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One hundred adult patients with a history of oral allergy syndrome (OAS) after ingestion of fruits and vegetables, 77 patients with hay fever and 13 with skin prick tests and RAST positive to pollens but without seasonal symptoms, and 32 normal nonallergic control subjects, had Phadebas RAST and skin prick tests with commercial extracts (CSPT) and with fresh foods (FFSPT) to assess the reliability of these three tests. Sensitivity was better with FFSPT for carrot, celery, cherry, apple, tomato, orange, and peach; better with CSPT for peanut, pea, and walnut; and better with RAST for hazelnut. Specificity, negative predictive value, and positive predictive value of the three tests were determined for apple, carrot, hazelnut, orange, pea, peanut, and tomato. Specificity in the patient groups ranged between 40% (pea) and 100% (apple) for CSPT, between 61% (peanut) and 87% (carrot) for RAST, and between 42% (carrot) and 93% (peanut) for FFSPT. However, all tests were negative in the control group. Thus, false positive results may result from cross-reactivity with pollen allergens. The diagnostic accuracy of these tests in the population with OAS proved comparable for peanut, carrot, hazelnut, and pea. FFSPT proved more sensitive than CSPT or RAST in confirming a history of OAS to certain alimentary allergens, such as apple, orange, tomato, carrot, cherry, celery, and peach.

Six hundred patients with pollen allergy answered a questionnaire about food hypersensitivity. Hypersensitivity to various nuts, fruits and roots was reported more often by patients with birch pollen allergy(70%) than be patients without birch pollen allergy (19%). The stronger the skin test reaction to birch pollen, the higher was the incidence of food hypersensitivity. A negative correlation was found between grass pollen allergy and food hypersensitivity. In the diagnosis of springtime hayfever, the presence of hypersensitivity to nuts, fruits and roots supports a diagnosis of birch pollen allergy.

Due to the high prevalence of food allergic diseases globally there are increasing demands in clinical practice for managing IgE-mediated conditions. During the last decade, component resolved diagnostics has been introduced into the field of clinical allergology, providing information that cannot be obtained from extract-based tests. Component resolved data facilitate more precise diagnosis of allergic diseases and identify sensitizations attributable to cross-reactivity. Furthermore it assists risk assessment in clinical practice as sensitization to some allergenic molecules is related to persistence of clinical symptoms and systemic rather than local reactions. The information may also aid the clinician in prescription of oral immunotherapy (OIT) in patients with severe symptoms, and in giving advice on food allergen avoidance or on the need to perform food challenges. The use of allergen components is rapidly evolving and increases our possibility to treat food allergic patients with a more individual approach. Using molecular allergology, we can already now better diagnose, prognose and grade the food allergy. In summary, daily routine molecular allergy diagnostics offers a number of benefits that give us a higher diagnostic precision and allow for better management of the patient.

Skin sensitivity to apple, carrot and potato, clinically related to birch pollinosis was investigated. Different skin test techniques using fresh fruit were compared. A simple prick test (SPT) technique with a lancet piercing the apple peel just before pricking the skin was shown to be the most practical and to give reproducible results. The allergenic activity in apple was found to be heat labile and deteriorated during storage at room temperature. Apple, carrot, potato, hazelnut and birch reactivity was transferable in Prausnitz-Kustner test like IgE antibodies. SPT reactivity to fresh material from apple, carrot and potato was investigated in 174 children of whom 128 suffered from pollen allergy. Positive SPT results were obtained almost exclusively in children who were SPT positive to a birch pollen extract. Children who noticed clinical symptoms when eating apple, raw carrot or potato were found to have a significantly larger SPT reaction than children with a negative history.

