Apple allergy across Europe: how allergen sensitization profiles determine the clinical expression of allergies to plant foods.
BACKGROUND
Allergy to a plant food can either result from direct sensitization to that food or from primary sensitization to pollen, latex, or another food.


OBJECTIVE
We sought to investigate the primary sensitizers in apple allergy across Europe, the individual allergens involved, and whether these differences determine the clinical presentation.


METHODS
Patients (n = 389) with positive case histories and skin prick test responses to fresh apple were selected in the Netherlands, Austria, Italy, and Spain. Skin prick tests and RASTs to a panel of pollens and plant foods were performed, as well as RASTs to Bet v 1 and the apple allergens Mal d 1, 2, 3, and 4.


RESULTS
In the Netherlands, Austria, and Italy apple allergy is mild (>90% isolated oral symptoms) and related to birch pollinosis and sensitization to Bet v 1 and its apple homologue, Mal d 1, which has an odds ratio of local reactions of 2.85 (95% CI, 1.47-5.55). In Spain apple allergy is severe (>35% systemic reactions) and related to peach allergy and sensitization to Mal d 3 (nonspecific lipid transfer protein), which has an odds ratio of systemic reactions of 7.76 (95% CI, 3.87-15.56).


CONCLUSIONS
The analysis of individual apple allergens in a clinical context has provided insight into the sensitization pathway and into the intrinsic risk an allergen bears to induce mild or severe food allergy.


CONCLUSIONS
Information on the sensitization pathway is essential to develop preventive strategies in food allergy. The application of individual food allergens with a known intrinsic risk will improve the prognostic value of diagnostic tests.
Fernández-Rivas
Montserrat
M
Allergy Unit, Fundación Hospital Alcorcón, Madrid. mfernandezri.hcsc@salud.madrid.org
Bolhaar
Suzanne
S
González-Mancebo
Eloina
E
Asero
Riccardo
R
van Leeuwen
Astrid
A
Bohle
Barbara
B
Ma
Yan
Y
Ebner
Christof
C
Rigby
Neil
N
Sancho
Ana I
AI
Miles
Susan
S
Zuidmeer
Laurian
L
Knulst
André
A
Breiteneder
Heimo
H
Mills
Clare
C
Hoffmann-Sommergruber
Karin
K
van Ree
Ronald
R
D000328:Adult; D000485:Allergens / Q000276:immunology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005512:Food Hypersensitivity / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D027845:Malus / Q000276:immunology*; D011852:Radioallergosorbent Test; D006255:Rhinitis, Allergic, Seasonal / Q000453:epidemiology / Q000276:immunology
D000485:Allergens; D007073:Immunoglobulin E