Association between fruit and vegetable allergies and pollen-food allergy syndrome in Japanese children: a multicenter cross-sectional case series

BACKGROUND: Recently, the prevalence of food allergies during childhood is increasing, with fruits being common allergens. However, data on allergens that cause fruit and vegetable allergies and pollen-food allergy syndrome (PFAS) in childhood are relatively few. This study aimed to examine the allergens in fruit and vegetable allergies in pediatric patients and to determine the association between fruit and vegetable allergies and PFAS.OBJECTIVE: This study aimed to examine the current status of fruit and vegetable allergies in Japanese children.METHODS: This was a multicenter case series observational study. The participants included children aged <15 years who developed allergic symptoms after eating fruits and vegetables and subsequently received treatment in the Pediatric Department of 6 hospitals in the Osaka Prefecture in Japan during the study period from August 2016 to July 2017. Participants' information was obtained using a questionnaire, and data were obtained by performing several types of allergy tests using blood samples.RESULTS: A total of 97 children (median age, 9 years; 56 males) were included in the study. Apple was the most common allergen, followed by peach, kiwi, cantaloupe, and watermelon. A total of 74 participants (76%) exhibited allergic symptoms due to PFAS; moreover, pathogenesis-related protein-10 (PR-10) was the most common allergen superfamily. On the contrary, in the group where neither PR-10 nor profilin was sensitized, kiwi and banana were the most common allergens, and the age of onset was lower than that in the PFAS group. Specific antibody titer was significantly associated with Birch for Bet v1 and latex for Bet v2 (r = 0.99 and r = 0.89).CONCLUSION: When we examine patients with fruit and vegetable allergies, we should first consider PFAS even in childhood specifically for children greater than 4 years old.

Mugwort Pollen-Related Food Allergy: Lipid Transfer Protein Sensitization and Correlation With the Severity of Allergic Reactions in a Chinese Population

PURPOSE: Little is known about the importance of lipid transfer protein (LTP) sensitization in China. In this study, we investigated the relationship between LTP sensitization and the severity of clinical symptoms in a population of patients with mugwort pollen-related food allergy. METHODS: Food-induced symptoms were evaluated in 148 patients with mugwort pollen allergy by a standardized questionnaire. Specific immunoglobulin E (IgE) to Art v 1, Art v 3, Pru p 3, Ara h 9 and Cor a 8 were quantified by ImmunoCAP. Immunoblotting of peach extracts were performed with sera from peach-allergic patients. RESULTS: In total, 72% (107/148) of the study population experienced food allergy. Forty-eight percent (51/107) of patients with mugwort pollen-related food allergy experienced at least 1 episode of food-induced anaphylaxis. Food allergy correlated with IgE reactivity to Art v 3, but not to Art v 1. Sensitization to Pru p 3, Ara h 9 or Cor a 8 was prevalent (80%, 69 or 63%, respectively) among individuals with food allergy. Food allergic patients with systemic reactions (SR) had higher values for Pru p 3, Ara h 9 and Cor a 8 than patients with oral allergy syndrome (OAS). Furthermore, the strong IgE reactivity detected in immunoblots of peach extracts indicated that Pru p 3 was the major allergen and was more prevalent in patients with SR than in patients with OAS (100% vs. 55%). CONCLUSIONS: LTPs are major food allergens for mugwort pollen-related food allergy in China, and may contribute to SR.

Determinação da potência relativa de extratos alergênicos de Phleum pratense por testes cutâneos / Establishing the relative potency of Phleum pratense allergenic extracts using skin prick tests