Summary Eighty highly atopic patients were selected for study because they had either atopic eczema (fifty cases) or atopic reactivity to foods, as judged by a positive skin-prick test (thirty cases). In all, sixty-five out of eighty subjects (81%) described symptoms of some kind provoked by foods, but correspondingly positive skin tests were found in only half of these, thirty-three out of eighty (41%). The symptoms experienced by thirty-one of the thirty-three patients with positive skin tests were immediate in onset (within 1 hr) and were at first confined to the upper gastrointestinal tract, the most frequent symptoms being oral irritation and throat tightness. In a proportion of these patients, further symptoms such as urticaria, asthma or anaphylaxis developed following the initial oral symptoms, which suggested the term‘oral allergy syndrome’. In the absence of the oral allergy, symptoms such as asthma, urticaria, migraine or eczema starting later than 1 hr after food were seldom associated with positive skin tests. In the oral allergy syndrome, the characteristic symptoms (strong association with positive skin tests and RAST, time of onset and sites at which symptoms are expressed) suggest a causative relationship between exposure to food antigens and specific IgE-induced release of mediators. In cases of food intolerance that lack a characteristic symptom pattern and a positive skin test or radio-allergo-sorbent test, it seems appropriate to consider non-IgE-mediated causes.

Background: Apricots are widely grown in Europe, and allergic reactions are becoming more common, especially oral allergy syndrome. Apricot belongs to the botanical subfamily of Prunoideae, which includes peach, the major allergen of which was identified as a 9-kd protein, a lipid transfer protein (LTP). Objective: The aim of the study was to evaluate the IgE reactivity pattern to an apricot extract in subjects with allergic reactions to apricot, as demonstrated by a positive oral challenge response. Methods: Thirty patients were investigated. All the patients displayed oral allergy syndrome (2 with systemic reactions) to apricot, with positive open food challenge responses, skin prick test responses, and serum-specific IgE antibodies to apricot. The IgE reactivity pattern to apricot extract was identified by using SDS-PAGE and immunoblotting. The major allergen, a 9-kd protein, was then purified by HPLC and characterized by periodic acid–Schiff stain, isoelectric point determination, and N-terminal amino acid sequencing. Results: The sera from all patients allergic to apricot recognized the 9-kd protein, whereas none of the other allergens, with molecular weights from 15 to 80 kd, acted as a major allergen. The 9-kd allergen has an isoelectric point of 8.7 and is not glycosylated. Determination of the N-terminal 34 amino acid sequence showed that it belongs to the LTP family, with a 94% homology with the LTP from peach. IgE blotting of the apricot extract was completely inhibited by the 9-kd purified LTP from peach. Conclusions: The major allergen of apricot is an LTP, which is highly cross-reactive with the LTP from peach. (J Allergy Clin Immunol 2000;105:371-7.)

It has been reported that various cultivars of fruits and vegetables may present a different pattern for the contained allergens. Here, we report on the different content in allergenic proteins for different peach (Prunus persica) cultivars, sampled during two consecutive harvest seasons. Fruits from six cultivars of peaches were harvested fully ripe, and the proteins extracted from whole or chemically peeled fruits were analyzed by SDS-PAGE and immunoblotting. All the protein extracts from whole fruit contained a 9 kDa protein. This protein proved to be absent in the extracts taken from chemically peeled fruit. In four cultivars, this protein corresponds to the allergen Pru p3, a lipid transfer protein that causes the oral allergy syndrome (OAS) in sensitized people. In the following year, fruits from four of the six cultivars of peaches studied previously were harvested at different times, at one and two weeks before the commercial ripening time and when fully ripe, to ascertain whether the presence of the 9 kDa allergen might be related to the ripening process. Two cultivars out of four produced an intense allergenic band corresponding to a 9 kDa protein already two weeks before the commercial ripening date, while the others showed a progressive increment of the 9 kDa allergen during ripening.

