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Background: Food allergy (FA) is an important health problem for which epidemiologic studies are needed. Objective: We performed an epidemiologic survey in France to determine the prevalence, clinical pictures, allergens, and risk factors of FA. Methods: This study was conducted on 33,110 persons who answered a questionnaire addressed to a representative sample of the French population on a scale of 1:1000 (44,000 subjects aged ≤60 years). One thousand one hundred twenty-nine persons with FA selected during phase 1 received a second questionnaire. Results: The reported prevalence of FA is 3.52%: 3.24% evolutionary FA; 0.12% asymptomatic cases thanks to eviction diets; and 0.17% cured FA. The subjects were characterized by overrepresentation of city dwellers (80% vs 76%), women (63% vs 50%), and health care personnel (11% vs 4%). Fifty-seven percent (vs 17%) presented with atopic diseases (P < .01). FA was often persistent, lasting more than 7 years in 91% of the adults. The most frequent allergens were 14% Rosaceae, 9% vegetables, 8% milk, 8% crustaceans, 5% fruit cross-reacting with latex, 4% egg, 3% tree nuts, and 1% peanut. Sensitization to pollen was significantly correlated with angioedema, asthma, rhinitis, and fruit allergy (P < .01). FA was 4 times more frequent in patients with latex allergy. The main manifestations of FA were atopic dermatitis for subjects under 6 years of age, asthma for subjects between 4 and 6 years of age, and anaphylactic shock in adults over 30 years of age (P < .007). Shocks were correlated with alcohol or nonsteroidal anti-inflammatory drug intake (P < .01 and P < .04, respectively). Conclusion: The prevalence of FA is estimated at 3.24% (range, 3.04% to 3.44%) in France. This study emphasizes the increasing risk of FA in well-developed countries and draws attention to certain FA risk factors, such as the intake of drugs (nonsteroidal anti-inflammatory drugs, β-blockers, and angiotensin-converting enzyme inhibitors) or alcohol, intolerance of latex gloves, and socioprofessional status. (J Allergy Clin Immunol 2001;108:133-40.)

Background: Few studies have evaluated IgE-mediated hypersensitivity to melon with details of clinical reactions confirmed by double-blind, placebo-controlled, food challenges (DBPCFCs). Objective: We sought to investigate clinical features (type and severity of reactions, age at onset, results of skin prick and in vitro tests, and incidence of other allergic diseases and associated food allergies) of acute allergic reactions to melon confirmed by DBPCFCs. Methods: Fifty-three consecutive adult patients complaining of adverse reactions to melon were included in the study. Skin prick tests and detection of specific IgE were performed in all patients with melon, avocado, kiwi, banana, chestnut, latex, pollen, and other offending foods. Patients first underwent an open food challenge, unless they had a convincing history of severe anaphylaxis. Positive open food challenge reactions were subsequently evaluated by DBPCFCs. Results: Actual clinical reactivity was confirmed in 19 (36%) of 53 patients. The most frequent symptom was oral allergy syndrome (n = 14), but two patients experienced life-threatening reactions, including respiratory symptoms and hypotension. The positive predictive value for a skin prick test was 42%, and that for specific IgE measurement was 44%. Forty-five reactions to 15 other foods were confirmed in 18 patients. The most common foods associated with melon allergy were avocado (n = 7), banana (n = 7), kiwi (n = 6), watermelon (n = 6), and peach (n = 5). Onset of melon-induced allergic symptoms occurred from 6 to 45 years (median, 20 years), preceded by seasonal rhinitis, asthma, or both in 88% (15/17). Conclusion: About one third of reported reactions to melon are confirmed by means of DBPCFC, which has been proven to be the most reliable procedure in the diagnosis of clinical fruit allergy. Isolated melon allergy is rare, with most patients either having allergic rhinitis, asthma, or both and associated food allergies. (J Allergy Clin Immunol 2000;106:968-72.)

Background Natural rubber latex (NRL) allergy occurs frequently in children with spina bifida and other children with disorders requiring multiple operations. Also atopic children who have not undergone surgery can be sensitized to NRL, but the outcome of these children has not been studied. Objective To study how NRL-allergic children manage at home and whether their skin prick test (SPT) reactivity, latex RAST or IgE antibody levels to NRL allergens change during the follow-up. Methods Twenty-four NRL-allergic children who had not undergone surgery and eight children with histories of multiple operations were followed up for a mean of 2.8 years. Clinical symptoms were recorded and all children were re-examined with SPT, latex RAST and ELISA for IgE antibodies to prohevein (Hev b 6.01), hevein (Hev b 6.02) and rubber elongation factor (REF, Hev b 1). Results Nineteen of the 24 NRL-allergic children (79%) who had not undergone surgery had occasionally contacts to balloons and other NRL products at home, and 10 of them experienced symptoms ranging from contact urticaria to systemic reactions. Three of the eight NRL-allergic children with a history of multiple operations had contacts to rubber balloons without any symptoms, and five children underwent 1–8 uneventful operations in a latex-free environment. SPT reactivity to NRL allergens, latex-RAST or IgE antibody levels to prohevein or hevein did not change in either group of NRL-allergic children during the follow-up. Conclusions Occurrence of clinical symptoms and no decrease in SPT reactivity or IgE levels to NRL allergens in the course of the present follow-up study imply that more attention should be paid to the protection of NRL-allergic children from rubber contacts in the home environment.

Background: Date fruits are allergenic and standardized extracts are required for diagnosis and therapy of this allergy. Since there are several cultivars of dates, this study was carried out to assess the allergenicity of different cultivars in order to select suitable source material for standardization. Methods: The protein profiles of 18 of the most commonly sold varieties were compared by SDS-PAGE and their relative allergenicity assessed by SPT and IgE-based ELISA and immunoblotting. Thirty-two date fruit-sensitive patients were skin tested with a pooled extract from all the cultivars. Six of the patients with high SPT results (≥3+) who volunteered were further tested with the 18 cultivars and their sera used in ELISA and immunoblotting. Results: Six of the cultivars gave high SPT-positive reactions in ≥4 of patients. Five of these high SPT-reactive cultivars gave high IgE ELISA scores (≥0.58) but individual cultivars varied in their number of IgE immunoblot bands. Cultivar-specific IgE-binding patterns indicated that only certain cultivars bound IgE at molecular weights of ≤14.3 and 27–33 kDa whilst all cultivars bound to a 54–58 kDa doublet. Cultivars that bind to the ≤14.3 and 27–33 kDa bands appeared to form the majority of the high SPT-reactive cultivars. When individual sera of 24 of the 32 SPT-positive patients were used in IgE immunoblots with the pooled cultivar extract, all sera bound IgE at ≤14.3 and 27–33 kDa and about 60% of sera bound to a 54–58 kDa doublet bands. Conclusions: These results indicate that allergenicity of date fruits is a cultivar-specific phenomenon. Sixty to 100% of sera from date fruit-allergic patients bind IgE to three major allergens of ≤14.3, 27–33 and 54–58 kDa. Five of the cultivars that evoke high SPT reactions, high IgE ELISA scores and bind IgE to the major allergens, can be selected for the preparation of ‘in-house’ allergen extracts and for allergen standardization.