Objetivos: Comparar a potência de extratos europeus de Phleum pratense para imunoterapia sublingual (ITSL), em relação ao extrato referência norte-americano. Métodos: Foram selecionados 15 sujeitos, com idade entre 18 e 55 anos, histórico clínico sazonal compatível e teste cutâneo com alta reatividade a gramíneas. O delineamento de estudo foi transversal, triplo cego e randômico, e comparadas as potências dos seguintes extratos alergênicos para ITSL: (A) Soluprick® (30 HEP/mL) e (B) Grazax® 75.000 SQ-T, ambos os extratos da ALK-Abelló; (C) Oralair® e (D) Staloral®, com 300 IR/mL, Stallergènes, França. O extrato de origem norteamericana (E) foi o padrão, contendo 10.000 BAU/mL. Todos os extratos foram usados em forma de concentrados e nas diluições 1:3, 1:10, e 1:30. Os testes foram aplicados em quadruplicata em dois dias não consecutivos. Os diâmetros de pápula e eritema foram registrados após 15 minutos. Resultados: Não houve diferença significativa entre os testes realizados no primeiro e segundo dias (p = 0,37) com extratos concentrados, na diluição 1:3 e também 1:10 (p = 0,20 e p = 0,33, respectivamente). No segundo dia de testes, a média obtida das pápulas do extrato A foi de 16,7 mm na diluição 1:3; de 14,3 mm na diluição 1:10; e de 9,8 mm na diluição 1:30. Houve diferenças significativas entre os extratos A, B, C, D e E na comparação entre as médias das pápulas obtidas em todas as diluições, mostrando diferença de potência entre os extratos. O diâmetro das pápulas obtidas com o material concentrado, em ordem decrescente de potência, foram C > A > E > D > B. As reações observadas com extratos concentrados mostrou que o mais potente foi Staloral, e o menos potente Grazax. Conclusões: Houve variabilidade significativa de potência nos diversos extratos comparados. Isto reforça a necessidade de padronização de extratos alergênicos para ITSL.

Objectives: To compare the potency of European Phleum pratense pollen extracts for sublingual immunotherapy (SLIT) compared to the U.S. reference extract. Methods: Fifteen subjects aged between 18 and 55 years, with compatible seasonal clinical history and skin tests highly reactive to grass, were selected. The design was cross-sectional, blind, randomized. The following extracts were compared for SLIT: (A) Soluprick® (30 HEP/mL) and (B) Grazax® 75,000 SQ-T, both from ALK-Abelló; (C) Oralair® and (D) Staloral®, with 300 IR/mL, Stallergènes, France. The American extract (E) was the standard 10,000 BAU/mL. Extracts were used in concentrate form and also diluted in 1:3, 1:10, and 1:30 ratios. Tests were applied in quadruplicate on two nonconsecutive days. Skin test reading were done after 15 minutes. Results: There were no significant differences between the tests conducted on the first and second days with the extracts in concentrate form (p = 0.37) or diluted at 1:3 or 1:10 (p = 0.20, p = 0.33, respectively). On the second day of tests, mean wheal sizes obtained with extract A were 16.7 mm with the 1:3 dilution, 14.3 mm with the 1:10 dilution, and 9.8 mm with the 1:30 dilution. There were significant differences between extracts A, B, C, D and E when comparing mean wheal sizes obtained with all dilutions, demonstrating differences in the extracts' potency. Mean wheal diameters obtained with the concentrates, in decreasing order of potency, were C > A > E > D > B. The reactions showed that the most potent extract was Staloral, and the least potent, Grazax. Conclusions: There were significant potency variations in the different extracts assessed. These results reinforce the need for standardization of allergenic extracts used for SLIT.

Chamber and Field Studies demonstrate Differential Amb a 1 Contents in Common Ragweed Depending on CO₂ Levels