According to literature, approximately 20%-70% of patients sensitized to pollen allergens experience oral allergy syndrome (OAS) symptoms after eating raw fruits and vegetables. There is no standard treatment established for OAS except avoiding implicated food. However, in patients with airborne pollen allergy treated with specific immunotherapy (SIT), an improvement of OAS symptoms has been reported in 30% to even 84% of individuals examined. The aim of the present study was to evaluate the prevalence of OAS symptoms in patients with various manifestations of pollen airborne allergy (atopic dermatitis (AD), asthma, allergic rhinitis) treated with subcutaneous type of SIT. In addition, the most common patterns of cross-reactivity in OAS were analyzed and correlations between OAS symptoms and patient age, type of sensitizing pollen allergens and atopy manifestations investigated. Also, the relationship between SIT duration and clinical improvement of both OAS symptoms and pollen allergy symptoms was analyzed. The study included 57 patients with airborne allergy treated with allergen vaccination (60% male and 40% female). Allergic rhinitis was diagnosed in 71%, AD in 19%, AD and asthma in 4%, allergic rhinitis and asthma in 4%, and both AD and allergic rhinitis in 2% of study patients. Twenty-eight percent of study patients complained of overt symptoms of OAS (22% of allergic rhinitis patients and 27% of AD patients); 69% of the subjects presenting with OAS showed polyvalent airborne allergy to pollens and 31% were sensitized to only one group of pollen allergens (mostly grass pollens, tree pollens and mugwort pollens). There was no statistically significant correlation between the presence of OAS symptoms and patient diagnosis, patient age and type of allergen vaccination used. According to patients' opinion, SIT significantly improved oral symptoms in 50% of study patients, 44% reported no impact of SIT on OAS symptoms and 6% of patients observed worsening of OAS symptoms after unintentional ingestion of implicated food during the course of SIT. The study revealed OAS as a significant problem in patients sensitized to various pollen allergens. The results on OAS prevalence in atopic subjects (28%) were consistent with some literature data. There was clear association between OAS and polyvalent airborne allergy (69%). Cross-reactivity patterns were typical (for example, tree pollen allergy - intolerance of apples, carrots and potatoes; grass pollen allergy - intolerance of kiwi fruit and tomatoes). Questionnaire analysis indicated that subcutaneous SIT significantly alleviated OAS symptoms associated with ingestion of the responsible fruit and vegetables in half of study subjects. Further evaluation of the duration/persistence and stability of the phenomenon is planned for the future.

Background - A considerable number of individuals suffer from oral allergy syndrome (OAS) to apple, resulting in the avoidance of apple consumption. Apple cultivars differ greatly in their allergenic properties, but knowledge of the causes for such differences is incomplete. Mal d 1 is considered the major apple allergen. For Mal d 1, a wide range of isoallergens and variants exist, and they are encoded by a large gene family. To identify the specific proteins/genes that are potentially involved in the allergy, we developed a PCR assay to monitor the expression of each individual Mal d 1 gene. Gene-specific primer pairs were designed for the exploitation of sequence differences among Mal d 1 genes. The specificity of these primers was validated using both in silico and in vitro techniques. Subsequently, this assay was applied to the peel and flesh of fruits from the two cultivars 'Florina' and 'Gala'. Results - We successfully developed gene-specific primer pairs for each of the 31 Mal d 1 genes and incorporated them into a qRT-PCR assay. The results from the application of the assay showed that 11 genes were not expressed in fruit. In addition, differential expression was observed among the Mal d 1 genes that were expressed in the fruit. Moreover, the expression levels were tissue and cultivar dependent. Conclusion - The assay developed in this study facilitated the first characterisation of the expression levels of all known Mal d 1 genes in a gene-specific manner. Using this assay on different fruit tissues and cultivars, we obtained knowledge concerning gene relevance in allergenicity. This study provides new perspectives for research on both plant breeding and immunotherapy.

IgE-associated food allergy affects approximately 3% of the population and has severe effects on the daily life of patients—manifestations occur not only in the gastrointestinal tract but also affect other organ systems. Birth cohort studies have shown that allergic sensitization to food allergens develops early in childhood. Mechanisms of pathogenesis include cross-linking of mast cell– and basophil-bound IgE and immediate release of inflammatory mediators, as well as late-phase and chronic allergic inflammation, resulting from T-cell, basophil, and eosinophil activation. Researchers have begun to characterize the molecular features of food allergens and have developed chip-based assays for multiple allergens. These have provided information about cross-reactivity among different sources of food allergens, identified disease-causing food allergens, and helped us to estimate the severity and types of allergic reactions in patients. Importantly, learning about the structure of disease-causing food allergens has allowed researchers to engineer synthetic and recombinant vaccines.

