Systemic allergic reactions induced by labile plant-food allergens: Seeking potential cofactors. A multicenter study.

Abstract

BACKGROUND:

Heat-and-pepsin-sensitive plant food allergens (PR-10 and profilin) sometimes cause systemic reaction.

OBJECTIVE:

To detect the risk factors for systemic reactions induced by labile food allergens.

METHODS:

A retrospective multicenter study was performed on patients with a documented history of systemic allergic reaction to labile plant food allergens and on age-matched controls with a history of oral allergy syndrome (OAS) induced by the same foods. Offending foods, their amount, and state (solid or liquid), and potential cofactors (nonsteroidal anti-inflammatory drugs, protonic pump inhibitors, exercise, alcohol, and fasting) were considered.

RESULTS:

We studied 89 patients and 81 controls. Sensitization to PR-10 or profilin, IgE to Bet v 1 and/or Bet v 2, and foods causing OAS were similar in the two groups. Twenty patients experienced >1 systemic allergic reaction. Tree nuts, Rosaceae, Apiaceae, and soymilk were the main offending foods. Seventeen (19%) patients were taking a PPI when the systemic reaction occurred (vs 5% in controls; P < .025). The ingestion of the offending food in liquid form (soymilk) was frequent among patients (15%) but unusual among controls (2%; P < .025). Soy milk-induced systemic reactions were independent of PPI treatment. Fasting and excess of allergen, but not NSAID and exercise, were other relevant cofactors for systemic reactions. Systemic reactions occurred without any identifiable cofactor in 39 (44%) cases.

CONCLUSION:

PR-10- and profilin-induced systemic reactions are facilitated by PPI, ingestion of large amounts of unprocessed foods, and fasting. Soybean beverages represent a risk for PR-10 hypersensitive patients and should be avoided.

• Authors: Riccardo Asero, Renato Ariano, Arianna Aruanno, Claudio Barzaghi, Paolo Borrelli, Moira Busa, Giorgio Celi, Massimo Cinquini, Gabriele Cortellini, Francesca D'Auria, Marco De Carli, Camilla Di Paolo, Giulia Garzi, Fabio Lodi Rizzini, Monica Magnani, Giuseppina Manzotti, Alessandro Marra, Stefano Miceli Sopo, Francesco Murzilli, Eleonora Nucera, Elena Pinter, Valerio Pravettoni, Federica Rivolta, Angela Rizzi, Nicoletta Saporiti, Enrico Scala, Danilo Villalta, Mona-Rita Yacoub, Giuliana Zisa
• Journal: Allergy (Allergy) Vol. 76 Issue 5 Pg. 1473-1479 (05 2021) ISSN: 1398-9995 [Electronic] Denmark
• PMID: 33080053 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

Chemical References

• Allergens
• Antigens, Plant
• Plant Proteins
• Immunoglobulin E

Topics

• Allergens
• Antigens, Plant
• Cross Reactions
• Food Hypersensitivity (diagnosis, epidemiology, etiology)
• Humans
• Immunoglobulin E
• Plant Proteins (adverse effects)
• Retrospective Studies