Background: Fruit allergy has been attributed to cross-reactive IgE to pollens and has been associated with a particular pollen sensitization. Objective: The aim of the study was to evaluate sensitization to several taxonomically unrelated pollens in peach- and pollen-allergic patients and to study cross-reactivity between them. Methods: One hundred sixty-five patients were evaluated: 70 peach- allergic patients together with 95 pollen-allergic patients (control group). Pollen skin tests in duplicate were performed to 5 grasses, 8 trees, and 7 weeds. Cross-reactivity between peach and taxonomically diverse pollens was determined by radioallergosorbent inhibition and Western blot inhibition tests. Experiments were also carried out after preadsorption of the sera with purified natural profilin. Results: The skin test results revealed that peach-allergic patients frequently reacted to most pollens—grasses, weeds, and trees—even when some of these are not found in our geographic area. There was a statistically significant increase in sensitization frequency to most trees and weeds, with a statistically higher occurrence of asthma (odds ratio 2.98, 95% confidence interval 1.46-6.09). Inhibition test results provided evidence that taxonomically unrelated grasses, weeds, and trees produced various and substantial degrees of inhibition in specific IgE to peach and that the peach extract elicited strong inhibitions to those pollens. Profilin was found to be a relevant cross-reactive antigen in these patients. Conclusion: The results of this study provide evidence that peach allergy is linked to sensitization to several taxonomically unrelated pollens. This is attributable to the ubiquitous nature of the IgE binding determinants—such as profilins—between peach and taxonomically unrelated pollens. (J Allergy Clin Immunol 1999;104:688-94.)

Background: Allergy to fresh fruits and vegetables is mostly observed in subjects with pollinosis, especially from birch, because of cross-reacting allergens in vegetable foods and pollens. However, allergic reactions to fruits, specifically Rosaceae fruits, have been reported in subjects without pollinosis. Objective: This study evaluated the pattern of IgE reactivity, identifying the allergen responsible in 2 groups of patients with oral allergy syndrome to peach with or without birch pollinosis. Methods: The allergenic components of peach were detected by SDS-PAGE and immunoblotting. The major peach allergen was purified by HPLC with a cation-exchange column followed by gel filtration chromatography. Its IgE-binding capacity and its homology with the protein of the crude extract were demonstrated by immunoblotting inhibition techniques. To better characterize this allergen, periodic acid-Schiff stain and isoelectrofocusing were used. The amino acid sequencing was done with a gas-phase sequencer. Results: SDS-PAGE and immunoblotting of the 15 patients allergic to peach, 8 without and 7 with birch pollinosis, showed that they all recognized a protein with a molecular weight of 9 kd. This was the only allergen recognized by patients not sensitized to pollen, whereas the birch pollen–sensitive patients had IgE binding to other allergenic proteins at higher molecular weights. The purified 9-kd protein retained its IgE-binding capacity, was negative to periodic acid-Schiff stain, and had an isoelectric point value of greater than 9. A search in the Swiss Prot Bank showed this was a lipid transfer protein, belonging to a group of molecules involved in the defensive system of plants. Conclusions: The major allergen of peach is a 9-kd protein belonging to the group of lipid transfer proteins. This is the only allergen recognized by patients allergic to peach but not sensitized to birch pollen. (J Allergy Clin Immunol 1999;103:520-6.)

Background: Allergy to apple and Prunus fruits is frequently associated with birch pollinosis, with the principal cross-reacting allergens involved being members of the Bet v 1 family. However, a major 13-kd component, nonimmunologically related to Bet v 1, has been implicated as allergen in patients allergic to Prunoideae fruit but not to birch pollen. Objective: We sought to isolate and characterize the 13-kd allergen present in apple and peach. Methods: Sera from patients allergic to both fruits were selected on the basis of clinical symptoms, skin prick tests responses, and specific IgE levels. Allergens were purified by reverse-phase HPLC and characterized by N-terminal amino acid sequencing, MALDI analysis, specific IgE immunodetection, and immunoblot inhibition assays. Results: A 13-kd protein band was recognized in crude apple and peach extracts by 9 of 10 and 10 of 10 sera from patients allergic to fruit, respectively. The isolation and characterization of the corresponding allergens allowed their identification as lipid-transfer proteins, with a molecular mass of 9058 d for the apple protein and 9138 d for the peach protein. Both purified allergens were recognized by sera from patients allergic to fruit and fully inhibited the IgE binding by the 13-kd component present in the 2 crude fruit extracts. Conclusion: Lipid-transfer proteins are relevant apple and peach allergens and, considering their ubiquitous distribution in tissues of many plant species, could be a novel type of panallergen of fruits and vegetables. (J Allergy Clin Immunol 1999;103:514-9.)

The purpose of this study was to investigate the prevalence of latex allergy in fruit-allergic patients, and to assess its clinical significance. Fifty-seven fruit-allergic patients and 50 non-fruit-allergic atopic patient controls were studied. All patients were questioned about conventional immediate symptoms after contact with latex products. Patients also underwent skin prick testing and determination of specific serum IgE to latex, as well as a screening test for environmental allergens. Immunologic latex sensitization occurred in 49/57 (85.9%) fruit-allergic patients, who showed a positive STP and/or CAP to latex, but in only two controls (P < 0.001). Six out of 57 (10.5%) fruit-allergic patients suffered from clinically relevant latex allergy. Symptoms included contact urticaria, angioedema, conjunctivitis, generalized urticaria, and moderate anaphylactic reactions. No control reported symptoms with latex products (P = 0.052). In all patients, clinical symptoms to fruits preceded a history of latex allergy. The fruits most associated were melon, peach, and banana. From our data, we conclude that there is a potential for allergic reactions to latex in patients with allergy to fruit. All patients with fruit allergy should be screened for individual risk of latex allergy.