Background: Oral allergy syndrome (OAS) characterized by oral IgE-mediated symptoms, which is caused by cross-reactivity between proteins in pollens, fresh fruit and vegetables. OAS is presents in 40% to 80% of Allergic rhinitis patients. Association between oral allergy syndrome and duration of seasonal allergic rhinitis is not well known. Early treatment of Patients with OAS caused improvement in quality of life and relief of their symptoms. Material and methods: In this prospective cross-sectional study between March 2012 to September 2012, 103 consecutive patients with seasonal allergic rhinitis were entered to this study. Their sensitizations to common aeroallergens were confirmed by skin prick test (SPT) by three mm more than negative control. According to food allergy history and prick-to-prick test results, we considered 63 of 103 patients for single-blind oral food challenge test. Data analyzed bty SPSS software (ver 11.5), and by Chi squeare test and paired T test. P-value lower than 0.05 was considered as significant. Results: Among studied cases, 63 patients (61.2%) with 28.8±10.6 years old had OAS and 40 (38.8%) with 26.8±13.2 years old not OAS. We found that there was significant difference between duration of seasonal allergic rhinitis in OAS group (7±5.9 years) and non-OAS group (5±4 years) (P=0.03, CI=0.03-0.04). This syndrome was more in women and patients who had concomitant asthma and allergic conjunctivitis but statistical association was not significant. Conclusions: This study showed that all of the patients with hay fever do not develop OAS. Duration of seasonal allergic rhinitis was associated significantly with oral allergy syndrome. However, further studies with more sample size and double-blind placebo controlled methods might be needed.

About 70% of patients allergic to birch pollen (BP) show IgE-mediated reactions to plant foods such as hazelnut, apple, stone fruits, kiwi, carrot, celeriac and soya bean, typically mild reactions of the upper oral cavity, termed oral allergy syndrome (OAS) 1. These food allergies are a consequence of sensitization to Bet v 1 and subsequent IgE and T-cell cross-reactivity with homologous food allergens 2,3, such as Cor a 1.04 4, Mal d 1 5, Pru p 1 6, Api g 1 7,8 and Gly m 4 9. These allergens possess high sequence and structural identities with Bet v 1 10,11. Nearly all BP-allergic patients are sensitized to Bet v 1 12,13 and are at risk of developing plant food allergy 14. However, most patients show allergic reactions only to a limited number of potentially allergenic foods. Moreover, IgE specific to a certain Bet v 1-related allergen does not predict a clinically manifest allergy 15. The factors that determine the clinical spectrum of Bet v 1-associated plant food allergy are mostly unknown. In contrast to IgE, Bet v 1-specific antibodies of other isotypes were less frequently investigated. Some patients undergoing allergen-specific immunotherapy (IT) develop blocking IgG which inhibits binding of allergens to IgE 16. Moreover, IgG4, IgG4/IgE ratios and IgG4 blocking activity were associated with tolerance to hazelnut and apple among Bet v 1-sensitized patients 13. Few studies examining the role of allergen-specific IgA have been published. The levels of Bet v 1-specific IgA in nasal fluids of BP-allergic children increased during the pollen season, albeit with unclear clinical relevance 17. Examinations of the significance of IgA for the development of natural or induced tolerance in milk- or egg-allergic children showed no correlation 18,19. Hence, we aimed to determine whether potentially tolerance-inducing allergen-specific IgG and IgA antibodies have an influence on the clinical activity of allergen-specific IgE. To this end, we used a panel of sera from well-characterized BP-allergic patients with individual patterns of plant food allergies to measure IgE, IgG1, IgG4 and IgA levels specific to Bet v 1-related allergens from hazelnut, peach, apple, soya, mung bean and celeriac. Moreover, we compared these concentrations with clinical symptoms to evaluate the significance of the different Ig classes in context with allergy or tolerance.

Food allergy is a common and increasing problem worldwide. The newly-found knowledge might provide novel experimental strategies, especially for laboratory diagnosis. Approximately 20% of the population alters their diet for a perceived adverse reaction to food, but the application of double-blind placebo-controlled oral food challenge, the “gold standard” for diagnosis of food allergy, shows that questionnaire-based studies overestimate the prevalence of food allergies. The clinical disorders determined by adverse reactions to food can be classified on the basis of immunologic or nonimmunologic mechanisms and the organ system or systems affected. Diagnosis of food allergy is based on clinical history, skin prick tests, and laboratory tests to detect serum-food specific IgE, elimination diets and challenges. The primary therapy for food allergy is to avoid the responsible food. Antihistamines might partially relieve oral allergy syndrome and IgE-mediated skin symptoms, but they do not block systemic reactions. Systemic corticosteroids are generally effective in treating chronic IgE-mediated disorders. Epinephrine is the mainstay of treatment for anaphylaxis. Experimental therapies for IgE-mediated food allergy have been evaluated, such as humanized IgG anti-IgE antibodies and allergen specific immunotherapy.

