52-5108-40_01 Allergy which allergens Fruits- Vegetables

284 Pages·2010·3.19 MB·English

Fruits & Vegetables
Allergy – Which allergens?
Author: Dr Harris Steinman,
Allergy Resources International, P O Box 565, Milnerton 7435, South Africa,
[email protected].
All rights reserved. No part of this publication may be reproduced in any form
without the written consent of Phadia AB.
©Phadia AB, 2010
Design: RAK Design AB, 2010
Printed by: Åtta.45 Tryckeri AB, Solna, Sweden
Contents
Introduction ..........................................................5
f49 Apple (Malus x domestica) ........................10
f237 Apricot (Prunus armeniaca) .......................24
f261 Asparagus (Asparagus officinalis) ...............29
f262 Aubergine, eggplant (Solanum melongena) ..33
f96 Avocado (Persea americana) ......................37
f51 Bamboo shoot (Phyllostachys pubescens) ...46
f92 Banana (Musa spp.) .................................48
f319 Beetroot (Beta vulgaris) ............................58
f211 Blackberry (Rubus fruticosus) ...................60
f288 Blueberry (Vaccinium myrtillis) ..................62
f260 Broccoli (Brassica oleracea var. italica) ......64
f217 Brussel sprouts (Brassica oleracea
var. gemmifera) ........................................67
f216 Cabbage (Brassica oleracea var. capitata) ...69
f295 Carambola (Averrhoa carambola) ...............72
f31 Carrot (Daucus carota) ..............................74
f291 Cauliflower (Brassica oleracea var. botrytis) ..83
f85 Celery (Apium graveolens) .........................85
f242 Cherry (Prunus avium) ..............................99
Rf341 Cranberry (Vaccinium oxycoccus) .............107
f244 Cucumber (Cucumis sativus) ...................110
f289 Date (Phoenix dactylifera) .......................113
f276 Fennel (Foeniculum vulgare) ...................116
f328 Fig (Ficus carica) ...................................119
f47 Garlic (Allium sativum) ...........................125
f259 Grape (Vitis vinifera) ...............................130
f209 Grapefruit (Citrus paradisi) ......................140
f292 Guava (Psidium guajava) ........................142
f318 Jack fruit (Artocarpus heterophyllus) ........144
f336 Jujube (Ziziphus jujuba) .........................147
f84 Kiwi (Actinidia deliciosa) ........................149
f208 Lemon (Citrus limon) ..............................160
f215 Lettuce (Lactuca sativa) .........................164
f306 Lime (Citrus aurantifolia) ........................169
f348 Litchi (Litchi chinensis) ..........................172
f302 Mandarin (Citrus reticulata) ....................176
f91 Mango (Mangifera indica) .......................179
f87 Melon (Cucumis melo spp.) ....................185
f342 Olive (Olea europaea) .............................191
f48 Onion (Allium cepa) ...............................194
f33 Orange (Citrus sinensis) ..........................199
f293 Papaya (Carica papaya) ..........................206
f294 Passion fruit (Passiflora edulis) ...............211
f95 Peach (Prunus persica) ...........................214
f94 Pear (Pyrus communis) ...........................224
f301 Persimon (Diospyros kaki) .......................229
f210 Pineapple (Ananas comosus) ...................232
f255 Plum (Prunus domestica) ........................236
f35 Potato (Solanum tuberosum) ...................240
f225 Pumpkin (Cucurbita pepo) ......................248

Contents
f343 Raspberry (Rubus idaeus) .......................250
f322 Red currant (Ribes sylvestre) ...................253
f330 Rose hip (Rosa spp.) ..............................255
f214 Spinach (Spinachia oleracea) ..................257
f44 Strawberry (Fragaria vesca) .....................260
f54 Sweet potato (Ipomea batatas) ................265
f25 Tomato (Lycopersicon lycopersicum) .......267
f329 Watermelon (Citrullus lanatus) ................276
Mixes fx7, fx8, fx9, fx11, fx12, fx13 ................280
fx14, fx15, fx16, fx17, fx19, fx21,
fx24, fx25 .............................................281
fx28, fx29, fx30, fx31, fx77 ...................282

Fruit and vegetable allergens Fruit is experiencing a renewed importance
in the human diet, as an indirect result of this
The botanical term “vegetable” means either very “sweet tooth”. With a very abundant
all plant material or all the edible parts of food supply and wide choice among foods
plants, compared to “fruit”, which denotes in the present-day developed world, the
the ripened ovaries of flowering plants and preference for sweetness has run amok, one
surrounding tissues (1). True fruits, therefore, result being widespread overindulgence in
are developed from the ovary in the base of candy, pastries and other processed sweet
the flower and contain the seeds of the plant foods. This has contributed to the obesity
(though cultivated forms may be seedless). epidemic and unprecedented rates of diabetes
Thus, many botanical fruits are not edible and other obesity-related illnesses. But with
at all, and some are actually extremely health awareness growing, there is, at least
poisonous (2). in industrialised countries, a partial return
to human dietary roots, with more and more
But in practice the definitions of the both
“natural”, less-processed foods being eaten,
words are traditional rather than scientific,
and this trend includes the replacement of
and somewhat arbitrary and subjective, being
fattening sweets with non-fattening fruits.
