Kiwifruit allergy across Europe: Clinical manifestation and IgE recognition patterns to kiwifruit allergens

• Published in: Journal of allergy and clinical immunology 2013-01, Vol.131 (1), p.164-171
• Main Authors: Le, Thuy-My, MD, Bublin, Merima, PhD, Breiteneder, Heimo, PhD, Fernández-Rivas, Montserrat, MD, PhD, Asero, Riccardo, MD, Ballmer-Weber, Barbara, MD, Barreales, Laura, MD, Bures, Peter, MD, Belohlavkova, Simona, MD, de Blay, Frédéric, MD, Clausen, Michael, MD, Dubakiene, Ruta, MD, Gislason, David, MD, van Hoffen, Els, PhD, Jedrzejczak-Czechowicz, Monika, MD, PhD, Kowalski, Marek L., MD, PhD, Kralimarkova, Tanya, MD, Lidholm, Jonas, PhD, DeWitt, Åsa Marknell, PhD, Mills, Clare E.N., PhD, Papadopoulos, Nikolaos G., MD, PhD, Popov, Todor, MD, PhD, Purohit, Ashok, MD, van Ree, Ronald, PhD, Seneviratne, Suranjith, MD, PhD, Sinaniotis, Athanasios, MD, Summers, Colin, MD, Vázquez-Cortés, Sonia, MD, Vieths, Stefan, PhD, Vogel, Lothar, PhD, Hoffmann-Sommergruber, Karin, PhD, Knulst, André C., MD, PhD
• Format: Article
• Language: English
• Subjects: Actinidia - adverse effects; Actinidia - immunology; Actinidin; Adolescent; Adult; Aged; Aged, 80 and over; allergens; Allergens - adverse effects; Allergens - immunology; Allergic diseases; Allergies; Allergy and Immunology; Antigens, Plant - adverse effects; Antigens, Plant - immunology; Biological and medical sciences; Child; component resolved diagnosis; diagnosis; Digestive allergic diseases; Europe; Female; Food; Food allergies; food allergy; Food Hypersensitivity - diagnosis; Food Hypersensitivity - immunology; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; ImmunoCAP; Immunoglobulin E - immunology; Immunopathology; kiwifruit; Male; Medical sciences; Middle Aged; Proteins; Quality of life; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Sensitivity and Specificity; Severity of Illness Index; skin prick test; Skin Tests; Young Adult
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2012.09.009

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. Conclusion 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.