Adverse reactions to food may be toxic or non toxic, depending on the susceptibility to a certain food; non toxic reactions that involve immune mechanisms are termed allergy if they are IgE-mediated. If no immunological mechanism is responsible, it is termed intolerance. The following disorders are considered a consequence of food allergy: gastrointestinal reactions (oral allergy syndrome, vomiting, diarrhea, protein-induced enterocolitic syndrome, eosinophilic gastroenteritis); respiratory reactions (rhinitis, asthma, laryngeal edema); cutaneous reactions (urticaria-angioedema, atopic dermatitis); anaphylaxis. There is much recent evidence to consider celiac disease an immunological disorder. Food allergy diagnosis is based on history, SPT, specific IgE, food challenges. DBPCFC is fundamental for diagnosing true food allergy; patients who have had anaphylaxis to food must not undergo DBPCFC. Rapidly progressive respiratory reactions and anaphylactic shock are life-threatening reactions that can be caused by food allergy. The doses of food inducing anaphylaxis can be very low, therefore commercial cross-contamination with an unsuspected food during food processing can be risky for the food allergic patient. The prevention of severe anaphylactic food reactions may lie in interdisciplinary collaboration among allergologists, chemists, food technologists, and experts in food industry research.

Background: Oral allergy syndrome (OAS) is characterized by an immediate allergic reaction that mainly or partially affects the oral mucosa, pharynx, or lips, and it is usually caused by ingesting fresh fruits or vegetables. Most patients with OAS also have allergic rhinitis due to pollen. As allergic rhinitis is increasingly prevalent in the Japanese population and the age at disease development is decreasing, morbidity associated with OAS among the younger population is likely to increase. However, there is little information about the prevalence of this disease among Japanese children, specifically the influences of residency in regions with different environments. Objectives: To investigate the prevalence of OAS and seasonal allergic rhinitis (SAR) among Japanese children and evaluate the relationship between OAS and SAR. Methods: We administered a questionnaire-based survey among children aged 7–15 years, living in 4 cities in central Japan. Results: The questionnaires were administered to 4103 children and completed by 3365 (82.0%). Overall, 524 children (15.6%) reported OAS-like symptoms after ingesting fruits or vegetables. The prevalence of seasonal SAR and oral symptoms significantly differed among the 4 cities. The total prevalence of oral symptoms co-occurring with SAR was 24.4%, which was significantly higher than the prevalence of symptoms occurring without SAR (10.2%, p < 0.001). Conclusion: Herein, oral symptoms were more likely to occur in patients with SAR than in those without SAR. The prevalence of SAR and food-induced oral symptoms significantly differed among the regions, suggesting they might be affected by regional differences in lifestyles and flora., Asian Pacific Journal of Allergy and Immunology. 2020., 新大院博(医)第990号

Oral allergy syndrome (OAS) is one of the most common types of food allergy. The syndrome includes itching and swelling of the lips, palate and tongue, usually after consuming fresh fruits and vegetables. The underlying pathogenic mechanism is cross-reactivity between IgE antibodies specific to pollen, and antigens in food, such as fresh fruits, vegetables and nuts that are structurally similar to pollen. Both pollen and food antigens can bind to IgE and trigger type I immune reaction. Diagnosis is primarily based on the patient’s history, and confirmed by skin tests, in vitro tests, and oral provocation tests. Differential diagnoses include many diseases (such as burning mouth syndrome, angioedema, hay fever, various other oral diseases, etc.), and for this reason a multidisciplinary approach is necessary, as different specialists need to be involved in the diagnostic procedure. Therapy includes avoiding, or thermal processing of, fruit and vegetables known to trigger a reaction, and antihistamine medications. If a more severe anaphylactic reaction develops, more aggressive therapy is required. The goal of this article is to present OAS, its etiopathogenesis, clinical picture, and symptoms, diagnostic approach and therapy for OAS.