Although atmospheric carbon dioxide (CO₂) has no apparent direct effect on human health, it does have direct effects on plants. The present study evaluated the influence of increased CO₂ levels on the concentration of allergens from common ragweed pollen by setting up a chamber study to model future air conditions and a field study to evaluate current air conditions. For the chamber study, we established 20 ragweed plants in an open-top chamber under different CO₂ levels (380–400, 500–520, 600–620, and 1,000–1,100 parts per million [ppm]). For the field study, we established ragweed plants in rural (Pocheon, Gyeonggi-do; mean CO₂ 320±54.8 ppm) and urban (Gangnam, Seoul; mean CO₂ 440±78.5 ppm) locations. Seeds of the common ragweed (Ambrosia artemisiifolia) were obtained from Daejin University. The Amb a 1 protein content of pollen extracts was quantified using a double sandwich enzyme-linked immunosorbent assay. In our chamber study, the median concentration of Amb a 1 in pollen increased with increasing in CO₂ concentration (1.88 ng/µg in 380–400 ppm CO₂; 3.14 ng/µg in 500–520 ppm CO₂; 4.44 ng/µg in 600–620 ppm CO₂; and 5.36 ng/µg in 1,000–1,100 ppm CO₂). In our field study, we found no significantly different concentration of Amb a 1 between the pollen extracts at the Pocheon (mean±standard deviation, 1.63±0.3 ng/µg pollen in 320±54.8 ppm CO₂) and the Gangnam (2.04±0.7 ng/µg pollen in CO₂ in 440±78.5 ppm CO₂) locations, although the concentration of Amb a 1 was increased in the Gangnam than in the Pocheon locations. Our results suggest that future increases in CO₂ levels to more than 600 ppm will significantly elevate the Amb a 1 content in common ragweeds, although the current different CO₂ levels do not cause differences in the Amb a 1 content of ragweed pollen.

Involvement of cross-reactive carbohydrate determinants-specific IgE in pollen allergy testing

BACKGROUND: Specific IgE antibodies against the low-molecular-weight carbohydrate antigen that does not bridge IgE molecules on mast cells are not associated with clinical symptoms. Cross reactivity can be determined in allergen-specific IgE detection assays when the carbohydrate structures between pollen allergens and plant derived food allergens are similar; in such cases, false positive results for grain or legume allergens can be reported for pollen allergic patients who are not sensitized to those allergens. This phenomenon arises owing to the presence of cross-reactive carbohydrate determinants (CCDs). OBJECTIVE: This study aimed to assess the impact of CCD interference on the results for pollen allergen-specific IgE antibodies in the general adult population and to perform CCD inhibition tests evaluating the involvement of CCD on samples positive to pollen allergens. METHODS: Serum samples from 322 subjects were tested for IgE antibodies to pollens and CCD. The research subjects were given questionnaires about pollen allergic symptoms to help assess the presence of allergies. Allergen IgE antibodies for Japanese cedar, Japanese cypress, orchard grass, ragweed, MUXF, bromelain, horseradish peroxidase (HRP), and ascorbate oxidase (ASOD) were analyzed. RESULTS: It was observed that among individuals who tested positive to any of the pollen allergens, the positive ratio of CCD-specific IgE antibody was the highest for HRP (13.5%–50.0%). The results from the inhibition tests revealed that CCD was marginally present. Although IgE antibodies for cedar pollen did not react with CCD, IgE antibodies for Japanese cypress, orchard grass, and ragweed might be detected by the presence of CCD. CONCLUSION: The results of the inhibition tests revealed the obvious presence of CCD suggesting its involvement. Considering these findings, careful evaluation of patient IgE results should be performed for Japanese cypress, orchard grass, and ragweed.

Induction of Bronchial Tolerance After 1 Cycle of Monophosphoryl-A-Adjuvanted Specific Immunotherapy in Children With Grass Pollen Allergies

