Oral allergy syndrome

Jeong-Hee Choi; Chang Youl Lee

doi:10.4168/aard.2018.6.2.85

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Choi and Lee: Oral allergy syndrome

Review

Allergy Asthma Respir Dis 2018;6(2):85-89.

Published online: 5 March 2018

DOI: https://doi.org/10.4168/aard.2018.6.2.85

Oral allergy syndrome

Jeong-Hee Choi, Chang Youl Lee

Department of Internal Medicine, Lung Research Institute, Hallym University College of Medicine, Chunchun, Korea

Correspondence to: Jeong-Hee Choi https://orcid.org/0000-0002-0599-875X Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong 18450, Korea Tel: +82-31-8086-2829, Fax: +82-31-8086-2482, E-mail: mdqueen@hallym.or.kr

Received 29 September 201725 October 2017 Accepted 27 October 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Oral allergy syndrome (OAS) is an IgE-mediated allergy caused by cross-reacting antigenic determinants in pollens and various fruits, vegetables, and nuts which are known as the most common food allergy in adults. Cross-reactive antigenic proteins include pathogenesis-related-10 protein, profilin, cross-reactive carbohydrate determinant and lipid transfer protein. The prevalence of OAS has been reported at up to 70% of birch pollen allergy. A nationwide multicenter study in our country has recently reported that the prevalence of OAS in Korea is 41.7% of pollen allergy. Typical symptoms of OAS are tingling, itching sense and edema of lips, mouth, and throat immediately after ingestion of raw fruits, vegetables, or nuts. These can progress to systemic symptoms including anaphylaxis. The diagnosis can be made by typical clinical history in patients with pollen allergy. Skin prick test using fresh fruits extracts can be helpful in confirming sensitization to foods, which has better sensitivity than commercial skin prick test or serum specific IgE test. Treatment of OAS is to avoid causative foods. Self-injectable epinephrine should be considered in the case of anaphylaxis. Aller-gen-specific immunotherapy to pollens has also been tried.

Keywords: Food allergy, Pollen, Allergic rhinitis

REFERENCES

1. Webber CM, England RW. Oral allergy syndrome: a clinical, diagnostic, and therapeutic challenge. Ann Allergy Asthma Immunol. 2010; 104:101–8.

2. Amlot PL, Kemeny DM, Zachary C, Parkes P, Lessof MH. Oral allergy syndrome (OAS): symptoms of IgE-mediated hypersensitivity to foods. Clin Allergy. 1987; 17:33–42.

3. Egger M, Mutschlechner S, Wopfner N, Gadermaier G, Briza P, Ferreira F. Pollen-food syndromes associated with weed pollinosis: an update from the molecular point of view. Allergy. 2006; 61:461–76.

4. Tuft L, Blumstein GI. Studies in food allergy: II. Sensitization to fresh fruits: clinical and experimental observations. J Allergy. 1942; 13:574–82.

5. Eriksson NE, Formgren H, Svenonius E. Food hypersensitivity in patients with pollen allergy. Allergy. 1982; 37:437–43.

6. Bircher AJ, Van Melle G, Haller E, Curty B, Frei PC. IgE to food allergens are highly prevalent in patients allergic to pollens, with and without symptoms of food allergy. Clin Exp Allergy. 1994; 24:367–74.

7. Anderson LB Jr, Dreyfuss EM, Logan J, Johnstone DE, Glaser J. Melon and banana sensitivity coincident with ragweed pollinosis. J Allergy. 1970; 45:310–9.

8. Möller C. Effect of pollen immunotherapy on food hypersensitivity in children with birch pollinosis. Ann Allergy. 1989; 62:343–5.

9. Ma S, Sicherer SH, Nowak-Wegrzyn A. A survey on the management of pollen-food allergy syndrome in allergy practices. J Allergy Clin Immunol. 2003; 112:784–8.

10. Cho YS, Lim YJ, Lee JC, Kim SH, Lim MK, Yoo B, et al. Oral allergy syndrome in pollen - sensitized patients. J Asthma Allergy Clin Immunol. 1998; 18:458–65.

11. Choi JH, Kim DK, Yang HJ, Yoo Y, Ahn YM, Park HS, et al. Oral allergy syndrome in patients with pollen allergies in Korea: a multicenter cross-sectional study [abstract]. In: Program and Abstract, 2017 KAAACI-WPAS-INTERASMA Joint Congress; 2017 May 11-13; Seoul, Korea. Seoul: The Korean Academy of Asthma, Allergy and Clinical Immunology,. 2017.

