Heterogeneity of pollen food allergy syndrome in seven Southern European countries: The @IT.2020 multicenter study.
Southern Europe
oral allergy syndrome
panallergen
pollen food allergy syndrome
seasonal allergic rhinitis
Journal
Allergy
ISSN: 1398-9995
Titre abrégé: Allergy
Pays: Denmark
ID NLM: 7804028
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
17
11
2020
received:
28
08
2020
accepted:
25
11
2020
pubmed:
26
1
2021
medline:
14
10
2021
entrez:
25
1
2021
Statut:
ppublish
Résumé
Pollen food allergy syndrome (PFAS) is a frequently underdiagnosed disease due to diverse triggers, clinical presentations, and test results. This is especially relevant in geographic areas with a broad spectrum of pollen sensitization, such as Southern Europe. To elucidate similarities and differences of PFAS in nine Southern European centers and identify associated characteristics and unique markers of PFAS. As part of the @IT.2020 Multicenter Study, 815 patients with seasonal allergic rhinitis (SAR), aged 10-60 years, were recruited in seven countries. They completed questionnaires regarding SAR, comorbidities, family history, and PFAS, and underwent skin prick testing (SPT) and serum IgE testing. Of the 815 patients, 167 (20.5%) reported PFAS reactions. Most commonly, eliciting foods were kiwi (58, 34.7%), peach (43, 25.7%), and melon (26, 15.6%). Reported reactions were mostly local (216/319, 67.7%), occurring within 5 min of contact with elicitors (209/319, 65.5%). Associated characteristics included positive IgE to at least one panallergen (profilin, PR-10, or nsLTP) (p = 0.007), maternal PFAS (OR: 3.716, p = 0.026), and asthma (OR: 1.752, p = 0.073). Between centers, heterogeneity in prevalence (Marseille: 7.5% vs. Rome: 41.4%, p < 0.001) and of clinical characteristics was apparent. Cypress played a limited role, with only 1/22 SPT mono-sensitized patients reporting a food reaction (p < 0.073). PFAS is a frequent comorbidity in Southern European SAR patients. Significant heterogeneity of clinical characteristics in PFAS patients among the centers was observed and may be related to the different pollen sensitization patterns in each geographic area. IgE to panallergen(s), maternal PFAS, and asthma could be PFAS-associated characteristics.
Sections du résumé
BACKGROUND
Pollen food allergy syndrome (PFAS) is a frequently underdiagnosed disease due to diverse triggers, clinical presentations, and test results. This is especially relevant in geographic areas with a broad spectrum of pollen sensitization, such as Southern Europe.
OBJECTIVES
To elucidate similarities and differences of PFAS in nine Southern European centers and identify associated characteristics and unique markers of PFAS.
METHODS
As part of the @IT.2020 Multicenter Study, 815 patients with seasonal allergic rhinitis (SAR), aged 10-60 years, were recruited in seven countries. They completed questionnaires regarding SAR, comorbidities, family history, and PFAS, and underwent skin prick testing (SPT) and serum IgE testing.
RESULTS
Of the 815 patients, 167 (20.5%) reported PFAS reactions. Most commonly, eliciting foods were kiwi (58, 34.7%), peach (43, 25.7%), and melon (26, 15.6%). Reported reactions were mostly local (216/319, 67.7%), occurring within 5 min of contact with elicitors (209/319, 65.5%). Associated characteristics included positive IgE to at least one panallergen (profilin, PR-10, or nsLTP) (p = 0.007), maternal PFAS (OR: 3.716, p = 0.026), and asthma (OR: 1.752, p = 0.073). Between centers, heterogeneity in prevalence (Marseille: 7.5% vs. Rome: 41.4%, p < 0.001) and of clinical characteristics was apparent. Cypress played a limited role, with only 1/22 SPT mono-sensitized patients reporting a food reaction (p < 0.073).