Results 44 peanut allergic children (median age 5 years) reacted to peanut on DBPCPC with clinical symptoms than ranged from oral allergy syndrome to anaphylaxis. 61% of patients reacted to 0.1g of peanut protein. The mean %CD63+ basophil at 10 and 100 ng/ml of PE was independently associated with severity (p=0.012) whilst CD-sens (1/EC50x100) was independently associated with threshold (p=0.039) of allergic reactions to peanut. Severity and threshold parameters were correlated both at the clinical (Rs=-0.38; p=0.013) and at the basophil level (Rs=0.65; p

Results Thirty-seven patients suffered from a systemic reaction and 38 patients reported an oral allergy syndrome (OAS) after eating hazelnut. In the population with systemic reactions, sensitization to Cor a 14 was seen in 19/20 preschoolchildren (median age (range) 2.6 years (1.0 – 5.4)), 8/10 schoolchildren (10.2 years (8.0 – 13.8 )) and 2/7 adults (28 years (18 – 33)) whereas sensitization to Cor a 9 was observed in 16/20 preschoolchildren, 7/10 schoolchildren and 3/7 adults. A minority of 13/37 and 5/37 was sensitized to Cor a 11 and Cor a 8. Combining of Cor a 14 and Cor a 9 enables us to correctly diagnose respectively 100 %, 80 % and 43 % of systemic reactions in preschool-, schoolchildren and adults. In contrast sensitization to Cor a 1.04 was generally associated with OAS, IgE reactivity to Cor a 1.04 was observed in respectively 6/7, 8/9 and 22/22 of preschool, schoolchildren and adults. Sensitization to Cor a 14 was seen in two patients with OAS, although these sIgE levels to Cor a 14 were significantly lower. Twenty-one percent of the infants with AD showed Cor a 14 sensitization, whereas 4/14 and 1/14 showed IgE reactivity to Cor a 9 and Cor a 11.

Potato was believed to have a lower allergenic potential and it was the one of the first preferred food for weaning period in infancy. To date, the allergenic reactions are mostly reported in adults including oral allergy syndrome, contact dermatitis, exacerbations of asthma, and rarely anaphylaxis.

Methods We evaluated subjects from Southern Romania, a Central European region with temperate continental climate with submediterranean and humid subtropical influences, where sensitization to Betulaceae pollen is less important in pollinosis compared with that to grass or weed pollen. We selected adult patients from the region of sylvosteppe with low density forests dominated by deciduous species, presenting symptoms of rhinoconjunctivitis in March to May and oral allergy syndrome to fresh Rosaceae fruits, allergic reactions in the mouth and throat without systemic symptoms, and having positive skin prick tests to Betulaceae tree pollen and positive prick-to-prick skin tests with fresh intact and unpeeled apple, pear, apricot, peach, cherry or plum. Because allergen components present in Fagales tree pollen and Rosaceae fruits are PR-10 proteins, profilins and isoflavone reductases, we measured the serum levels of specific IgE to European birch pollen and to recombinant allergen components Bet v1 (birch major PR-10 allergen with ribonuclease activity), Bet v2 (birch-pollen profilin), and Bet v6 (birch-pollen isoflavone reductase), using a multiparameter immunoblot test system based on single purified allergen components (SPAC 1).

Background Sunflower seeds (Helianthus annuus) can trigger anaphylactic reactions, generalized urticaria, angioedema, oral allergy syndrome and other symptoms after ingestion. These reactions have been attributed to 2S albumins (SFA-8) and LTP (Hel a 3). We aimed to characterize the basophil response to storage proteins and oleosins from sunflower seed in patients allergic to sunflower. Methods The proteins 2S, 11S and oleosins were purified from a raw sunflower seed extract by FPLC/HPLC and identified by specific antibodies and peptide mass fingerprinting. We tested the immunological recognition of these proteins by basophil activation test (BAT). Four concentrations (1, 0.2, 0.1, 0.02 ig/ml) of each protein and the sunflower roasted extract were used. Ten patients were selected by clinical history and skin prick test positive to commercial extract. Twelve subjects with skin prick test negative to commercial extract and not food allergy were included as controls. Results All patients showed a positive basophil response to roasted extract. BAT was positive in 87.5% of cases for 2S albumin, 60% for oleosins, and 57.14% for 11S albumin. 50% of patients were positive to the 3 proteins, 37.5% only for 2S albumin and 12.5% for storage proteins (both 2S and 11S albumin). In 40% of controls the concentration 1 ig/ml of 2S albumin induced low basophil activation. Conclusions