12. Sicherer SH. Clinical implications of cross-reactive food allergens. J Allergy Clin Immunol. 2001; 108:881–90.

13. Ortolani C, Pastorello EA, Farioli L, Ispano M, Pravettoni V, Berti C, et al. IgE-mediated allergy from vegetable allergens. Ann Allergy. 1993; 71:470–6.

14. Stewart GA, Richardson JP, Zhang J, Robinson C. The sturucture and fuc-tion of allergens. Adkonson NF, Bochner BS, Burks AW, Busse WW, Holgate ST, Lemanske RF, editors. Middleton's allergy: principles and practice. 8th ed.Philadelphia (PA): Elsevier/Saunders;2014. p. 398–429.

15. Pastorello EA, Ortolani C, Farioli L, Pravettoni V, Ispano M, Borga A, et al. Allergenic cross-reactivity among peach, apricot, plum, and cherry in patients with oral allergy syndrome: an in vivo and in vitro study. J Allergy Clin Immunol. 1994; 94:699–707.

16. Fernández-Rivas M, van Ree R, Cuevas M. Allergy to Rosaceae fruits without related pollinosis. J Allergy Clin Immunol. 1997; 100(6 Pt 1):728–33.

17. Ebner C, Birkner T, Valenta R, Rumpold H, Breitenbach M, Scheiner O, et al. Common epitopes of birch pollen and apples: studies by western and northern blot. J Allergy Clin Immunol. 1991; 88:588–94.

18. Breiteneder H, Ebner C. Molecular and biochemical classification of plant-derived food allergens. J Allergy Clin Immunol. 2000; 106(1 Pt 1):27–36.

19. Kondo Y, Urisu A. Oral allergy syndrome. Allergol Int. 2009; 58:485–91.

20. Lüttkopf D, Ballmer-Weber BK, Wüthrich B, Vieths S. Celery allergens in patients with positive double-blind placebo-controlled food challenge. J Allergy Clin Immunol. 2000; 106:390–9.

21. Mittag D, Vieths S, Vogel L, Becker WM, Rihs HP, Helbling A, et al. Soybean allergy in patients allergic to birch pollen: clinical investigation and molecular characterization of allergens. J Allergy Clin Immunol. 2004; 113:148–54.

22. Ballmer-Weber BK, Vieths S, Lüttkopf D, Heuschmann P, Wüthrich B. Celery allergy confirmed by double-blind, placebo-controlled food challenge: a clinical study in 32 subjects with a history of adverse reactions to celery root. J Allergy Clin Immunol. 2000; 106:373–8.

23. Ebo DG, Hagendorens MM, Bridts CH, De Clerck LS, Stevens WJ. Sensitization to cross-reactive carbohydrate determinants and the ubiquitous protein profilin: mimickers of allergy. Clin Exp Allergy. 2004; 34:137–44.

24. Asero R, Mistrello G, Roncarolo D, de Vries SC, Gautier MF, Ciurana CL, et al. Lipid transfer protein: a pan-allergen in plant-derived foods that is highly resistant to pepsin digestion. Int Arch Allergy Immunol. 2000; 122:20–32.

25. Mari A, Iacovacci P, Afferni C, Barletta B, Tinghino R, Di Felice G, et al. Specific IgE to cross-reactive carbohydrate determinants strongly affect the in vitro diagnosis of allergic diseases. J Allergy Clin Immunol. 1999; 103:1005–11.

26. Batanero E, Crespo JF, Monsalve RI, Martín-Esteban M, Villalba M, Ro-dríguez R. IgE-binding and histamine-release capabilities of the main carbohydrate component isolated from the major allergen of olive tree pollen, Ole e 1. J Allergy Clin Immunol. 1999; 103(1 Pt 1):147–53.

27. Anhoej C, Backer V, Nolte H. Diagnostic evaluation of grass- and birch-allergic patients with oral allergy syndrome. Allergy. 2001; 56:548–52.

28. Ortolani C, Ispano M, Pastorello EA, Ansaloni R, Magri GC. Comparison of results of skin prick tests (with fresh foods and commercial food extracts) and RAST in 100 patients with oral allergy syndrome. J Allergy Clin Immunol. 1989; 83:683–90.

29. Osterballe M, Scheller R, Stahl Skov P, Andersen KE, Bindslev-Jensen C. Diagnostic value of scratch-chamber test, skin prick test, histamine release and specific IgE in birch-allergic patients with oral allergy syndrome to apple. Allergy. 2003; 58:950–3.

30. Ebo DG, Bridts CH, Verweij MM, De Knop KJ, Hagendorens MM, De Clerck LS, et al. Sensitization profiles in birch pollen-allergic patients with and without oral allergy syndrome to apple: lessons from multi-plexed component-resolved allergy diagnosis. Clin Exp Allergy. 2010; 40:339–47.

