Allergy to Strawberry in Children From the Mediterranean Area: Is It Really Allergy?

Cabrera‐Freitag, Paula; Becerro, A Bermejo; Ramirez, Maximiliano; Álvarez-Perea, Alberto; Herrero, Sofía; Fuentes‐Aparicio, Victoria; Remón, L. Zapatero

doi:10.18176/jiaci.0491

Cited by 3 publications

(3 citation statements)

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“…Klingebiel et al showed that BA in patients allergic to peach GRP with clinical reactions requiring cofactors was lower than that without cofactor requirement [ 14 ], which is consistent with our patient’s BA. The low number of positive results in OFCTs against strawberries in a previous study may be because no cofactors were added to the OFCTs [ 6 ]. Cofactors, such as exercise, are ones that lower the threshold for allergic reactions to food and increase the likelihood of a systemic reaction.…”

Section: Discussionmentioning

confidence: 99%

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Generalized allergic reaction in response to exercise due to strawberry gibberellin-regulated protein: a case report

Inuo

Okazaki

Shiraki

et al. 2022

Allergy Asthma Clin Immunol

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Background The Rosaceae family includes fruits, such as peach, apple, Japanese apricot, cherry (Prunoideae subfamily), and strawberry (Rosoideae subfamily). The allergens responsible for Rosaceae fruit allergies have been reported to include Bet v 1 and profilin, which mainly cause oral symptoms, and lipid transfer protein (LTP). Recently, gibberellin-regulated protein (GRP) has been identified as an allergen that induces generalized symptoms in peach-, orange-, and plum-related allergies. Most patients with food allergies induced by GRP show allergic symptoms accompanied by cofactors, such as exercise or drugs. To date, there are very few reports of generalized symptoms induced by strawberry. Case presentation We evaluated the reactivity of strawberry GRP in a 15-year-old boy who was confirmed to have generalized symptoms induced by strawberry with exercise using an oral food challenge test (OFCT). The patient’s serum exhibited a strong positive reaction to strawberry GRP but not to peach GRP or peach LTP. The patient’s basophils reacted to strawberry and peach GRP but not to peach LTP. Conclusions Strawberry GRP may be a causative component for strawberry with exercise-induced generalized symptoms in this patient. This is the first study to investigate the role of GRP in strawberry with cofactor-induced allergic symptoms. Further epidemiological and clinical researches are necessary to improve diagnostic and therapeutic approaches for patients with strawberry allergy.

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Section: Discussionmentioning

confidence: 99%

“…Interestingly, a previous report suggested that Fra a 3 is less potent than peach or apple LTP [ 5 ]. To date, there are very few reports of generalized symptoms induced by strawberry [ 2 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Generalized allergic reaction in response to exercise due to strawberry gibberellin-regulated protein: a case report

Inuo

Okazaki

Shiraki

et al. 2022

Allergy Asthma Clin Immunol

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“…Recently, a retrospective study conducted in Spain studied 43 children with a self-reported history of strawberry allergy. Among these children, 67% had positive strawberry allergy testing, but 94% tolerated the fruit, bringing into question the relevance of reported reactions and testing ( 33 ). A similar study for tomato allergy has not been reported.…”

Section: Introductionmentioning

confidence: 99%

Fruitful or unfruitful: strawberry and tomato specific immunoglobulin E testing at a tertiary pediatric center

Chong,

Izadi,

Chwa

et al. 2023

Front. Allergy

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BackgroundSuspected strawberry and tomato (S/T) food allergy (FA) can be evaluated using specific immunoglobulin E (sIgE) testing despite its low specificity and positive predictive value.ObjectiveThis study aims to understand ordering patterns for S/T sIgE testing and identify relevant factors to clinical decision-making.MethodsWe retrospectively reviewed 814 patients with sIgE testing available for strawberries (651), tomatoes (276), or both (113) from January 2012 to May 2022 at a tertiary pediatric hospital. Patient demographics, provider specialty, and reasons for testing were collected. Student’s t-test and multiple regression analyses were performed to test the association between the S/T sIgE level and clinically relevant outcome (CRO) status. Fisher’s exact test and general linear models were used to evaluate and compare potential predictive factors for CRO status.ResultsAllergy and immunology, gastroenterology, and general pediatrics ordered most S/T sIgE testing. Testing was ordered most frequently for non-IgE-mediated gastrointestinal symptoms, mild possible IgE-mediated reactions, and eczema. Testing was most often ordered for infants and school-age children. Mean sIgE levels were higher for S/T tests resulting in a CRO when controlling for other predictor variables (p = 0.015; p = 0.002 for S/T, respectively). Only 2.2% and 5.4% of tests resulted in a CRO for S/T, and severe allergy was rare. Testing for non-IgE-mediated GI symptoms or eczema, or in non-atopic patients, yielded no CROs. Exposure and reaction history of present illness (ERH) was associated with CROs (p < 0.001; p = 0.04) with a high negative predictive value (99.5%; 100%) and low positive predictive value (11.5%; 15.0%). ERH (p < 0.001, η2 = 0.073; p = 0.009, η2 = 0.123) was a more significant predictor than the sIgE level (p = 0.002, η2 = 0.037; p = 0.212, η2 = 0.030) for CRO status.ConclusionThe diagnosis of S/T food allergy is made primarily based on clinical history. S/T sIgE testing for children and adolescents should be avoided for patients without an ERH and in the workup of non-IgE-mediated GI symptoms. Testing for eczema and non-atopic patients is likely low-yield.

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Screening of Immunoglobulin E mediated Food Allergies among Children

Anani

Elkelany

Hashem

et al. 2021

Revue Française d'Allergologie

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Allergy to Strawberry in Children From the Mediterranean Area: Is It Really Allergy?

Cited by 3 publications

References 0 publications

Generalized allergic reaction in response to exercise due to strawberry gibberellin-regulated protein: a case report

Generalized allergic reaction in response to exercise due to strawberry gibberellin-regulated protein: a case report

Fruitful or unfruitful: strawberry and tomato specific immunoglobulin E testing at a tertiary pediatric center

Screening of Immunoglobulin E mediated Food Allergies among Children

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