determined by local customs of food selection
and preparation. In general, vegetables have Fruits and vegetables form a large part of
traditionally been regarded are those plant the average middle-class diet. Fixed numbers
parts suitable for savoury or salted dishes, of portions per day are recommended by
rather than sweet dishes. However there are dieticians, and the recommendations are widely
many exceptions, such as the Pumpkin, which heeded, especially by parents and schools. In
is eaten in both savoury and sweetened dishes. the modern era, fruits can be cheap, abundant
In contrast to this, some edible botanical “convenience foods”. Apples, Oranges,
fruits, including the Tomato, the Eggplant, Bananas, Lemons and Limes have for most of
the Bell pepper, and the Bean pod, are classed living memory been easy to transport and store
as culinary “vegetables”. The term “fruit” and so very readily accessible. Commercial
can refer to a part of a plant which is not fruit juices, often available in single-portion
technically a fruit but which is used in sweet servings, have expanded in variety from
cooking: Rhubarb, for example. Mushrooms Apple and Orange juices and lemonade to
belong to the biological kingdom Fungi, not a bewildering array, including exotic mixes.
the plant kingdom, and yet they are also Some fruits such as Mangoes, which because
generally considered to be vegetables. Some of their tropical or semi-tropical origins and
vegetables, such as Carrot, Celery, and Bell difficulty of transport and storage were seldom
pepper are eaten either raw or cooked, while if ever tasted in temperate zones by previous
others, like the Potato, are eaten only when generations, are now growing familiar because
cooked. Most fruits are eaten both raw and of advanced storage and transport technology.
cooked. South African and Israeli fruits, for example,
are transported by plane to Europe within
Fruits are a staple of the human diet
a few hours, and boxed juices (many with
predating agriculture by millions of years,
shelf-lives of from six months to a year) are a
if the evidence of primate diets is relevant.
growing industry in a number of tropical and
Preference for fruit-like sweetness in food is
semi-tropical countries. Additionally, fruit is
generally considered by anthropologists to
often used as a flavourant or other additive
be programmed into homo sapiens through
in processed foods. Finally, there is broader
natural selection and to serve as a signal that a
fruit exposure through greatly increased travel
new food is edible and not harmful. The human
opportunities. The increasing availability of
“sweet tooth” is probably heavily indebted to
vegetables is less dramatic but is still notable.
the prominence of fruit in the environment and
Some of the same factors in transport and
nutrition of early hominids.
retail have been influential, and under
consumer pressure, prepared salads have
become common convenience foods.

Allergen exposure (or Latex-food syndrome) links fruit and
vegetables to one of the most vicious allergies,
It is not surprising that fruit and vegetable
which has, among other depredations, forced
allergy is increasing: two very clear causes
some surgeons and dentists out of practice.
are the increasing availability of fruit and
The Mango component in an allergy complex
vegetables in general and the movement of
may be trivial; but the Latex component could
some fruits and vegetables into regions where
be devastating.
they were almost never eaten before. This
movement complicates the increase in allergy, Occupational fruit and/or vegetable
however, as some methods of processing and allergy are also important and increasing.
