Position paper of the EAACI: food allergy due to immunological cross‐reactions with common inhalant allergens

Abstract

In older children, adolescents, and adults, a substantial part of all IgE-mediated food allergies is caused by cross-reacting allergenic structures shared by inhalants and foods. IgE stimulated by a cross-reactive inhalant allergen can result in diverse patterns of allergic reactions to various foods. Local, mild, or severe systemic reactions may occur already after the first consumption of a food containing a cross-reactive allergen. In clinical practice, clinically relevant sensitizations are elucidated by skin prick testing or by the determination of specific IgE in vitro. Component-resolved diagnosis may help to reach a diagnosis and may predict the risk of a systemic reaction. Allergy needs to be confirmed in cases of unclear history by oral challenge tests. The therapeutic potential of allergen immunotherapy with inhalant allergens in pollen-related food allergy is not clear, and more placebo-controlled studies are needed. As we are facing an increasing incidence of pollen allergies, a shift in sensitization patterns and changes in nutritional habits, and the occurrence of new, so far unknown allergies due to cross-reactions are expected.Food as a trigger for allergic reactions is gaining more importance, and up to 60% of food allergies in older children, adolescents, and adults are linked with an inhalant allergy. In contrast to classical food allergies where primary sensitization is thought to occur in the gastrointestinal tract and is directed mostly against stable food allergens, primary sensitization in pollen-related and some other cross-reactive food allergies is considered to be against aeroallergens.Although epidemiologic data are scarce, there is no doubt that the increase in pollen allergies is going to be followed by an increase in the so-called pollen-related food allergies (1-4).Cross-reaction is based on the binding of an IgE antibody to homologous allergen structures-shared linear or-in most cases-conformational epitopes (i.e., structural similarities). Such structures may be conserved among proteins with

Вікова динаміка рівня алергенспецифічного IgE в дітей із харчовою алергією та патологією верхніх відділів шлунково-кишкового тракту

“…Алергія -це неадекватна реакція організму на різ-ні речовини, що виявляється при безпосередньому контакті з ними. Харчова алергія -це проблема, най-більш поширена останніми роками [1]. Існує багато різних опитувальників, що можуть бути використані для встановлення якості життя у хворих на харчову алергію та гастродуоденальну патологію.…”

A new allergen family involved in pollen food-associated syndrome: Snakin/gibberellin-regulated proteins

“…Therefore, snakin/GRP may represent a new diagnostic marker of PFAS in addition to other allergens such as Bet v 1-like proteins involved in the well-studied birch/apple syndrome. 9 Whether specific allergenic immunotherapy using a BP14-containing cypress pollen extract can reduce the food-related symptoms remains unknown for the moment and would deserve more investigations. With regard to allergy to Cupressaceae pollen, Inuo et al 10 reported that a specific allergenic immunotherapy performed with a Japanese cedar pollen extract led to a decrease in basophile activation to tomato in a patient with a cedar/tomato syndrome.…”

Approaches to assess IgE mediated allergy risks (sensitization and cross-reactivity) from new or modified dietary proteins

“…In individuals with known clinical allergy to a specific food, cross reactivity can occur when a novel protein has a high amino acid sequence homology to a known allergenic protein, epitope or component as is in the food causing the allergy . There are many examples of clinically relevant cross reacting proteins in the literature, such as Bet v 1, LTP, profilin and others (Hoffmann-Sommergruber and Mills, 2009;Werfel et al, 2015).…”