31. Rodriguez J, Crespo JF, Burks W, Rivas-Plata C, Fernandez-Anaya S, Vives R, et al. Randomized, double-blind, crossover challenge study in 53 subjects reporting adverse reactions to melon (Cucumis melo). J Allergy Clin Immunol. 2000; 106:968–72.

32. Asero R. Effects of birch pollen-specific immunotherapy on apple allergy in birch pollen-hypersensitive patients. Clin Exp Allergy. 1998; 28:1368–73.

33. Asero R. Fennel, cucumber, and melon allergy successfully treated with pollen-specific injection immunotherapy. Ann Allergy Asthma Immunol. 2000; 84:460–2.

34. Bolhaar ST, Tiemessen MM, Zuidmeer L, van Leeuwen A, Hoffmann-Sommergruber K, Bruijnzeel-Koomen CA, et al. Efficacy of birch-pollen immunotherapy on cross-reactive food allergy confirmed by skin tests and double-blind food challenges. Clin Exp Allergy. 2004; 34:761–9.

35. Bucher X, Pichler WJ, Dahinden CA, Helbling A. Effect of tree pollen specific, subcutaneous immunotherapy on the oral allergy syndrome to apple and hazelnut. Allergy. 2004; 59:1272–6.

36. Herrmann D, Henzgen M, Frank E, Rudeschko O, Jäger L. Effect of hy-posensitization for tree pollinosis on associated apple allergy. J Investig Allergol Clin Immunol. 1995; 5:259–67.

37. Kelso JM, Jones RT, Tellez R, Yunginger JW. Oral allergy syndrome successfully treated with pollen immunotherapy. Ann Allergy Asthma Immunol. 1995; 74:391–6.

38. Kinaciyan T, Jahn-Schmid B, Radakovics A, Zwölfer B, Schreiber C, Fran-cis JN, et al. Successful sublingual immunotherapy with birch pollen has limited effects on concomitant food allergy to apple and the immune response to the Bet v 1 homolog Mal d 1. J Allergy Clin Immunol. 2007; 119:937–43.

39. Hansen KS, Khinchi MS, Skov PS, Bindslev-Jensen C, Poulsen LK, Malling HJ. Food allergy to apple and specific immunotherapy with birch pollen. Mol Nutr Food Res. 2004; 48:441–8.

Table 1.

Major pollen and related food allergens

Pollen allergens		Food allergens
Bet v 1 group (PR-10)
Aln g 1 (alder)	Bet v 1 (birch)	Api g 1 (celery)	Ara h 8 (peanut)	Cor a 1 (hazel)	Dau c 1 (carrot)
Car b 1 (hornbeam)	Cas s 1 (chestnut)	Fra a 1 (strawberry)	Gly m 4 (soybean)	Mal d 1 (apple)	Pru ar 1 (apricot)
Cor a 1 (hazelnut)	Que a 1 (White oak)	Pru av 1 (sweet cherry)	Pyr c 1 (pear)	Sol t 1 (potato)	Vig r 1 (mung bean)
Profilin
Art v 4 (mugwort)	Bet v 2 (brich)	Ana c 1 (pineapple)	Ara h 5 (peanut)	Api g 4 (celery)	Cap a 2 (bell pepper)
Cyn d 12 (Bermuda grass)	Hel a 2 (sunflower)	Cit s 2 (sweet orange)	Cor a 2 (hazel)	Cuc m 2 (muskmelon)	Dau c 4 (carrot)
Ole e 2 (olive)	Phl p 12 (timothy)	Gly m 3 (soybean)	Lit c 1 (lychee)	Lyc e 1 (tomato)	Mal d 4 (apple)
		Mus xp 1 (banana)	Pru av 4 (sweet cherry)	Pru p 4 (peach)	Pyr c 4 (pear)
Lipid transfer protein
Cas s 8 (chestnut)	Art v 3 (mugwor)	Aspa o 1 (asparagus)	Bra o 3 (cabbage)	Pru ar 3 (apricot)	Pru p 3 (peach)
Pla a 3 (plane tree)	Par j 1 (pellitory)	Cit l 3 (lemon)	Cit s 3 (sweet orange)	Pru d 3 (European plum)	Zea m 14 (maize, corn)
Par j 2 (pellitory)	Par o 1 (pellitory)	Fra a 3 (strawberry)	Lac s 1 (lettuce)	Vit v 1 (grape)	Cor a 8 (hazelnut)
		Lyc e 3 (tomato)	Mal d 3 (apple)	Pru av 3 (sweet cherry)	Jug r 3 (English walnut)

Modified from Kondo Y and Urisu A. Allergol Int 2009;58:485-91.¹⁹

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