storage can activate or de-activate certain Those employed in fruit and vegetable
fruit allergens. Heat-lability and heat-stability, growing, handling and processing – not an
for instance, are important in fruit allergen inconsiderable group of people – are at risk
metamorphosis. from topical exposure to produce. Topical
allergy occurs, and non-allergy topical
Fruit and vegetable allergy symptoms
reactions are factors as well, as fruits contain
span a wide range, from atopic dermatitis to
a variety of volatile chemicals and other
urticaria to oral allergy syndrome (itching lips,
substances that can be irritating to the skin.
tongue and throat, and sometimes swollen
Even mechanical irritation is a problem in
lips, tongue, throat or palate) to anaphylaxis
some fruit workers. Finally, sulphite as a
(A claim put forth is that anaphylaxis-prone
preservative of fruits and vegetables would
allergy does not exist in conjunction with
logically affect producers and handlers much
oral allergy syndrome, but this is debatable).
more than it affects consumers.
Some authors have suggested that “pollen-
food syndrome” is a more apt description of A thorough interview and specific testing
reactions involving cross-reactive pollen and are necessary to determine the exact aetiology
food allergens and encompassing symptoms of occupational reactions to fruit, as well as of
of oral allergy syndrome. reactions to ingestion, in which such factors
as histamine and the toxicity of pits and seeds
Considered in isolation, fruit and vegetable
may need to be taken into account.
allergy might seem to create relatively little
danger or trouble. Fruits and vegetables, when
compared to Peanut or fish, were initially not Cross-reactivity
known for commonly causing anaphylactic
The analysis of cross-reactivity was initially
reactions in very tiny amounts; and it was
fruit to fruit and vegetable to vegetable. It
relatively easy to avoid one or several fruits or
then moved from the botanical family level
vegetables in a diet. However, severe reactions
to the level of panallergens, which allow
have been recorded to both (3-4). It also must
cross-reactivity among much more distantly
be kept in mind that fruit and vegetables,
related entities. It was panallergens that
like Soya, Wheat, and Cow’s milk, may now
explained pollen-fruit cross-reactivity, pollen-
commonly be added to processed food, and
vegetable allergy, and fruit-vegetable allergy.
that, like these allergens, fruits and vegetables
A greater number of culprit pollens can now
are not always properly labelled. A fruit or
be recognised, and a substance as unexpected
vegetable extract called a “flavourant”, for
as Natural rubber latex can be included in
example, can act as a hidden allergen (5).
allergy equations.
More importantly still, the role of fruits and
Therefore, though fruits remain central
vegetables in cross-reactivity (see below) sets
to considerations of cross-reactivity, this
them in the middle of some of the major dramas
phenomenon appears increasingly complex.
of allergy. Fruit-fruit cross-reactivity in itself
To begin with, all fruits and vegetables contain
creates the danger of incomplete diagnosis and
a number of allergens, some of which are
allergens unexpectedly encountered later on.
panallergens. It is possible simply to be allergic
Also, hay fever is on the increase, giving great
to Apple, because of one or more unique Apple
importance to the role that fruits play in pollen-
allergens. It is more likely, however, that a
fruit cross-reactivity. Latex-fruit syndrome
patient will have a cluster of allergies, and it is

conceivable, because of multiple panallergens, dominant features, and profilin being the
to be vulnerable to overlapping patterns of panallergen most frequently implicated (15-
cross-reactivity. (What actually manifests itself 21). Subsequently, a number of allergens or
clinically depends, of course, not only on the panallergens have been identified, and this has
array of allergens but also on the particular shed light on causes and patterns. Profilin was
vulnerabilities and experiences of subjects. originally considered to be unquestionably
A heat-labile allergen in Apple, for example, the most important factor, but LTP is now
would never affect someone who ate Apples receiving significant attention (22-23).
only in pies. A heat-stable allergen in Apple,
Cross-reactivity may occur between fruits
which occurs, would).
and pollens other than Birch. In a laboratory
Certain genera such as Citrus (Grapefruit, study, cross-allergenicity between Apple
Lemon, Lime, Mandarin, Orange) display pulp and 5 pollen species, investigated by
cross-reactivity that is demonstrable at more RAST inhibition, demonstrated that Apple
or less the expected degree, but other genera pulp extract effectively inhibited RASTs to
simply do not show the expected cross- all the pollens except one, Japanese Cedar
reactivity. The Rosaceae fruits (Apple, Apricot, pollen (24). Similarly, a study reported on an
Blackberry, Blueberry, Cherry, Peach, Pear, association between grass pollen allergy and
Plum, Raspberry, Rose hip, Strawberry) show sensitisation to Tomato, Potato, Green pea,
cross-reactivity at a family level. These are the Peanut, Watermelon, Melon, Apple, Orange
most important botanical relationships as far and Kiwi (25).