Latex allergy is becoming a major health concern among healthcare workers, of whom approximately 2.8 to 18% are reportedly sensitized.The purpose of this study was to analyze the results of a natural rubber latex (NRL) allergy screening program to identify sensitized hospital employees.Nurses (n = 130) assigned to operating theaters and intensive care units were evaluated using a written questionnaire for symptoms of atopy (asthma, rhinoconjunctivitis, and atopic eczyma), possible reactions to latex gloves, other medical devices and previous surgery. Serological testing for total immunoglobulin E (IgE), latex-specific IgE, and specific-IgE to melon, banana, kiwi, tomato, and chestnut were performed using Pharmacia CAP radioallergosorbent tests. Skin pick test (SPT) for latex allergen was also performed.Elevated serum total IgE was found in 22(16.9%) of the 130 nurses, 3(16.7%) of whom had increased latex-specific IgE further confirmed by SPT. The overall prevalence of latex allergy was 2.3% (3/130). No cross reactive fruit-allergy was found among the latex-sensitized nurses.This study supports the existence of other forms of atopy are related to an increased risk of latex sensitization. The NRL screening program used in this study is feasible for use in identifying latex-sensitized employees.

Clinically significant allergic reactions to latex have recently been reported with increasing frequency. Most instances of latex allergy have been noted in adults who are atopic and are in the healthcare or latex manufacturing industries. Relatively few cases of latex allergy occur in pediatric patients and in these an atopic diathesis is usually also recognized. The exception are the spina bifida children who have frequent mucosal exposure to latex medical items. The cooccurrence of hypersensitivity to certain fruits in latex-allergic patients was reported by M'Rahai et al. in 1991, and this observation has since been amply confirmed in the literature. The objective was to describe a 6-year-old Caucasian boy without known atopy who presented with a history of cutaneous and respiratory reactions to banana and avocado and from whom a history of adverse reactions to common latex products was also elicited. The results of the allergy evaluation of this patient are presented. MEDLINE was searched for reports in English of latex allergy and of latex plus fruit allergy in adults and children from 1979 through 1995. In the patient presented here, immediate hypersensitivity to latex and fruit was assayed by RAST and skin tests. The RAST to latex was strongly positive, equivocal to avocado and chestnut, and negative to banana and kiwi fruit. The prick skin test was positive for banana, avocado and chestnut. Clinically significant allergy to latex and to certain fruit cooccurs. If one component of the dyad is present, the other should be sought and evaluated.

A method based on ion-exchange column chromatography to enhance the protein content of fruit allergenic extracts was found to help make the subsequent SDS-PAGE immunoblotting assays possible; otherwise, they were difficult to achieve due to the high carbohydrate content. Fractionated extracts of apple, pear, and peach (peel and pulp) were obtained by anion-exchange chromatography (Q-SepharoseTM column), providing clear electrophoretic patterns which allowed IgE detection by enzymatic assays of the transferred membranes. This chromatographic method produced in one single step an enriched extract directly from the standard crude aqueous one, with an increment in the protein content of more than sixfold, on average; thus, it proved to be more suitable than the usual chemical fractionation procedures.

The relevance of contact allergy to plant-related food has recently emerged. Oral allergy syndrome is one of the most characteristic symptoms of fruit allergy, although it also causes systemic reactions. Plant-food allergy is increasing at the same time as pollen allergy, and fruit-induced allergic contact urticaria could be rising as well. Objectives The present study was carried out in order to investigate whether one particular primary melon-peel allergen is responsible for contact urticaria. Methods Fourteen patients presenting with contact urticaria after touching melon peel were evaluated. A melon-peel extract was prepared and analysed by immunoblotting using the patients’ sera. Molecular characterization of IgE-binding bands was performed using mass spectrometry. Melon-peel lipid transfer protein (LTP) was purified. Inhibition studies and contact challenge with the protein were performed to confirm IgE reactivity to the purified allergen. Results An IgE-binding band of ~8–9 kDa was observed in an immunoblotting assay with all the patients’ sera and was identified as an LTP. The melon-peel LTP was purified in two chromatography steps. Inhibition studies confirmed LTP as a major allergen in patients with melon-peel contact urticaria. Contact challenge with melon-peel LTP was performed in five patients, all of whom had positive results, exhibiting itchy erythema and hives in the area of contact. Conclusions This study confirmed our previous findings that melon-peel LTP is a major allergen and is responsible for contact allergy. This knowledge may be used to improve both diagnosis and treatment of patients allergic to melon.

Background Latex allergy and its clinical presentation are rising in prevalence across the globe, especially amongst patients with spina bifida (SB). While studies have been well-established in Europe and America, data from Asia are limited. Objective The aim of this study is to investigate the scenario in Singapore. Methods 35 subjects with SB, aged 5 to 32 years answered a questionnaire and underwent skin prick test (SPT) using a latex solution, 3 common house dust mites and 3 commonly cross-reacting food allergens (banana, kiwi and avocado). We also noted the relation between latex sensitization with atopy and doctor-diagnosed allergy. The prevalence of cross-reactivity with fruits was also studied. Results Sensitization to latex (i.e. a positive SPT) was found in 16 (46%, 95% confidence interval 29%-63%) of the subjects. Only 5 (31%) of the subjects who were sensitized to latex had clinical manifestations. Atopy (i.e. positive SPT to house dust mites) was present in 23 (66%) of the subjects and 13 (57%) of them was also sensitized to latex. There was a positive trend between latex sensitization and atopy (81.2% vs. 52.6%, p = 0.076), as well as latex sensitization with those having both atopy and doctor-diagnosed allergy (i.e. asthma, allergic rhinitis, eczema, drug allergy) (93.8% vs. 63.2%, p = 0.032). Only 6 (38%) subjects had allergy to the food allergens tested. Conclusion Almost half of the SB patients in Singapore are sensitized to latex. This number is comparable to that in Europe and America. Positive trend between latex sensitization and those with both atopy and doctor-diagnosed allergy (p = 0.032) is suggestive of a possible cause-effect relationship.