PURPOSE: Subcutaneous allergen-specific immunotherapy (SCIT) is a well-established and clinically effective method to treat allergic diseases, such as rhinitis and asthma. It remains unclear how soon after initiation of an ultra-short course of grass pollen immunotherapy adjuvanted with monophosphoryl lipid A (MPL)-specific bronchial tolerance can be induced. METHODS: In a prospective study of 69 children double-sensitized to birch and grass pollens (51 males, average age 11.1 years), development of bronchial tolerance after 1 cycle of SCIT for grass was evaluated. In all the patients, the bronchial allergen provocation test (BAP) was performed before and after treatment. According to the results of the first BAP, the patients were divided into 2 groups: those showing a negative BAP with a decrease in FEV1 of or =20% (SAR with allergic asthma [SAR and Asthma] group, n=22). All the patients received MPL-adjuvanted, ultra-short course immunotherapy for birch, but only those with a positive BAP to grass received MPL-SCIT for grass. RESULTS: After the pollen season, the BAP in the SAR group remained unchanged, while it was improved in the SAR and Asthma group (decrease in FEV1 of 28.8% vs 12.5%, P<0.01). The IgG4 levels increased after SCIT (median before SCIT 0.34 to 11.4 after SCIT), whereas the total and specific IgE levels remained unchanged. CONCLUSIONS: After 1 cycle of MPL-SCIT, specific bronchial tolerance may be significantly induced, whereas in patients without SCIT, bronchial hyperactivity may remain unchanged.

Climate Change and Air Pollution: Effects on Respiratory Allergy

A body of evidence suggests that major changes involving the atmosphere and the climate, including global warming induced by anthropogenic factors, have impact on the biosphere and human environment. Studies on the effects of climate change on respiratory allergy are still lacking and current knowledge is provided by epidemiological and experimental studies on the relationship between allergic respiratory diseases, asthma and environmental factors, such as meteorological variables, airborne allergens, and air pollution. Urbanization with its high levels of vehicle emissions, and a westernized lifestyle are linked to the rising frequency of respiratory allergic diseases and bronchial asthma observed over recent decades in most industrialized countries. However, it is not easy to evaluate the impact of climate changes and air pollution on the prevalence of asthma in the general population and on the timing of asthma exacerbations, although the global rise in asthma prevalence and severity could also be an effect of air pollution and climate change. Since airborne allergens and air pollutants are frequently increased contemporaneously in the atmosphere, an enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of respiratory allergy and asthma in atopic subjects in the last 5 decades. Pollen allergy is frequently used to study the relationship between air pollution and respiratory allergic diseases, such as rhinitis and bronchial asthma. Epidemiologic studies have demonstrated that urbanization, high levels of vehicle emissions, and westernized lifestyle are correlated with an increased frequency of respiratory allergy prevalently in people who live in urban areas in comparison with people living in rural areas. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc.) can affect both components (biological and chemical) of this interaction.

Evaluation of the association between pollen count and the outbreak of allergic disease

PURPOSE: This study focused on the evaluation of the relation between pollen concentration and the outbreak of allergic disease (symptom index), and this outcome would be necessary to upgrade risk grade for the pollen forecasting system. METHODS: Airborne particles carrying allergens, such as pollen, were collected daily at the Seoul and Guri area by using 7-day Burkard samplers for 6 years. A total of 596 Subjects were recruited from Hanyang University Seoul Hospital (n=144 for spring, n=139 for autumn), and Hanyang University Guri Hospital (n=157 for spring, n=156 for autumn). Symptom index was evaluated and recorded by phone calling to study subjects daily or asking questionnaire when they visit outpatient clinic every week. Statistical analysis of data was performed by using correlation coefficients and regression models with time series graph. RESULTS: Two peak seasons of pollen concentration were May and September in Korea. In skin prick tests, the sensitization rate to ragweed pollen was gradually increased in children. In the same period, sensitization rates to airborne pollen, especially oak, birch for spring, and Japanese hop for autumn were increased annually. There was a significantly relationship between symptom index of allergic patients and allergic pollen concentrations in this study. Especially symptom index was significantly correlated to the concentration of oak pollen of day 1 in spring and to the concentration of Japanese hop pollen of day 0 in autumn. CONCLUSION: Sensitization rates to pollens increased annually. There is a significant relationship between allergy symptom index and pollen concentration. There remains to confirm the Korean own risk grade of pollen allergy.