CONCLUSIONS
PFAS is a frequent comorbidity in Southern European SAR patients. Significant heterogeneity of clinical characteristics in PFAS patients among the centers was observed and may be related to the different pollen sensitization patterns in each geographic area. IgE to panallergen(s), maternal PFAS, and asthma could be PFAS-associated characteristics.
Substances chimiques
Allergens
0
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3041-3052Informations de copyright
© 2021 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.
Références
Werfel T, Asero R, Ballmer-Weber BK, et al. Position paper of the EAACI: food allergy due to immunological cross-reactions with common inhalant allergens. Allergy 2015;70(9):1079-1090. https://doi.org/10.1111/all.12666
Poncet P, Sénéchal H, Charpin D. Update on pollen-food allergy syndrome. Expert Rev Clin Immunol. 2020;16(6):561-578. https://doi.org/10.1080/1744666X.2020.1774366
Bedolla-Barajas M, Kestler-Gramajo A, Alcalá-Padilla G, Morales-Romero J. Prevalence of oral allergy syndrome in children with allergic diseases. Allergol Immunopathol (Madr). 2017;45(2):127-133. https://doi.org/10.1016/j.aller.2016.04.017
Bircher AJ, Van Melle G, Haller E, Curty B, Frei PC. IgE to food allergens are highly prevalent in patients allergic to pollens, with and without symptoms of food allergy. Clin Exp Allergy J Br Soc Allergy Clin Immunol. 1994;24(4):367-374. https://doi.org/10.1111/j.1365-2222.1994.tb00248.x
Guvenir H, Dibek Misirlioglu E, Buyuktiryaki B, et al. Frequency and clinical features of pollen-food syndrome in children. Allergol Immunopathol (Madr) 2020;48:78-83.
Li JD, Du ZR, Liu J, Xu YY, Wang RQ, Yin J. Characteristics of pollen-related food allergy based on individual pollen allergy profiles in the Chinese population. World Allergy Organ J. 2020;13(5):100120. https://doi.org/10.1016/j.waojou.2020.100120
Osawa Y, Ito Y, Takahashi N, et al. Epidemiological study of oral allergy syndrome in birch pollen dispersal-free regions. Allergol Int. 2020;69(2):246-252. https://doi.org/10.1016/j.alit.2019.09.008. Epub 2019 Nov 7.
Price A, Ramachandran S, Smith GP, Stevenson ML, Pomeranz MK, Cohen DE. Oral Allergy Syndrome (Pollen-Food Allergy Syndrome). Dermatitis. 2015;26(2):78. https://doi.org/10.1097/DER.0000000000000087
Asero R, Ariano R, Aruanno A, et al. Systemic allergic reactions induced by labile plant-food allergens: Seeking potential cofactors. A multicenter study. Allergy. 2021;76:1473-1479. https://doi.org/10.1111/all.14634
Kim M, Ahn Y, Yoo Y, et al. Clinical manifestations and risk factors of anaphylaxis in pollen-food allergy syndrome. Yonsei Med J 2019;60:960-968.
Skypala IJ. Can patients with oral allergy syndrome be at risk of anaphylaxis? Curr Opin Allergy Clin Immunol 2020;20(5):459-464. https://doi.org/10.1097/ACI.0000000000000679. PMID: 32842037.
Florido Lopez JF, Quiralte Enriquez J, de Saavedra A, et al. An allergen from Olea europaea pollen (Ole e 7) is associated with plant-derived food anaphylaxis. Allergy 2002;57(Suppl 71):53-59. https://doi.org/10.1034/j.1398-9995.2002.057s71053.x
Asero R, Celi G, Scala E. Labile plant food allergens: Really so harmless? Case series and literature review. Allergy. 2020;75(6):1517-1518. https://doi.org/10.1111/all.14184. Epub 2020 Jan 31.