as demonstrated cross-reactivity is concerned,
Pollen-fruit cross-reactivity is strongly
but the necessarily very incomplete nature of
(though not exclusively) characterised by oral
such an account should be kept in mind. The
allergy syndrome, which creates a fairly clear
large number of fruit species, and the exotic
diagnostic guide. The particular symptoms
history of many fruits, has meant that many
of oral allergy syndrome (see above) should
species have not yet been adequately examined
suggest to the clinician that he consider the
for their allergenic characteristics (6).
involvement of a number of other fruits,
On the other hand, because of panallergens, and the probability of a co-existing allergic
there are strong patterns of cross-reactivity rhinitis to specific pollens. This is particularly
spanning distant, non-fruit relationships. relevant in the Northern Hemisphere, with
These can be summarised under the headings its abundance of Birch, Mugwort and other
of Latex-fruit cross-reactivity and pollen-fruit implicated pollens.
cross-reactivity.
Some panallergens, such as profilin, may
Regarding the former, approximately 30- result mostly in mild symptoms. However,
50% of individuals who are allergic to Natural others, and in particular lipid transfer
rubber latex (NRL) show an associated proteins, are heat-stable and may result in
hypersensitivity to some plant-derived foods, severe reactions, including anaphylaxis; and
especially fresh fruits (7-9). An increasing importantly, they may be more prevalent
number of plant sources, such as Avocado, in certain population groups than others
Banana, Chestnut, Kiwi, Tomato, Potato and (26). For example, Peach allergy has two
Bell pepper, have been associated with this different patterns: that of central Europe,
syndrome (10-13). Chitinase appears to be with oral allergy syndrome (OAS), related
the main panallergenic culprit in Latex-fruit to a primary sensitisation to Birch pollen
cross-reactivity, but other panallergens play Bet v 1 and profilins; and that of southern
a role (8,14). Europe, with mostly systemic symptoms,
in many cases due to sensitisation to lipid
Regarding pollen-fruit syndrome, studies
transfer proteins (27-28).
have reported cross-reactivity between Birch
pollen and a number of foods, e.g., Apple,
Pear, Melon, Hazelnut, Peach, Cherry, Plum,
Celery, Carrot and Potato, with oral allergy
syndrome and allergic rhinitis being the pre-

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Fruit and vegetable ImmunoCAP® Allergens available for IgE antibody testing
f49 Apple (Malus x domestica) f348 Litchi (Litchi chinensis)
f237 Apricot (Prunus armeniaca) f302 Mandarin (Citrus reticulata)
f261 Asparagus (Asparagus officinalis) f91 Mango (Mangifera indica)
f262 Aubergine, eggplant (Solanum f87 Melon (Cucumis melo spp.)
melongena)
f342 Olive (Olea europaea)
f96 Avocado (Persea americana)
f48 Onion (Allium cepa)
f51 Bamboo shoot (Phyllostachys
f33 Orange (Citrus sinensis)
pubescens)
f293 Papaya (Carica papaya)
f92 Banana (Musa spp.)
f294 Passion fruit (Passiflora edulis)
f319 Beetroot (Beta vulgaris)
f95 Peach (Prunus persica)
f211 Blackberry (Rubus fruticosus)
f94 Pear (Pyrus communis)
f288 Blueberry (Vaccinium myrtillis)
f301 Persimon (Diospyros kaki)
f260 Broccoli (Brassica oleracea var.
f210 Pineapple (Ananas comosus)
italica)
f255 Plum (Prunus domestica)
f217 Brussel sprouts (Brassica oleracea
var. gemmifera) f35 Potato (Solanum tuberosum)
f216 Cabbage (Brassica oleracea var. f225 Pumpkin (Cucurbita pepo)
capitata) f343 Raspberry (Rubus idaeus)
f295 Carambola (Averrhoa carambola) f322 Red currant (Ribes sylvestre)
f31 Carrot (Daucus carota) f330 Rose hip (Rosa spp.)