Biological Effects of Cloth Containing Specific Ore Powder in Patients with Pollen Allergy / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>The custom-homebuilding company, Cosmic Garden Co. Ltd., located in Okayama City, Japan was established in 1997 and uses specific natural ore powder (SNOP) in wall materials and surveys customers in order to improve allergic symptoms.</p><p><b>METHODS</b>To investigate the biological effects of SNOP, patients with a pollen allergy were recruited to stay in a room surrounded by cloth containing SNOP (CCSNOP), and their symptoms and various biological parameters were compared with those of individuals staying in a room surrounded by control non-woven cloth (NWC). Each stay lasted 60 min. Before and immediately after the stay, a questionnaire regarding allergic symptoms, as well as POMS (Profile of Mood Status) and blood sampling, was performed. Post-stay minus pre-stay values were calculated and compared between CCSNOP and NWC groups.</p><p><b>RESULTS</b>Results indicated that some symptoms, such as nasal obstruction and lacrimation, improved, and POMS evaluation showed that patients were calmer following a stay in CCSNOP. Relative eosinophils, non-specific Ig E, epidermal growth factor, monocyte chemotactic protein-1, and tumor necrosis factor-α increased following a stay in CCSNOP.</p><p><b>CONCLUSION</b>This ore powder improved allergic symptoms, and long-term monitoring involving 1 to 2 months may be necessary to fully explore the biological and physical effects of SNOP on allergic patients.</p>

Partial Characterization of bermuda, carabao, cogon, and talahib grass pollen extracts

@#<p style="text-align: justify;"><strong>BACKGROUND</strong>: Grass pollen grains are important causes of respiratory allergies. The Philippines has a different grass flora compared to that of western countries, so pollen extracts have to be processed for use in the diagnosis and treatment of respiratory allergies. The local pollen extracts available in clinical practice have not yet been characterized, which is important in improving extract quality.<br /><strong>OBJECTIVE:</strong> This study aims to perform physicochemical characterization through protein content determination and gradient sodium-dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) of extracts from four grasses: Cynodon dactylon (bermuda grass), Axonopus compressus (carabao grass), Imperata cylindrica (cogon), and Saccharum spontaneum (talahib) and immunologic characterization by identifying its IgE-binding component through immunoblot.<br /><strong>METHODS</strong>: This is a descriptive study. The pollen grains were processed into allergen extracts and protein contents were determined. The extracts were separated by gradient SDS-PAGE and subjected to immunoblotting. Bands were visualized using Fluorchem C2 aided with Alpha View Software.<br /><strong>RESULTS:</strong> Total protein in the pollen extracts ranged from 281.3-968.61 µg/ml. Protein bands of bermuda were in the 14.4-66.3 kDa range, carabao grass at 3.5-66.3 kDa, cogon at 3.5-200 kDA, and talahib at 21.5-66.3 kDa. A single IgE-binding protein band was seen on immunoblot at 55.4 kDa using a single serum sample.<br /><strong>CONCLUSION</strong>: Protein contents of the allergen extracts vary. The molecular weights of the different protein bands seem to correspond to known groups of grass pollen allergens. There was only one IgE-binding protein band seen on preliminary immunoblot.</p>

Immunoglobulin E-binding reactivities of natural pollen grain extracts from selected grass species in the Philippines

BACKGROUND: Pollen grains have been reported to be present in the Philippine atmosphere but studies regarding their allergenicity are limited. OBJECTIVE: The present study aimed to profile the sensitization of allergic individuals to selected grass pollen species and to characterize the pollen proteins that may be responsible for this allergenic response. METHODS: The protein profile of the grass pollen extracts from Cynodon dactylon, Saccharum spontaneum, Sporobulus indicus, Chloris barbata, Oryza sativa, Imperata cylindrica, and Zea mays was analyzed by Sodium Dodecyl Sulphate Polyacrylamide Gel Electrophoresis. The specific-IgE profile of the allergic individuals and the allergenic potential of the pollen extracts were evaluated through Enzyme-linked Immunosorbent Assay and IgE immunoblotting. RESULTS: Sensitization of the allergic individuals to the pollen extracts was detected with I. cylindrica and O. sativa to be the most frequently recognized with more that 92% reactivity, whereas for C. dactylon and Z. mays, were found to have less than 25% reactivity. CONCLUSION: Multiple IgE-binding proteins from S. indicus, S. spontaneum and C. barbata that were detected may be responsible for the allergic reactions among Filipino subjects.