Results L.V.C.L., female, 12 years old, from Rio de Janeiro, Brazil, was attended in march 2012 at the clinic of Allergy and Immunology, with moderate persistent rhinitis. She had a positive skin test to Dermatophagoides pteronyssinus and specific immunotherapy was started. In September 2012, patient reported severe itching in the oral cavity and pharynx when eating lettuce. She denied symptoms similar to any other food. In dezembro 2012, was performe “prick to prick” for lettuce, with the following result: histamine=7mm; negative control=0mm and lettuce=9 mm. Patient was instructed not to eat lettuce. The test was confirmed on another occasion and was also performed in the patient’s grandmother, who did not have a history of reaction to lettuce, with the same lettuce tested in the patient, to exclude the presence of irritants as a cause of positive skin test. The result of patient’s grandmother was: histamine=5 mm; negative control=0mm and lettuce=0mm. In May 2013, was performed RAST (radioallergosorbent) test for lettuce and result was negative. The patient was advised to maintain an exclusion diet of lettuce but she decided to eat lettuce on their own. By eating organic and non-organic lettuce, the patient presented severe oropharyngeal pruritus, as reported in future consultations.

Profilins constitute a family of highly conserved proteins, which are present in all eukaryotic cells and are involved in processes related to cell motility. The first allergenic profilin was described in birch pollen and was designated Bet v 2. Allergenic profilin were identified in tree and grass pollens, in weeds, in plant-derived foods, as well as in latex. Due to conserved structure of the profilins, specific IgE may cross-react with homologues from virtually every plant source. Therefore, profilin sensitization is a risk factor for allergic reactions to multiple pollen and food allergen sources. Profilins are randomly distributed in pulp and peel and they are labile to heat denaturation and pepsin digestion. In fact the ingestion of vegetables in profilin sensitized patients usually determines reactions restricted to the oral cavity (oral allergy syndrome, OAS), despite in literature systemic reactions to zucchini and litches are reported. We describe the history of six patients with adverse reactions after eating plant-derived food and positive allergological evaluation (skin tests, specific IgE, basophil activation test and double-blind placebo-control challenges (DBPCFC) for profilin, that have been undergone to desensitization treatment. The protocol of desensitization started with a drop of profilin solution (50 µg/ml) diluted 1:1018 in water until the highest dose of 10 drops of undiluted solution three times a week. They underwent this desensitization treatment at home and were followed in Day Hospital regimen monthly. According to the protocol they were trained in medical treatment of allergic reactions and equipped with an emergency kit: autoinjectable epinephrine, betamethasone and clorphenamine. At the end of the treatment all patients had negative DBPCFCs with culprit foods and a decrease of specific IgE levels for profilin and vegetable foods. Moreover, the desensitization with profilin has proved to be safe as no serious adverse events were observed in our patients. Profilin desensitization allowed that our patients could manage their diet without restriction, eating several foods previously not tolerated.

Results The median age of onset of the allergic reaction was 3.9 ± 2.2 years. The leguminous most commonly responsible for allergy were the peas involved in 5 reactions, followed by chickpeas and beans, each involved in three reactions. All children were allergic to more than one leguminous, with a median of two leguminous involved in allergic reactions. All reactions except for one were immediate with a mild to severe degree of severity. Regarding the clinical findings of the allergic reactions, the mucocutaneous, gastrointestinal and respiratory symptoms occurred with similar frequency. Oral allergy syndrome was seen in one reaction. Two of these reactions fulfilled anaphylaxis criteria. All children except for one were allergic to at least another class of food besides the leguminous. Concomitant allergic rhinitis was also seen in all patients except for one. SPT, namely prick to prick tests, were performed and confirmed the allergy in all patients.

Methods In this cross sectional study, 103 consecutive patients with seasonal allergic rhinitis were enrolled. Sensitization to common aeroallergen confirmed by skin prick test 3 millimeter more than negative control. Clinical symptoms, personal and familial history of atopy and demographic data were listed. According to food allergy history 63 of 103 patients had positive Open SingleBlind Oral Food Challenge Test that was associated with oral allergy syndrome.