The study of cross-reactivity in allergy is key to both understanding. the allergic response of many patients and providing them with a rational treatment In the present study, protein microarrays and a co-sensitization graph approach were used in conjunction with an allergen microarray immunoassay. This enabled us to include a wide number of proteins and a large number of patients, and to study sensitization profiles among members of the LTP family. Fourteen LTPs from the most frequent plant food-induced allergies in the geographical area studied were printed into a microarray specifically designed for this research. 212 patients with fruit allergy and 117 food-tolerant pollen allergic subjects were recruited from seven regions of Spain with different pollen profiles, and their sera were tested with allergen microarray. This approach has proven itself to be a good tool to study cross-reactivity between members of LTP family, and could become a useful strategy to analyze other families of allergens. Yes

Papain is a proteolytic enzyme which is widely used in food industry, pharmaceuticals, and cosmetics. Occupational and non-occupational papain allergies have previously been documented; however, there are limited publications about papain allergy with its relative fruit allergy. Here, we present a case of occupational, IgE-mediated papain allergy with kiwi fruit and fig fruit allergy. A 53-year-old man suffered from rhinitis for several years, with the onset of his symptoms coinciding with the time he started to work at a sausage processing plant where papain is often used as a meat tenderizer. He began to experience symptoms of chest tightness, shortness of breath and wheezing shortly after starting work 5 years ago. Furthermore, he experienced several episodes of oral itching, and tongue and oropharyngeal angioedema after injestion of kiwi fruit and fig fruit. The patient had a lifelong history of allergic conjunctivitis, allergic rhinitis, and childhood asthma. Specific IgE was positive to kiwi fruit, papain and chymopapain (2.95 kUA/L, >100 kUA/L, and 95.0 kUA/L, respectively). Similar bands at 10-15 kDa in blotting with papain and kiwi fruit extracts were found. This patient showed a potential association between papain allergy and sensitization to kiwi fruit. We also reviewed 13 patients with papain allergy published in the literature, with 85% (11/13) of the patients sensitized through the respiratory tract, and 40% (4/11) having atopy. Further studies should focus on the determination of cross-reactive allergens between papain and its fruit relatives, and the prevalence of food allergy in patients with papain allergy should be investigated in a relatively large cohort.

Scope Banana fruit has become an important cause of fruit allergy in the recent years. Among the five registered IUIS allergens, Mus a 1 and Mus a 2 have been characterized in detail. In this study, molecular characterization and evaluation of the allergenic properties of beta-1,3-glucanase from banana (Musa acuminata), denoted as Mus a 5, were performed Methods and results: The gene of Mus a 5 was cloned and sequenced. The obtained cDNA revealed a novel Mus a 5 isoform with an open reading frame encoding a protein of 340 amino acids comprising a putative signal peptide of 28 amino acid residues. By MALDI-TOF analysis Mus a 5 isolated from banana fruit revealed a molecular mass of 33 451 +/- 67 Da. Two Mus a 5 isoforms (pI 7.7 and 8.0) were detected by 2D immunoblot with an identical N-terminal sequence. By mass fingerprint, 76 and 83% of the primary structure was confirmed for the two mature Mus a 5 isoforms, respectively. IgE reactivity to Mus a 5 was found in 74% of patients sensitized to banana fruit. Upregulation of basophil activation markers CD63 and CD203c was achieved with Mus a 5 in a concentration-dependent manner. Conclusion: Mus a 5 is a functional allergen and a candidate for the component-resolved allergy diagnosis of banana allergy.

Fruit allergy has become a health problem with regard to food safety and quality of life. Breeding and selection of hypoallergenic fruit cultivars is an efficient way to counteract allergy. This chapter reviews the prevalence of fruit allergy, common symptoms, and fruit species involved and their corresponding allergen proteins. Advancements in their linkage map positions and gene expression in fruit tissue are summarized, and genomic sequencing of apple and peach allergen genes. The genetic basis of cultivar differences in apple allergenicity has been illustrated in particular. Strategies to produce hypoallergenic fruits through conventional breeding and marker-assisted selection are discussed.

Multicenter Study; Research Support, Non-U.S. Gov't; Cross-reactivity of plant foods is an important phenomenon in allergy, with geographical variations with respect to the number and prevalence of the allergens involved in this process, whose complexity requires detailed studies. We have addressed the role of thaumatin-like proteins (TLPs) in cross-reactivity between fruit and pollen allergies. A representative panel of 16 purified TLPs was printed onto an allergen microarray. The proteins selected belonged to the sources most frequently associated with peach allergy in representative regions of Spain. Sera from two groups of well characterized patients, one with allergy to Rosaceae fruit (FAG) and another against pollens but tolerant to food-plant allergens (PAG), were obtained from seven geographical areas with different environmental pollen profiles. Cross-reactivity between members of this family was demonstrated by inhibition assays. Only 6 out of 16 purified TLPs showed noticeable allergenic activity in the studied populations. Pru p 2.0201, the peach TLP (41%), chestnut TLP (24%) and plane pollen TLP (22%) proved to be allergens of probable relevance to fruit allergy, being mainly associated with pollen sensitization, and strongly linked to specific geographical areas such as Barcelona, Bilbao, the Canary Islands and Madrid. The patients exhibited >50% positive response to Pru p 2.0201 and to chestnut TLP in these specific areas. Therefore, their recognition patterns were associated with the geographical area, suggesting a role for pollen in the sensitization of these allergens. Finally, the co-sensitizations of patients considering pairs of TLP allergens were analyzed by using the co-sensitization graph associated with an allergen microarray immunoassay. Our data indicate that TLPs are significant allergens in plant food allergy and should be considered when diagnosing and treating pollen-food allergy. Yes

Food allergies can affect both people and animals, and the number of food allergies not only in human but also in animals has increased. Food allergies can affect a patient’s quality of life and lead to a loss of pleasure in eating. There are many kinds of food in the world, and it is possible for all people to have food allergies. The kinds of food allergy differ depending on country, nationality, age, and religion. For example, peanut allergy is common in western countries, but in Asia, it does not occur as frequently. And the incidence of egg allergy in children is higher than that in adults. Not all food allergies in childhood continue into adulthood; in some cases, the symptoms often improve with age, so-called allergy march. In case where food is restricted by religion, the number of its foods allergy must be rare. Food allergies of childhood have close relation to growth and development; this is a serious problem for not only patients but also their families and educational institutions. In some countries, information regarding and measures against food allergy are inadequate. Because religion, economy, education, and nationalities are different, addressing these inadequacies will require large amounts of time and effort. Overcoming food allergy is difficult, but food allergy of childhood often improve with grow up. There are some puzzling aspects of food allergy in childhood; some contaminated foods, plural food allergies and foods that are impossible or difficult to avoid (ex. flour). It needs to measure for people with food allergy, especially, in case of disaster and war. Regardless of religion, economy, education, or nationality, children cannot easily avoid allergens. Their families and other related people must maintain their living environment, and it is important to prepare some kinds of foods without allergens in these cases. Food allergies in adults often appear as a result of occupational problems. Our study showed that some cases of occupational disease were caused by foods; these included a patient working in a bakery with a flour allergy, a green grocer with a vegetable and fruit allergy, a noodle shop worker with a flour allergy, a cook with a fruit allergy, etc (Sugiura K & Sugiura M. 2010a). Occupational food allergies affect a patient’s life and occupation. The avoidance of foods that cause allergic reactions during only meals can not resolve the problem of occupational food allergy; if other workers in the same office do not understand the allergy, a patient’s symptoms are going to progress, finally food allergy causing them to resign from their work. Economic and productivity loss due to food allergy are huge; a response is therefore needed to problems of allergy in the office and on social ground (Sugiura K & Sugiura M. 2010a). Recently, the number of pets with food allergies has been increasing. Basically, food allergy in pets is similar to that in humans with regard to symptoms, examinations, treatment, and safety measures. Because animals do not speak, it is often difficult to diagnose animal food allergy. Most of the food allergies in animals show as red spots, scratching, runny nose