Evaluation of the Relationship between Pollen Count and the Outbreak of Allergic Diseases / 소아알레르기및호흡기학회지

PURPOSE: The distribution of pollens in the air is mainly related to the weather conditions, especially temperature and humidity. This study focused on the evaluation of the relationship between pollen count and the outbreak of allergic diseases (symptom index) from allergic patients in Korea in order to determine Korean own allergy risk grade for the pollen forecasting system. METHODS: Airborne particles carrying allergens were collected daily in nationwide 8 stations (Seoul, Guri, Daejeon, Daegu, Kwangju Busan, Kangneung, and Jeju) by using 7 day- Burkard sampler in South Korea for 8 months (March 1, 2008-October 31, 2008). They were counted and recorded along with weather factors. Symptom index was calculated and recorded by phone calling to allergic patients 3 times a week. RESULTS: Airborne pollens have 2 peak seasons (May and September) in Korea. In the skin prick test, ragweed was the highest sensitization rate (5.9%), followed by mugwort (5.8 %), alder (4.9%), birch (4.8%) and oak grasses among the pollen extracts in Korean school-aged children. There are significant relationship between symptom index of allergic patients and allergic pollen concentrations. Korean own risk grade of pollen allergy was made by using the data from this study. CONCLUSION: Risk grade of pollens for allergy pollen forecast among each allergic plant was established. Further studies are needed to confirm it our result.

Evaluation of the Relationship between Pollen Count and the Outbreak of Allergic Diseases / 소아알레르기및호흡기학회지

PURPOSE: The distribution of pollens in the air is mainly related to the weather conditions, especially temperature and humidity. This study focused on the evaluation of the relationship between pollen count and the outbreak of allergic diseases (symptom index) from allergic patients in Korea in order to determine Korean own allergy risk grade for the pollen forecasting system. METHODS: Airborne particles carrying allergens were collected daily in nationwide 8 stations (Seoul, Guri, Daejeon, Daegu, Kwangju Busan, Kangneung, and Jeju) by using 7 day- Burkard sampler in South Korea for 8 months (March 1, 2008-October 31, 2008). They were counted and recorded along with weather factors. Symptom index was calculated and recorded by phone calling to allergic patients 3 times a week. RESULTS: Airborne pollens have 2 peak seasons (May and September) in Korea. In the skin prick test, ragweed was the highest sensitization rate (5.9%), followed by mugwort (5.8 %), alder (4.9%), birch (4.8%) and oak grasses among the pollen extracts in Korean school-aged children. There are significant relationship between symptom index of allergic patients and allergic pollen concentrations. Korean own risk grade of pollen allergy was made by using the data from this study. CONCLUSION: Risk grade of pollens for allergy pollen forecast among each allergic plant was established. Further studies are needed to confirm it our result.

Investigation of Pollinosis in Beijing Residents over the Age of 15 / 环境与健康杂志

Objective To know the incidence of pollen allergy among Beijing residents over the age of 15. Methods In 2005-2006,10 966 people aged 15-75 years were randomly selected and the information on pollen allergy and pollinosis was investigated by the telephone questionary. Results The response rate of the telephone survey was 67.2%,the total incidence of pollinosis was 2.51%,the incidence for male and female was 1.63% and 3.73% respectively,the difference was statistically significant(P

Correlation between allergy and HLA genetic polymorphism / 中国药理学通报

Allergy increasingly threatens human health. At present, the molecular mechanisms of allergy have been one of the hot topics. It is believed that genetic factor and environmental factor play important roles in allergy. It is not surprising that particular HLA (human leukocyte antigen) class II alleles have been implicated in susceptility to allergic diseases and in restriction of the IgE responses to a variety of allergens. It will provide an original measure if the correlation between allergy and HLA genetic polymorphism was illuminated.