f291 Cauliflower (Brassica oleracea var. f214 Spinach (Spinachia oleracea)
botrytis)
f44 Strawberry (Fragaria vesca)
f85 Celery (Apium graveolens)
f54 Sweet potato (Ipomea batatas)
f242 Cherry (Prunus avium)
f25 Tomato (Lycopersicon
Rf341 Cranberry (Vaccinium oxycoccus) lycopersicum)
f244 Cucumber (Cucumis sativus) f329 Water melon (Citrullus lanatus)
f289 Date (Phoenix dactylifera) Mixes: fx7, fx8, fx9, fx11, fx12, fx13, fx14
f276 Fennel (Foeniculum vulgare) fx15, fx16, fx17, fx19, fx21, fx24,
fx25, fx28, fx29, fx30, fx31, fx77
f328 Fig (Ficus carica)
f47 Garlic (Allium sativum) Allergen components – Recombinant/
f259 Grape (Vitis vinifera) purified native
f209 Grapefruit (Citrus paradisi) f430 rAct d 8 PR-10, Kiwi
f292 Guava (Psidium guajava) f417 rApi g 1.01 PR-10, Celery
f318 Jack fruit (Artocarpus f419 rPru p 1 PR-10, Peach
heterophyllus)
f420 rPru p 3 LTP, Peach
f336 Jujube (Ziziphus jujuba)
f421 rPru p 4 Profilin, Peach
f84 Kiwi (Actinidia deliciosa)
Information regarding available allergen
f208 Lemon (Citrus limon)
components can be found in “Allergy – Which
f215 Lettuce (Lactuca sativa)
allergens?, Native & recombinant allergen
f306 Lime (Citrus aurantifolia) components”.

f Apple
Malus x domestica
Family: Rosaceae
Common
names: Apple, Cultivated apple,
Crabapple
Source
material: Peel from green Apple
Synonymes: M. domestica, M.
communis, M. pumila,
M. sylvestris
For continuous updates:
www.immunocapinvitrosight.com
exist. Different cultivars are available for
temperate and subtropical climates. Most
of these cultivars are bred for eating fresh
(dessert Apples), though some are cultivated
specifically for cooking (cooking Apples) or
producing cider. Cider Apples are typically too
tart and astringent to eat fresh, but they give
Allergen Exposure
the beverage a rich flavour that dessert Apples
Geographical distribution cannot. Old cultivars are often oddly shaped
and russeted, and have a variety of textures
Apples are among the most widely grown
and colours (1).
fruits in the Western Hemisphere.
Apples can be classified into 4 main groups:
The Apple is the pomaceous fruit of the
dessert, culinary, cider and ornamental.
Apple tree, species Malus domestica in the
Varieties are also often grouped into summer
Rosaceae (Rose) family. It is among the most
and late-fall, according to the time of
widely cultivated tree fruits. The tree is small
maturity. Apples are grown in temperate zones
and deciduous, reaching 5 to 12 metres tall,
throughout the world. They are relatively
with a broad, often densely twiggy crown. The
easy to transport and store, and so are readily
leaves are alternately arranged simple ovals 5
available throughout the year. Commercially,
to 12 cm long and 3 to 6 cm broad on a 2 to
Apples can be stored for some months in
5 cm petiole with an acute tip, serrated margin
controlled-atmosphere chambers to delay the
and a slightly downy underside. Flowers are
ethylene-induced onset of ripening. Ripening
produced in spring simultaneously with the
begins when the fruit is removed.
budding of the leaves. The flowers are white
with a pink tinge that gradually fades, 5-
Environment
petaled, and 2.5 to 3.5 cm in diameter. The
fruit matures in autumn and is typically 5 to 9 Readily edible varieties are all cultivated.
cm in diameter. The centre of the fruit contains Apples are most valued as a fresh dessert
5 carpels arranged in a 5-point star, each carpel fruit, but also may be made into jams, jellies,
containing 1 to 3 seeds (1). vinegars, fresh juice, a purée called applesauce,
a preserve called Apple butter, wines, ciders,
The tree originated from Central Asia,
brandies and pastries. They may also be baked,
where its wild ancestor is still found today.
fried, stewed, dried, spiced, candied, or used
Early cultivation probably predates written
in mincemeat or chutney. The fruit is a source
history, and over 7,500 known cultivars
10