Objective Up to 2 out of 3 spina bifida (sb) patients with natural rubber latex (NRL) antibodies (ab) have crossreacting IgE-ab against tropical fruit, due to structural homologies between several NRL antigens and allergenic fruit proteins. It is essential to investigate whether the patients were first sensitized against NRL or fruit, to give recommendations for an evidence-based prophylaxis. Patients and methods We investigated sera of 96 sb patients for specific IgE ab against NRL, banana and kiwi as examples for crossreacting fruit by FEIA (ImmunoCAP System, Phadia). These tests were repeated up to 3 times (mean after 2 years, maximum after 7 years). Results In the first testing only 2 of 50 NRL-IgE negative patients (4%) had ab against banana or kiwi. 4 of the 46 NRL-IgE positive patients (8%) showed ab against banana (2) or kiwi (2), 3 (7%) against both fruit. Symptoms of fruit allergy were presented by 3 patients, all symptomatic patients had high levels of specific fruit-ab. In the follow-up study 2 patients with low sensitization against NRL lost their NRL ab and their fruit ab, another 2 only the fruit ab, whereas 4 NRL-sensitized patients newly developed ab against banana and 1 against kiwi. Only 2 patients developed ab against fruit without being sensitized against NRL. 7 out of 10 patients with banana and kiwi ab were atopics. Conclusions In most cases the sensitization against fruit follows the NRL sensitization. There is no need to recommend sb patients without NRL sensitization to primarily avoid tropical fruit.

The purpose of this paper is to review and discuss studies on molecular diagnosis in fruit and vegetable allergy.Celeriac, carrot and tomato are the most prevalent allergenic vegetables, whereas fruit allergy is mainly induced by apple, peach and kiwi. Component-resolved molecular diagnosis has been recently applied in two well-defined patient groups with kiwifruit and celeriac allergy, respectively. In kiwifruit allergy Act d 1 and Act d 3 were identified as potential marker allergens for severe symptoms. For celeriac allergy, however, such markers are still missing. In both studies component-resolved molecular diagnosis approach improved in particular sensitivity compared to extract-based diagnostic test assays.Food and vegetable allergy can be acquired both via a direct sensitization over the gastrointestinal tract and via a primary sensitization to pollen or latex. The diagnosis of fruit and vegetable allergy in birch pollen-sensitized patients should not be excluded on a negative IgE testing to extracts. Bet v 1-related allergens are often under-represented in extracts. Few recombinant allergens derived from fruits and vegetables are nowadays commercially available and facilitate diagnosis of fruit and vegetable allergies.

Kiwifruit has become a frequent cause of fruit allergy in the recent years. The molecular basis of type I hypersensitivity to kiwifruit is attributed to 11 IUIS allergens, with Act d 1, Act d 2 and Act d 5 characterized in extenso. Evaluation of the allergenic properties of Act d 4, a cysteine proteinase inhibitor from green kiwifruit (Actinidia deliciosa) was performed in this study. Identity of the purified glycoprotein was determined by Edman degradation and by mass fingerprint whereby more than 90% of the primary structure of the mature kiwifruit cystatin was confirmed. Using MALDI TOF analysis, molecular masses of 10902.5 and 11055.2 Da were detected for Act d 4, respectively. Positive skin prick reactivity with Act d 4 was induced in three kiwifruit allergic patients, as well as the upregulation of CD63 and CD203c molecules in the basophile activation assay. The IgE reactivity was detected in dot blot analysis while Western blot analysis was negative using sera from six kiwifruit patients, suggesting the presence of conformational IgE epitopes on the Act d 4 molecule. As activator of effector cells in type I hypersensitivity Act d 4 is a functional allergen contributing to the clinical symptoms of kiwifruit allergy.

References 1. YASSIN MS, LIERL MB, FISHER TJ, O'BRIEN K, CROSS J, STEINMETZ C. Latex allergy in hospital employees. Ann Allergy 1994; 72:245±249. 2. SLATER JE, CHHABRA SK. Latex antigens. J Allergy Clin Immunol 1992;89:673±678. 3. FLORIDO JF, SAENZ B, GONZAÂ LEZ P, VALLECILLO A, PASCUAL C, MARTIÂN M. SensibilizacioÂn a chirimoya y otras frutas en el So Ândrome de Alergia Oral. Rev Esp Alergol Inmunol Clin 1994;9 Suppl 1:91. 4. GONZALO MA, MONEO I, VENTAS P, POLO F, GARCIÂA JM. IgE-mediated hypersensitivity to custard-apple. Allergy 1997;52:597. 5. WADEE AA, BOTING LA, RABSON AR. Fruit allergy: demonstration of IgE antibodies to a 30 kd protein present in several fruits. J Allergy Clin Immunol 1990;85:801±807. 6. Do ÂAZ-PERALES A, COLLADA C, BLANCO C, et al. Class I chitinases with hevein-like domain, but not class II enzymes, are relevant chestnut and avocado allergens. J Allergy Clin Immunol 1998;102:127±133.

High fruit intakes are associated with significant health benefits but fruit allergy sufferers may be discouraged from eating fruit due to the symptoms they experience. Knowledge about allergens involved in fruit allergy and the frequent cross-reactions to other allergens is essential to (a) design the best strategy for fruit allergy testing (b) prescribe optimal avoidance diets, and (c) design technological solutions for development of hypoallergenic fruits. The objective of this review was to investigate whether some characteristic disease entities could be identified in Europe for allergy to Rosaceae fruits. Five allergy patterns were found involving the allergen families PR-10, LTP, and profilin. In the Western Mediterranean area allergies to Rosaceae fruits are caused by monosensitization to LTP, monosensitization to profilin, or co-sensitization to both these allergens. On the contrary, monosensitization to PR-10 and, to a lesser degree, co-sensitization to profilin and PR-10 is dominant in Northern and Central Europe. LTP sensitization is present both in pollinosis and non-pollinosis patients and is associated with peach allergy in particular. The disease pattern for patients sensitized to profilin is characterized by several concomitant allergies including grass and other pollens, Rosaceae and non-Rosaceae fruits. Finally, PR-10 sensitization is primarily associated to concomitant birch pollen and apple allergy.

