title: Carrot allergy: double-blinded, placebo-controlled food challenge and identification of allergens.
abstract: BACKGROUND
  Allergic reactions to carrot affect up to 25% of food-allergic subjects. Clinical manifestations of carrot allergy and IgE responses to carrot proteins, however, have never been studied in subjects with carrot allergy confirmed by means of double-blinded, placebo-controlled food challenge (DBPCFC).
  
  
  OBJECTIVE
  The purposes of this investigation were to confirm clinically relevant sensitizations to carrot by means of DBPCFC, to validate current diagnostic methods, and to identify IgE-reactive carrot proteins in patients with true allergy.
  
  
  METHODS
  DBPCFCs were performed in 26 subjects with histories of allergic reactions to carrot. Patients underwent skin prick tests with carrot extract, fresh carrot, and various pollen extracts. Specific IgE to carrot, celery, birch, and mugwort pollen and to rBet v 1, rBet v 2, and rBet v 6 were measured through use of the CAP method. Carrot allergens were identified by means of immunoblotting and blotting inhibition.
  
  
  RESULTS
  Twenty of 26 patients had positive DBPCFC results. The sensitivity of the determination of carrot-specific IgE antibodies through use of the CAP method (> or =0.7 kU/L) was 90%, the sensitivity for skin prick testing with commercial extracts was 26%, and the sensitivity for prick-to-prick tests with raw carrot was 100%. The Bet v 1--related major carrot allergen Dau c 1 was recognized by IgE from 85% of patients; 45% were sensitized to cross-reactive carbohydrate determinants and 20% to carrot profilin. In 1 subject, a Bet v 6--related carrot allergen was recognized. In 4 patients, IgE binding to Dau c 1 was not inhibited or was weakly inhibited by rBet v 1 or birch pollen extract.
  
  
  CONCLUSIONS
  This study confirmed the allergenicity of carrot by means of DBPCFC. DBPCFC-positive patients had exclusively specific IgE antibodies to birch pollen--related carrot allergens, Dau c 1 being the major allergen. The lack of inhibition of IgE binding to Dau c 1 by birch allergens in a subgroup of patients might indicate an secondary immune response to new epitopes on the food allergen that are not cross-reactive with Bet v 1.
authors.affiliation: Allergy Unit, Department of Dermatology, University Hospital, Zürich, Switzerland.
authors.forename: B K
authors.initials: BK
authors.lastname: Ballmer-Weber
authors.forename: B
authors.initials: B
authors.lastname: Wüthrich
authors.forename: A
authors.initials: A
authors.lastname: Wangorsch
authors.forename: K
authors.initials: K
authors.lastname: Fötisch
authors.forename: F
authors.initials: F
authors.lastname: Altmann
authors.forename: S
authors.initials: S
authors.lastname: Vieths
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens; D052179:Antigens, Plant; D003429:Cross Reactions; D018552:Daucus carota / Q000009:adverse effects*; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010940:Plant Proteins; D011058:Pollen / Q000276:immunology; D012882:Skin Tests
chemical_list: D000485:Allergens; D052179:Antigens, Plant; C119925:Dau c 1 protein, Daucus carota; D010940:Plant Proteins