailed food allergy history was obtained from 137 patients with LA. Latex allergy was defined by positive history of IgE mediated reactions to contact with latex and positive skin prick test to latex and/or positive in vitro test (AlaSTAT and/or Pharmacia CAP). Food allergy was diagnosed by a convincing history of possible IgE mediated symptoms occurring within 60 minutes of ingestion. We identified 49 potential allergic reactions to foods in 29 (21.1%) patients. Foods responsible for these reactions include banana 9 (18.3%), avocado 8 (16.3%), shellfish 6 (12.2%), fish 4 (8.1%), kiwi 6 (12.2%), tomato 3 (6.1%), watermelon, peach, carrot 2 (4.1%) each, and apple, chestnut, cherry, coconut, apricot, strawberry, loquat, one (2.0%) each. Reactions to foods included local mouth irritation, angioedema, urticaria, asthma, nausea, vomiting, diarrhea, rhinitis, or anaphylaxis. Our study confirms the earlier reports of increased prevalence of food allergies in patients with LA. We also report increased prevalence of shellfish and fish allergy not previously reported. The nature of cross reacting epitopes or independent sensitization between latex and these foods is not clear.
The so-called 'latex-fruit syndrome' is a well-documented phenomenon in cross-reactive allergies. By contrast, there is a lack of information about allergy to exotic fruits in patients with a predominant pollen sensitization. Since the ubiquitous protein profilin has been identified as an allergen in natural rubber latex as well as in pollen-related foods, the aim of this study was to investigate the role of profilin in allergy to certain exotic fruits.
Recombinant profilins from banana and pineapple were cloned by a PCR technique after isolation of total RNA using degenerated profilin-specific primers. The unknown 5' ends of copy DNA (cDNA) were identified by rapid amplification of 5'cDNA ends (5'-RACE) and expression in Escherichia coli BL21(DE3) cells. The recombinant profilins were purified by affinity chromatography using poly-(L)-proline as the solid phase. IgE-binding capabilities were characterized by means of immunoblot and Enzyme Allergosorbent Test (EAST). The cross-reactivity to birch pollen profilin and latex profilin was studied by EAST as well as by immunoblot inhibition experiments.
Both banana and pineapple profilin were found to consist of 131 amino acid residues with high amino acid sequence identity to known allergenic pollen and food profilins (71-84%). IgE binding to the recombinant profilins was observed in 7/16 sera from subjects with suspected banana allergy (44%) and in 8/19 sera from subjects with suspected pineapple allergy (42%). Inhibition experiments indicated similar IgE reactivity of natural and recombinant allergens. In addition, high cross-reactivity to birch pollen profilin Bet v 2 and latex profilin Hev b 8 was demonstrated by immunoblot inhibition as well as EAST inhibition experiments.
Since a high IgE-binding prevalence of about 40% was obtained in both banana and pineapple allergy, we conclude that profilin is an important mediator of IgE cross-reactivity between pollen and exotic fruits.
Coconut (Cocos nucifera) is a monocotyledonous plant of the Arecaceae family. Allergy to coconut is infrequent, with only 5 cases reported so far in the medical literature.
To identify coconut allergens in 2 patients allergic to this food.
We describe 2 patients allergic to coconut: an adult pollen-allergic patient monosensitized to coconut who presented with severe oropharyngeal symptoms and a child with a previous allergy to walnut, not allergic to pollen, who developed anaphylaxis on coconut ingestion. Both patients had positive skin prick test results and serum specific IgE (CAP) to coconut. IgE sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting was performed to identify the allergens involved, and a strong IgE binding band detected in both patients was further analyzed by matrix-assisted laser desorption/ionization time-of-flight mass spectroscopy (MALDI-TOF MS). Stability to pepsin digestion of the coconut extract and its cross-reactivity with tree nuts were studied.
An immunoblot showed an almost identical profile of IgE binding proteins in the coconut extract in both patients who reacted strongly to a band of approximately 29 kDa. The peptide analysis by MALDI-TOF MS of this band obtained the sequence GHGKREDPEKR. The protein with the highest correlation with this peptide was found to be a 7S globulin from Elaeis guineensis, another oil palm species also belonging to the Arecaceae family. The 29-kDa band was digested by pepsin in less than 1 minute. Cross-reactivity among coconut, walnut, and hazelnut was demonstrated by CAP inhibition in patient 2.
We have identified a 7S storage protein as a novel coconut allergen.
Recommandations de la SPLF sur asthme et allergie. Conférence d'expert-Texte court
- Société de Pneumologie de Langue Française
Intérêt des allergènes recombinants dans la pratique de l'allergologie
- Karoui