title: Kiwifruit allergy across Europe: clinical manifestation and IgE recognition patterns to kiwifruit allergens.
abstract: BACKGROUND
  Kiwifruit is a common cause of food allergy. Symptoms range from mild to anaphylactic reactions.
  
  
  OBJECTIVE
  We sought to elucidate geographic differences across Europe regarding clinical patterns and sensitization to kiwifruit allergens. Factors associated with the severity of kiwifruit allergy were identified, and the diagnostic performance of specific kiwifruit allergens was investigated.
  
  
  METHODS
  This study was part of EuroPrevall, a multicenter European study investigating several aspects of food allergy. Three hundred eleven patients with kiwifruit allergy from 12 countries representing 4 climatic regions were included. Specific IgE to 6 allergens (Act d 1, Act d 2, Act d 5, Act d 8, Act d 9, and Act d 10) and kiwifruit extract were tested by using ImmunoCAP.
  
  
  RESULTS
  Patients from Iceland were mainly sensitized to Act d 1 (32%), those from western/central and eastern Europe were mainly sensitized to Act d 8 (pathogenesis-related class 10 protein, 58% and 44%, respectively), and those from southern Europe were mainly sensitized to Act d 9 (profilin, 31%) and Act d 10 (nonspecific lipid transfer protein, 22%). Sensitization to Act d 1 and living in Iceland were independently and significantly associated with severe kiwifruit allergy (odds ratio, 3.98 [P = .003] and 5.60 [P < .001], respectively). Using a panel of 6 kiwifruit allergens in ImmunoCAP increased the diagnostic sensitivity to 65% compared with 20% for skin prick tests and 46% ImmunoCAP using kiwi extract.
  
  
  CONCLUSIONS
  Kiwifruit allergen sensitization patterns differ across Europe. The use of specific kiwifruit allergens improved the diagnostic performance compared with kiwifruit extract. Sensitization to Act d 1 and living in Iceland are strong risk factors for severe kiwifruit allergy.
authors.affiliation: Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands. t.t.m.le-2@umcutrecht.nl
authors.forename: Thuy-My
authors.initials: TM
authors.lastname: Le
authors.forename: Merima
authors.initials: M
authors.lastname: Bublin
authors.forename: Heimo
authors.initials: H
authors.lastname: Breiteneder
authors.forename: Montserrat
authors.initials: M
authors.lastname: Fernández-Rivas
authors.forename: Riccardo
authors.initials: R
authors.lastname: Asero
authors.forename: Barbara
authors.initials: B
authors.lastname: Ballmer-Weber
authors.forename: Laura
authors.initials: L
authors.lastname: Barreales
authors.forename: Peter
authors.initials: P
authors.lastname: Bures
authors.forename: Simona
authors.initials: S
authors.lastname: Belohlavkova
authors.forename: Frédéric
authors.initials: F
authors.lastname: de Blay
authors.forename: Michael
authors.initials: M
authors.lastname: Clausen
authors.forename: Ruta
authors.initials: R
authors.lastname: Dubakiene
authors.forename: David
authors.initials: D
authors.lastname: Gislason
authors.forename: Els
authors.initials: E
authors.lastname: van Hoffen
authors.forename: Monika
authors.initials: M
authors.lastname: Jedrzejczak-Czechowicz
authors.forename: Marek L
authors.initials: ML
authors.lastname: Kowalski
authors.forename: Tanya
authors.initials: T
authors.lastname: Kralimarkova
authors.forename: Jonas
authors.initials: J
authors.lastname: Lidholm
authors.forename: Asa Marknell
authors.initials: AM
authors.lastname: DeWitt
authors.forename: Clare E N
authors.initials: CE
authors.lastname: Mills
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Papadopoulos
authors.forename: Todor
authors.initials: T
authors.lastname: Popov
authors.forename: Ashok
authors.initials: A
authors.lastname: Purohit
authors.forename: Ronald
authors.initials: R
authors.lastname: van Ree
authors.forename: Suranjith
authors.initials: S
authors.lastname: Seneviratne
authors.forename: Athanasios
authors.initials: A
authors.lastname: Sinaniotis
authors.forename: Colin
authors.initials: C
authors.lastname: Summers
authors.forename: Sonia
authors.initials: S
authors.lastname: Vázquez-Cortés
authors.forename: Stefan
authors.initials: S
authors.lastname: Vieths
authors.forename: Lothar
authors.initials: L
authors.lastname: Vogel
authors.forename: Karin
authors.initials: K
authors.lastname: Hoffmann-Sommergruber
authors.forename: André C
authors.initials: AC
authors.lastname: Knulst
mesh_terms: D029042:Actinidia / Q000009:adverse effects / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000485:Allergens / Q000009:adverse effects / Q000276:immunology*; D052179:Antigens, Plant / Q000009:adverse effects / Q000276:immunology; D002648:Child; D005060:Europe; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012882:Skin Tests; D055815:Young Adult
chemical_list: D000485:Allergens; D052179:Antigens, Plant; D007073:Immunoglobulin E