Misleading Allergens in the Diagnosis of Latex Allergy: Profilin and Cross-Reactive Carbohydrate Determinants

Abstract

Background: It has been suggested that latex-specific IgE analysis may lead to false-positive results, especially in patients with pollen allergy. In the present study, the reasons underlying clinically irrelevant latex-specific IgE positivity were investigated. Methods: Thirty patients with latex allergy (group 1), 89 patients sensitised to aeroallergens (group 2a), and 98 healthy individuals without allergy (group 2b) were enrolled. Participants from all 3 groups were subjected to skin prick tests with aeroallergens including latex, latex-specific IgE analysis (ImmunoCAP), and nasal provocation test with latex. All cases demonstrating positive latex-specific IgE also underwent specific IgE tests (ImmunoCAP) with latex profilin, birch pollen profilin, peach lipid transfer protein, and pineapple bromelain as cross-reactive carbohydrate determinants. Results: Comparison of the atopic and healthy control groups showed that the rate of positive latex-specific IgE was significantly higher in group 2a. Latex profilin-, birch pollen profilin-, and bromelain-specific IgE were remarkably higher in group 2a. Conclusion: False positivity to latex-specific IgE in ImmunoCAP analysis may be observed in approximately 19% of patients with pollen allergy. Profilins and bromelain are the main contributors to clinically irrelevant positive latex-specific IgE.

Birch pollen allergy in Europe

“…Extracts of alder, hornbeam, hazel, and oak are IgE cross‐reactive toward Bet v 2 . IgE cross‐reactivity toward birch pollen allergens and non‐tree allergens such as grass, mugwort, latex, and/or olive tree has also been identified . This broad cross‐reactivity is primarily due to homology among allergens of the profilin and polcalcin protein families, and the clinical relevance of sensitization to these proteins is questionable.…”

A robust method for the estimation and visualization of IgE cross-reactivity likelihood between allergens belonging to the same protein family

“…Tests including multiplex platforms provide a great body of information concerning IgE binding to individual allergens. Understanding the cross-reactivity of individual allergenic proteins may help in explaining the results of allergy testing [257, 267]. Therefore, we are convinced that the A-RISC index can be used in the interpretation of results originating from component resolved allergy diagnostics.…”

Advances and novel developments in molecular allergology

“…CRD may also have disadvantages, as shown when diagnosing true latex allergy. Since plant profilins and CCD‐bearing bromelains are highly cross‐reactive, CRD resulted in clinically irrelevant false‐positive results among atopic patients with pollen sensitization 44 . For distinguishing exclusively shellfish‐sensitized patients from those sensitized to other invertebrates like molluscs, mites, and cockroaches, a decision tree based on tropomyosin and arginine kinase sequences was proposed 45 .…”