Purpose: Recently, component-resolved diagnosis (CRD) using microarray technology has been introduced to the field of clinical allergy. This study was aimed to investigate the clinical usefulness of microarray-based IgE detection for diagnosing clinical raw fruit allergy in birch pollen-sensitized children. Methods: Thirty-one children with allergic disease who had been sensitized to pollen were studied. A pollen-sensitized patient was defined as having an allergen-specific history with concomitant positive skin-prick tests (SPTs) to natural allergen extracts or positive allergen-specific IgE. All subjects underwent SPTs for pollen and fruit. In all subjects, specific IgE to pollen and fruit were measured by ImmunoCAP. Specific IgE antibodies to allergen components were determined by a customized allergen microarray (ISAC). Results: Thirteen of the 31 patients (41.9%) had a history of fruit hypersensitivity with positive SPTs. Measuring IgE to allergen components by ISAC, all the 13 patients with fruit hypersensitivity were positive to at least one of Mal d 1, Pru p 1, Pru p 3, Act d 8, and Act d 2 compared to 12 of the 13 patients (92.3%) who had at least 1 positive IgE to fruits (apple, peach, and kiwi) using ImmunoCAP. The sensitivity of ISAC microarray was 100.0% for the diagnosis of fruit hypersensitivity, but its specificity was 27.7% (5/18). The sensitivity of ImmunoCAP was 92.3%, and its specificity was 83.3%. Conclusion: The sensitivity of allergen components tested using microarray for the diagnosis of clinical fruit hypersensitivity in children with pollen allergy was high; however, its specificity was low.(Allergy Asthma Respir Dis 2015;3:200-205)

Mulberry (Morus spp.) is a widespread deciduous tree and its fruit is commonly eaten in Korea and eastern Asia. Some reports demonstrate that mulberry fruit is a food allergen in the Mediterranean area. However, there has been no report of systemic allergic reactions after ingesting mulberry fruit in Korea. An 18-year-old boy with a mulberry fruit allergy visited our allergy clinic. He had experienced generalized urticaria, chest tightness, breathing difficulty, and abdominal cramping after ingesting mulberry fruit. The patient had a positive skin reaction to mulberry fruit extract (mean wheal size, 5 mm). We performed an ELISA to detect specific IgE antibody (Ab) to mulberry fruit extract in the patient's serum compared to those of non-atopic healthy controls and birch-sensitized individuals. Specific IgE Ab to mulberry fruit extract was detected in the patient's serum, as compared to non-atopic healthy controls. Another subject, who was strongly sensitized to birch pollen, also had a positive serum-specific IgE Ab to mulberry fruit. We performed IgE immunoblot analysis using the patient's and the other subject's sera, who had serum-specific IgE to mulberry fruit, to identify the IgE-binding component. An identical IgE-binding component to mulberry extract was detected in the two subjects at around 17 kDa, and which might be PR 10 of Bet v 1. In conclusion, mulberry fruit could induce a systemic allergic reaction through an IgE-mediated mechanism, and cross-reactivity might occur between mulberry fruit and birch pollen.

Background Lipid transfer proteins (LTPs) are relevant allergens in certain plants. The role of the LTP of Hevea brasiliensis in the latex-fruit syndrome is widely unknown. Objective To study IgE reactivity with recombinant Hevea LTP in sera of fruit-allergic adults with and without natural rubber latex (NRL) allergy. Methods An LTP-specific complementary DNA of H brasiliensis leaves was amplified, subcloned into the pMAL expression system, and analyzed. The recombinant protein was coupled to ImmunoCAP, and the IgE-binding properties were studied in sera of 10 NRL-allergic patients without symptoms to fruit and 48 atopic patients with fruit allergy. Eleven of these 48 patients were also allergic to NRL, 14 displayed sensitization to NRL without symptoms on NRL exposure so far, and 23 had neither symptoms nor IgE antibodies to NRL. Results After expression in Escherichia coli , a soluble maltose-binding protein-rHev b 12 fusion protein was isolated and coupled to ImmunoCAP to determine rHev b 12 specific IgE reactivity. rHev b 12 specific IgE binding was found in 3 fruit-allergic patients with NRL sensitization (0.68, 0.88, and 0.96 kU/L) and in 3 fruit-allergic patients without NRL sensitization (1.58, 2.25, and 2.27 kU/L). The remaining 52 serum samples and all maltose-binding protein control test results were negative ( Conclusions In these patients, rHev b 12 specific IgE reactivity seems to result from common cross-reactive epitopes with some of the fruit LTPs tested and underscores only an involvement in co-recognition. No clinical relevance of IgE binding to the LTP of H brasiliensis in association with NRL allergy was detected.

Background Natural rubber latex allergy is an important health problem. Multiple contacts with latex in childhood are a risk factor. Many aspects of this disease are still unknown, one of which is the clinical outcome of these children. The aim of this study was to evaluate the clinical and epidemiological features of latex allergy and compliance with latex avoidance instructions in allergic children. Material and methods Seventeen consecutive patients with a history of latex allergy, fruit allergy or chronic urticaria were selected. The patients underwent a skin prick test and determination of specific-IgE to latex at the start and at end of the study (median follow-up: 3 years). At diagnosis, patients with a positive result to one of the tests and a clinical history of latex allergy were considered allergic; patients with a positive test but without a clinical history suggestive of allergy were considered sensitized. These children were given latex avoidance instructions. Results Eleven children (64.7 %) were classified as allergic and 6 (35.3 %) as sensitized. Five patients had undergone latex-free surgery after diagnosis without incident. During follow-up, 11 patients (8 allergic and 3 sensitized) had contact with latex. Contact occurred in the home in 10 children, and all were symptomatic. Specific-IgE levels to latex at the end of the study were significantly higher in patients who had contact with latex during the follow-up period than in those without latex contact. Conclusions Strict compliance with latex avoidance instructions is essential both inside and outside the hospital. Greater emphasis should be placed on reducing latex exposure in the home and school environments, as such contact could maintain positive IgE-antibody levels.

Regular consumption of fruits has a positive influence on human health by disease prevention. However parallel to dietetic benefits, IgE-mediated fruit allergies have been shown to be an increasing health risk for children and adults in the Northern hemisphere. The spectrum of food allergies ranges from chronical symptoms to more acute problems and even anaphylaxis. Fruit proteins with high primary sequence similarity display also homologous tertiary structures, resulting in similar epitopes to IgEs and consequently in cross-reactivity. In this review we present the major allergens of stone and pome fruits and discuss the presence of homologous proteins in small fruits. Interestingly these proteins, which might pose an allergenic potential for pre-sensitised individuals are expressed also in strawberry, raspberry and blueberry, otherwise rich in beneficial biofactors.

