TY - JOUR
T1 - Systemic allergic reactions induced by labile plant-food allergens
T2 - Seeking potential cofactors. A multicenter study
AU - Asero, Riccardo
AU - Ariano, Renato
AU - Aruanno, Arianna
AU - Barzaghi, Claudio
AU - Borrelli, Paolo
AU - Busa, Moira
AU - Celi, Giorgio
AU - Cinquini, Massimo
AU - Cortellini, Gabriele
AU - D’Auria, Francesca
AU - De Carli, Marco
AU - Di Paolo, Camilla
AU - Garzi, Giulia
AU - Lodi Rizzini, Fabio
AU - Magnani, Monica
AU - Manzotti, Giuseppina
AU - Marra, Alessandro
AU - Miceli Sopo, Stefano
AU - Murzilli, Francesco
AU - Nucera, Eleonora
AU - Pinter, Elena
AU - Pravettoni, Valerio
AU - Rivolta, Federica
AU - Rizzi, Angela
AU - Saporiti, Nicoletta
AU - Scala, Enrico
AU - Villalta, Danilo
AU - Yacoub, Mona Rita
AU - Zisa, Giuliana
N1 - Publisher Copyright:
© 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/10/20
Y1 - 2020/10/20
N2 - Background: Heat-and-pepsin-sensitive plant food allergens (PR-10 and profilin) sometimes cause systemic reaction. Objective: To detect the risk factors for systemic reactions induced by labile food allergens. Methods: A retrospective multicenter study was performed on patients with a documented history of systemic allergic reaction to labile plant food allergens and on age-matched controls with a history of oral allergy syndrome (OAS) induced by the same foods. Offending foods, their amount, and state (solid or liquid), and potential cofactors (nonsteroidal anti-inflammatory drugs, protonic pump inhibitors, exercise, alcohol, and fasting) were considered. Results: We studied 89 patients and 81 controls. Sensitization to PR-10 or profilin, IgE to Bet v 1 and/or Bet v 2, and foods causing OAS were similar in the two groups. Twenty patients experienced >1 systemic allergic reaction. Tree nuts, Rosaceae, Apiaceae, and soymilk were the main offending foods. Seventeen (19%) patients were taking a PPI when the systemic reaction occurred (vs 5% in controls; P <.025). The ingestion of the offending food in liquid form (soymilk) was frequent among patients (15%) but unusual among controls (2%; P <.025). Soy milk-induced systemic reactions were independent of PPI treatment. Fasting and excess of allergen, but not NSAID and exercise, were other relevant cofactors for systemic reactions. Systemic reactions occurred without any identifiable cofactor in 39 (44%) cases. Conclusion: PR-10- and profilin-induced systemic reactions are facilitated by PPI, ingestion of large amounts of unprocessed foods, and fasting. Soybean beverages represent a risk for PR-10 hypersensitive patients and should be avoided.
AB - Background: Heat-and-pepsin-sensitive plant food allergens (PR-10 and profilin) sometimes cause systemic reaction. Objective: To detect the risk factors for systemic reactions induced by labile food allergens. Methods: A retrospective multicenter study was performed on patients with a documented history of systemic allergic reaction to labile plant food allergens and on age-matched controls with a history of oral allergy syndrome (OAS) induced by the same foods. Offending foods, their amount, and state (solid or liquid), and potential cofactors (nonsteroidal anti-inflammatory drugs, protonic pump inhibitors, exercise, alcohol, and fasting) were considered. Results: We studied 89 patients and 81 controls. Sensitization to PR-10 or profilin, IgE to Bet v 1 and/or Bet v 2, and foods causing OAS were similar in the two groups. Twenty patients experienced >1 systemic allergic reaction. Tree nuts, Rosaceae, Apiaceae, and soymilk were the main offending foods. Seventeen (19%) patients were taking a PPI when the systemic reaction occurred (vs 5% in controls; P <.025). The ingestion of the offending food in liquid form (soymilk) was frequent among patients (15%) but unusual among controls (2%; P <.025). Soy milk-induced systemic reactions were independent of PPI treatment. Fasting and excess of allergen, but not NSAID and exercise, were other relevant cofactors for systemic reactions. Systemic reactions occurred without any identifiable cofactor in 39 (44%) cases. Conclusion: PR-10- and profilin-induced systemic reactions are facilitated by PPI, ingestion of large amounts of unprocessed foods, and fasting. Soybean beverages represent a risk for PR-10 hypersensitive patients and should be avoided.
KW - anaphylaxis
KW - food allergy
KW - pollen allergy
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U2 - 10.1111/all.14634
DO - 10.1111/all.14634
M3 - Article
C2 - 33080053
AN - SCOPUS:85094648297
JO - Allergy: European Journal of Allergy and Clinical Immunology
JF - Allergy: European Journal of Allergy and Clinical Immunology
SN - 0105-4538
ER -