Mastrorilli C, Cardinale F, Giannetti A, Caffarelli C. Pollen-Food Allergy Syndrome: A not so Rare Disease in Childhood. Medicina (Mex). 2019;55(10):641. https://doi.org/10.3390/medicina55100641
Biedermann T, Winther L, Till SJ, Panzner P, Knulst A, Valovirta E. Birch pollen allergy in Europe. Allergy 2019;74(7):1237-1248. https://doi.org/10.1111/all.13758
Movérare R, Westritschnig K, Svensson M, et al. Different IgE Reactivity Profiles in Birch Pollen-Sensitive Patients from Six European Populations Revealed by Recombinant Allergens: An Imprint of Local Sensitization. Int Arch Allergy Immunol 2002;128(4):325-335.
Mastrorilli C, Tripodi S, Caffarelli C, et al. Endotypes of pollen-food syndrome in children with seasonal allergic rhinoconjunctivitis: a molecular classification. Allergy 2016;71(8):1181-1191. https://doi.org/10.1111/all.12888
Özdemir SK, Özgüςlü S. Pollen food allergy syndrome in Turkey: Clinical characteristics and evaluation of its association with skin test reactivity to pollens. Asian Pac J Allergy Immunol 2018;36(2):77-81. https://doi.org/10.12932/AP0881
Flores E, Cervera L, Sanz ML, Diaz-Perales A, Fernández J. Plant Food Allergy in Patients with Pollinosis from the Mediterranean Area. Int Arch Allergy Immunol 2012;159(4):346-354. https://doi.org/10.1159/000338282
Hoffmann TM, Acar Şahin A, Aggelidis X, et al. “Whole” vs. “fragmented” approach to EAACI pollen season definitions: A multicenter study in six Southern European cities. Allergy 2020;75(7):1659-1671. https://doi.org/10.1111/all.14153
Castillo Marchuet MJ, Luengo O, Cardona V. Cypress Pollen Allergy in a Mediterranean Area. J Investig Allergol Clin Immunol. 2020;30(1):67. https://doi.org/10.18176/jiaci.0444. Epub 2019 Sep 18.
Sénéchal H, Šantrůček J, Melčová M, et al. A new allergen family involved in pollen food-associated syndrome: Snakin/gibberellin-regulated proteins. J Allergy Clin Immunol 2018;141(1):411-414.e4. https://doi.org/10.1016/j.jaci.2017.06.041. Epub 2017 Aug 4.
Caimmi D, Barber D, Hoffmann-Sommergruber K, et al. Understanding the molecular sensitization for Cypress pollen and peach in the Languedoc-Roussillon area. Allergy 2013;68(2):249-251. https://doi.org/10.1111/all.12073
Hugues B, Didierlaurent A, Charpin D. Cross-reactivity between cypress pollen and peach: a report of seven cases. Allergy 2006;61(10):1241-1243. https://doi.org/10.1111/j.1398-9995.2006.01156.x
Asero R, Abbadessa S, Aruanno A, et al. Detection of Gibberellin-Regulated Protein (Peamaclein) Sensitization among Italian Cypress Pollen-Sensitized Patients. J Investig Allergol Clin Immunol 2022;32(1). https://doi.org/10.18176/jiaci.0542. [Epub ahead of print]
Hauser M, Roulias A, Ferreira F, Egger M. Panallergens and their impact on the allergic patient. Allergy Asthma Clin Immunol 2010;6(1):1. https://doi.org/10.1186/1710-1492-6-1
Ferreira F, Hawranek T, Gruber P, Wopfner N, Mari A. Allergic cross-reactivity: from gene to the clinic. Allergy 2004;59(3):243-267. https://doi.org/10.1046/j.1398-9995.2003.00407.x
Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, et al. EAACI Molecular Allergology User’s Guide. Pediatr Allergy Immunol 2016;27:1-250. https://doi.org/10.1111/pai.12563
Bogas G, Muñoz-Cano R, Mayorga C, et al. Phenotyping peach-allergic patients sensitized to LTP and analysing severity biomarkers. Allergy 2020;75:3228-3236. https://doi.org/10.1111/all.14447
Oeo-Santos C, Navas A, Benedé S, et al. New insights into the sensitization to nonspecific lipid transfer proteins from pollen and food: New role of allergen Ole e 7. Allergy 2020;75(4):798-807. https://doi.org/10.1111/all.14086. Epub 2019 Nov 6.