Allergy to natural rubber latex (NRL) has become an important health issue in recent years, but little is known about how this condition is investigated by physicians in the UK. This postal questionnaire of British dermatology and allergy specialists shows substantial variation in diagnostic practice, most notably with regard to the utilization and choice of starting dose of commercial latex prick test dilutions, reliance on allergen-specific immunoglobulin E measurement, investigation of associated fruit allergy and provision of resuscitation equipment/method of consent when challenge testing. 17% of responding physicians who investigate for NRL allergy do not perform prick test or glove challenge because of the potential risk of anaphylaxis or lack of resuscitation facilities. 87% of allergy clinic specialists report no reduction in the number of patients presenting as new referrals with suspected NRL allergy. These findings suggest a need for robust guidance to achieve more consistent investigative practice by those dealing with this condition.

Background The latex-fruit syndrome is a well-defined disorder whose genetic background has not been elucidated. Objective To study the genetic basis of the latex-fruit syndrome. Methods In a case-control study, we have investigated a carefully selected group of patients allergic to latex, searching for association between latex-fruit allergy and HLA class I and II genes, HLA-DR functional groups, and markers IL4-R1 and FceRI-βca . Results Seventy-eight patients allergic to latex without spina bifida, 33% of them also allergic to fruits, were included in our protocol. Skin prick test results with both a commercial latex extract and purified hevein were significantly greater in patients allergic to latex and fruit than in patients allergic to latex and not fruit. A cutoff point of >7 mm for commercial latex skin prick test diagnosed latex-fruit allergy with a sensitivity of 66.7% (95% CI, 41.0-86.6) and a specificity of 83.3% (95% CI, 68.6-93.0) in our series of patients. No significant differences were found regarding HLA class I, IL4-R1 , or FceRI-βca allele distributions. However, comparison of HLA class II allelic frequencies between patients allergic to latex and fruit and patients allergic to latex and not fruit showed significant associations of latex-fruit allergy with DQB1∗0201 (corrected P value, .001; odds ratio, 7.3; 95% CI, 2.6-20.0), as well as with HLA-DR functional group E (corrected P value, .028; odds ratio, 16.0; 95% CI, 1.9-134.1). When comparing allelic distribution among different subgroups of patients allergic to latex, additional significant associations of latex-fruit allergy with DRB1∗0301 and ∗0901, and of latex and not fruit allergy with DQB1∗0202, DRB1∗0701 and ∗1101, were demonstrated. Conclusions Latex-fruit allergy is associated with HLA-DQB1∗0201, DRB1∗0301, and ∗0901, as well as with HLA-DR functional group E, whereas latex–not-fruit allergy is associated with DQB1∗0202, and with both DRB1∗0701 and ∗1101 alleles.

Summary Background Ornamental Ficus benjamina (FB) has been recognized as a new indoor allergen. Little is known about the prevalence in moderately exposed subjects and the proposed association with fruit and Hevea latex hypersensitivity. Objective To study the prevalence of FB sensitization and the relationship with Hevea latex allergy, to identify cross-reacting fruits, and to characterize the responsible allergens. Methods A skin prick test solution prepared from FB latex (200 μg/mL) was included in our routine screening programme for suspect inhalant allergy. Patients reacting with the FB extract were further skin tested with exotic fruits by the prick-to-prick method. Inhibition of fig and FB CAP by FB latex, fig (Ficus carica), kiwi, the thiolproteases ficin and papain, Hevea latex and rHev b 6.02 (hevein) was performed in selected patients. Results Of 2662 patients with a positive skin test to any aeroallergen, 66 (2.5%) reacted with FB. Ten patients showed isolated sensitization to FB. Although FB-positive subjects were more often co-sensitized to Hevea latex than FB-negative (10.6% vs 3.8%, P

Although screening tests to prevent anaphylaxis during anaesthesia have been advocated, such tests are unlikely to have significant impact on reducing the incidence of anaphylaxis during anaesthesia. This is due to the low prevalence of the disease, the diversity of drugs used in anaesthesia and the incidence of false positive and negative tests. The suggested risk factors of allergy, i.e. atopy, asthma, family history, female sex, previous exposure, vasectomy, use of zinc protamine sulfate insulin and allergy to cosmetics, eggs, fish and non-anaesthetic drugs are not valid. Although all have theoretical or real associations with anaphylaxis during anaesthesia the majority of patients with such a history undergo uneventful anaesthesia. Fruit allergy, anaphylaxis to cephalosporins and penicillin, barbiturate allergy, gelatin allergy and allergy to metabisulphite and eggs require consideration in avoiding particular drugs. The incidence of anaesthetic anaphylaxis can be reduced by avoiding latex exposure in patients with spina bifida or latex allergy, and preventing second reactions in patients with a history of anaphylaxis, or major undiagnosed or undocumented adverse events during anaesthesia. Determining the cause of an adverse event and the drug responsible, and adequately communicating those findings can reduce second reactions. Avoiding neuromuscular blocking drugs (NMBDs) in patients who have reacted to an NMBD, and use of non-intravenous techniques should also reduce the incidence of second reactions. Desensitisation, and blocking with monovalent quaternary ammonium compounds may allow improved safety of NMBDs and pretreatment with antihistamines and corticosteroids may block or ameliorate the severity of reactions, but there is currently little evidence to support their routine use.

Background: The peach lipid transfer protein Pru p 3 has been identified as a major allergen from this fruit. Homologous cross-reactive allergens have been found in several plant foods and pollens. Recombinant Pru p 3 has been recently produced in the yeast Pichia pastoris . Objective: We sought to evaluate the potential role of recombinant Pru p 3 as a novel tool for the diagnosis of fruit allergy. Methods: Circular dichroism analysis was used to compare the protein folding of natural Pru p 3 and recombinant Pru p 3. IgE binding by both molecular forms was quantified by means of ELISA and ELISA inhibition assays, and their biologic activity was estimated by using basophil activation, histamine release, and sulphidoleukotriene production tests. Individual sera or blood samples from patients with peach allergy (up to 17) were used in the assays. Results: A nearly identical circular dichroism spectra was shown by using natural Pru p 3 and recombinant Pru p 3, indicating that both protein forms are similarly folded. No difference was detected in the IgE-binding capacity of the 2 mo-lecular versions. Basophil activation and induction of sulphidoleukotriene production were positive in 9 of 10 patients, and histamine release was induced in at least half of the patients, with similar effects of the natural and recombinant forms in the 3 assays. Conclusion: Recombinant Pru p 3 shows a strong immunologic activity equivalent to that of its natural counterpart, and therefore it can be a useful tool for diagnosis (and future immunotherapy) of fruit allergy. (J Allergy Clin Immunol 2003;111:628-33.)

