Subjects develop tolerance to Pru p 3 but respiratory allergy to Pru p 9: A large study group from a peach exposed population

Abstract

Peach tree allergens are present in fruit, pollen, branches, and leaves, and can induce systemic, respiratory, cutaneous, and gastrointestinal symptoms. We studied the capacity of peach fruit/Pru p 1, Pru p 3, Pru p 4, Pru p 7 and peach pollen/Pru p 9 for inducing symptoms following oral or respiratory exposure in a large group of subjects. We included 716 adults (aged 21 to 83 y.o.) exposed to peach tree pollen and fruit intake in the study population. Participants completed a questionnaire and were skin tested with a panel of inhalant and food allergens, including peach tree pollen, Pru p 9 and peach fruit skin extract. Immunoglobulin E antibodies (SIgE) to Pru p 1, Pru p 3, Pru p 4 and Pru p 7 were quantified. Sensitised subjects underwent oral food challenge with peach fruit and nasal provocation test with peach tree pollen and Pru p 9. The prevalence of sensitisation to peach fruit was 5% and most of these had SIgE to Pru p 3, with a very low proportion to Pru p 4 SIgE and no SIgE to Pru p 1 and Pru p 7. In only 1.8%, anaphylaxis was the clinical entity induced. Cases with positive skin tests to peach and SIgE to Pru p 3 presented a good tolerance after oral challenge with peach fruit. The prevalence of skin sensitisation to peach tree pollen was 22%, with almost half recognising Pru p 9. This induced respiratory symptoms in those evaluated by nasal provocation. In a large population group exposed to peach fruit and peach tree pollen, most individuals were tolerant, even in those with SIgE to Pru p 3. A positive response to Pru p 9 was associated with respiratory allergy.

Is exposure to pollen a risk factor for moderate and severe asthma exacerbations?

“…To our best knowledge, this is the first systematic review and meta‐analysis to comprehensively summarize the relationships between pollen exposure and asthma exacerbation, as assessed through various respiratory outcomes with strict methodological concerns. The existing literature collected in a recent review of the respiratory health burden attributable to short‐term exposure to pollen had already suggested evidence of an association between outdoor pollen concentrations and most of the asthma outcomes we considered, especially in people with pre‐existing respiratory diseases 3–139 . Our overall meta‐analysis, subgroup analysis, and publication bias assessment confirm that a relationship between pollen exposure and asthma exacerbation exists but this require additional research due to its heterogeneity.…”

“…Horticulturists and fruit tree workers can develop occupational respiratory allergic diseases (rhinoconjunctivitis and asthma) 35 . Teranishi et al 46 conducted an epidemiological study on pollinosis among Japanese pear orchard workers and found positive skin tests (SPT) in 5.4% of them. Jiang et al 47 described a case of occupational allergy to peach ( Prunus persica ) pollen in an artificial pollination worker.…”

Cofactors, age at onset, allergic comorbidities and gender are different in patients sensitized to omega-5 gliadin and Pru p 3

“…In our cohort we did not find a significant difference in terms of clinical presentation in those positive for Pru p 4, similarly to other studies 23 . However, the rates of sensitization to profilins are low in some areas such as Spain or South Italy 22 , 24 , thus preventing to fully evaluate this aspect that should be further investigated.…”