Skypala IJ, Calderon MA, Leeds AR, Emery P, Till SJ, Durham SR. Development and validation of a structured questionnaire for the diagnosis of oral allergy syndrome in subjects with seasonal allergic rhinitis during the UK birch pollen season. Clin Exp Allergy 2011;41(7):1001-1011. https://doi.org/10.1111/j.1365-2222.2011.03759.x
Di Fraia M, Arasi S, Castelli S, et al. A new molecular multiplex IgE assay for the diagnosis of pollen allergy in Mediterranean countries: A validation study. Clin Exp Allergy 2019;49:341-349. https://doi.org/10.111/cea.13264
Charpin D, Ramadour M, Lavaud F, et al. Climate and Allergic Sensitization to Airborne Allergens in the General Population: Data from the French Six Cities Study. Int Arch Allergy Immunol 2017;172(4):236-241. https://doi.org/10.1159/000471511
Rial MJ, Sastre J. Food Allergies Caused by Allergenic Lipid Transfer Proteins: What Is behind the Geographic Restriction? Curr Allergy Asthma Rep 2018;18:56. https://doi.org/10.1007/s11882-018-0810-x
D’Amato G, Cecchi L, Bonini S, et al. Allergenic pollen and pollen allergy in Europe. Allergy 2007;62(9):976-990. https://doi.org/10.1111/j.1398-9995.2007.01393.x
Mesonjesi E, Piluri Ziu E, Gupta R, Strachan D, Priftanji A. The prevalence and time trend of asthma in Albanian children in 2011 - Alb ISAAC. Clin Transl. Allergy 2015;5(S2):2045-7022. https://doi.org/10.1186/2045-7022-5-S2-P8
Priftanji AV, Qirko E, Layzell JCM, Burr ML, Fifield R. Asthma and allergy in Albania. Allergy 1999;54(10):1042-1047. https://doi.org/10.1034/j.1398-9995.1999.00108.x
Iliopoulou A, Petrodimopoulou M, Konstantakopoulou M, et al. Profilin sensitization and its clinical relevance to a population of atopic adults in Greece. Rev Fr Allergol 2018;58(2):72-76. https://doi.org/10.1016/j.reval.2017.11.001
Karantoumanis D, Savvatianos S, Konstantinopoulos AP, et al. PD19 - Co-recognition of lipid transfer protein in pollen and foods in a Greek pediatric population. Clin Transl Allergy. 2014;4(Suppl 1):P19. https://doi.org/10.1186/2045-7022-4-S1-P19.
Lyons SA, Clausen M, Knulst AC, et al. Prevalence of Food Sensitization and Food Allergy in Children Across Europe. J Allergy Clin Immunol Pract. 2020;8(8):2736-2746.e9. https://doi.org/10.1016/j.jaip.2020.04.020. Epub 2020 Apr 21 PMID: 32330668.
Tavares B, Machado D, Loureiro G, Cemlyn-Jones J, Pereira C. Sensitization to profilin in the Central region of Portugal. Sci Total Environ 2008;407(1):273-278. https://doi.org/10.1016/j.scitotenv.2008.08.013.
Pereira C, Valero A, Loureiro C, et al. Iberian study of aeroallergens sensitisation in allergic rhinitis. Eur Ann Allergy Clin Immunol. 2006;38(6):186-194.
Barber D, de la Torre F, Feo F, et al. Understanding patient sensitization profiles in complex pollen areas: a molecular epidemiological study. Allergy 2008;63(11):1550-1558. https://doi.org/10.1111/j.1398-9995.2008.01807.x