Background: The few cases of food allergy to fig reported to date, whose main manifestations were anaphylactic reactions, have been related to a cross-sensitisation to weeping fig (Ficus benjamina) or to the ‘latex-fruit syndrome’. Here we report on two cases of the oral allergy syndrome (OAS) to fig in patients whose main allergic manifestations were related to sensitisation to grass and birch pollens. Methods: The patients were characterised by clinical history, skin prick tests (SPT) with commercial and in-house extracts, prick-by-prick test, specific IgE measurements and challenge tests. PBS-soluble and insoluble extracts of both fig skin and pulp were examined for the presence of potential allergens by IgE immunoblotting. Results: Both patients showed OAS followed by respiratory symptoms when challenged with fig. They were negative in both specific IgE detection and SPT with commercial extracts of fig and many other plant materials, including F. benjamina and Hevea brasiliensis, while grass and birch pollens gave positive results. Prick-by-prick tests and SPT with in-house extracts indicated that the fig skin had a much higher allergenicity than the pulp. Despite negative IgE detection by the CAP assay, immunoblotting experiments showed that potential fig allergens were PBS-soluble and present only in the skin of the fruit. Conclusions: OAS to fig followed by respiratory symptoms can be present in patients not sensitised to weeping fig or having the latex-fruit syndrome. Different parts of the fig can have different allergenicities, the most important allergens being proteins related to the skin of the fruit. Improved commercial fig extracts to be used for the diagnosis of this type of allergy have to be developed.

Background: Prescribing therapeutic elimination diets in patients with fruit allergy should include recommendations on which other foods of the same family or group may be safely consumed. Evidence-based data on the management of fruit allergy are lacking; therefore, advice may vary from just avoiding the offending fruit, to overly restrictive diets of the entire botanical family. The aims of this investigation were to assess clinical reactivity to potential cross-reactive foods in fruit-allergic patients, and the implications for prescribing specific therapeutic elimination diets. Methods: Sixty-five adults diagnosed with clinical allergy to one or more fruits were evaluated for IgE-mediated allergy to other related foods, which might share cross-reactive antigens. Those with actual allergy to some Rosaceae fruit (including peach, apple, apricot, plum, and almond) underwent skin prick testing (SPT), food-specific IgE assessment by the Pharmacia CAP-FEIA system, and oral challenges with the entire group. For those with allergy to other fruits (chestnut, melon, banana, kiwi, or avocado) immunologic and clinical reactivity to all five were evaluated. Since a number of people in the study also had proven clinically allergy to some nut or legume (peanut, sunflower seed, walnut, pistachio, or hazelnut), the reactivity to the entire set was investigated. Results: Thirty-four of those tested (52%) were found to be clinically allergic to more than one fruit, so 125 allergic reactions occurred in the 65 patients. Peach, melon, kiwi, apple, and banana accounted for 72% of allergic reactions. Forty-two (65%) had sensitization to pollens, causing seasonal allergic rhinitis and/or asthma, and 18 (28%) were sensitized to latex. The 65 with IgE-mediated fruit allergy underwent 351 additional SPT and food-specific IgE determinations with potential cross-reactive foods considered in this study; 223 (64%) of these results were positive. The routine challenges with potential cross-reactive foods uncovered 18 further reactions in 14 (22%) out of 65 (to avocado in seven; apricot in three; plum in one; almond and peanut in one; banana and hazelnut in one; avocado, banana and kiwi in one). Only 8% (18/223) of positive results for SPT, or food-specific IgE levels of greater than 0.35 kUA/l to potential cross-reactive foods investigated in this study, were clinically relevant. Conclusion: Elimination diets that rely on total group avoidance, or only on the results of allergy testing, might have resulted in unnecessary restriction of 205 foods in the 65 people studied. The lack of routine oral challenges with related fruits—before prescribing dietary restriction—may have allowed 18 food reactions in one-fifth (14/65) of patients to be overlooked.

Results Among 56 patients (46 male, age range 14-22,5 years, median 16,6 years) 55% had positive family history of atopy, 64% reported atopic dermatitis and 80% asthma and/or allergic rhinitis. 1/3 developed their first reaction to a food allergen during infancy, the main allergens being egg (11%), milk (9%) and fish (7%).32% first experienced FA as preschoolers, 27% between 6-12 years and only 11% in adolescence. In 21/56 patients the first reaction was anaphylaxis. All subjects became tolerant to milk and egg before adolescence. The most common allergens in late adolescence were nuts (including peanut) (55%), fruits (25%), fish (23%) and sesame seed (9%). Nut allergy appeared in 48,4% (15/31 patients) in preschool years, in 25,8% between 6-12 years and in 25,8% during adolescence. The rates for fish allergy apparition were 69,2%(9/13 patients), 23,1% and 7,7%, respectively. Fruit allergy emerged in most patients between 6 12 years old. Only 2 patients became tolerant to fish and 3 to nuts before/during adolescence. Over half of the patients experienced at least 1 anaphylactic reaction and 20% had 2 or more. An adrenaline auto-injector was prescribed to 80% of the patients. Nevertheless, only 18% reported carrying it at all circumstances and 20% occasionally.

Type 1 allergy against natural rubber latex is an increasing problem in health care workers and children with spina bifida or urogenital malformations. The aim of our study was to evaluate the prevalence of latex IgE antibodies and cross-reacting fruit antibodies in patients with spina bifida compared with atopic and non-atopic controls. Risk factors for sensitization should be determined. Sera of 148 patients with spina bifida and 98 controls (44 with atopy) were screened for IgE antibodies against latex, banana and kiwi by fluorescence enzyme immunoassay (CAP system). Atopies, allergic symptoms after latex contacts and the number of operations were compiled by a questionnaire. Patients with spina bifida developed latex IgE antibodies (or =0.7 kU/l) more frequently (40.5%) than atopic children (11.4%) or healthy controls (1.9%). All 18 symptomatic patients belonged to the spina bifida group and had high values of latex antibodies. The risk for developing latex antibodies increases with the number of operations. There was no difference in the history of atopic diseases and in a screening test of IgE antibodies against inhalative allergens between latex sensitized and not sensitized children with spina bifida. Antibodies against banana were more frequent in the latex sensitized children with spina bifida. (18.3% vs 3.4%, P = 0.002).The high prevalence of latex antibodies in children with spina bifida justifies a primary prophylaxis by avoiding latex contacts, especially during anaesthesia and surgery, a correlation between the number of operations and the development of latex antibodies exists.