[豆类交叉反应性]

[Legume cross-reactivity].

作者信息

Ibáñez M D, Martínez M, Sánchez J J, Fernández-Caldas E

机构信息

Servicio de Alergia del Hospital Niño Jesús, Madrid. Spain.

出版信息

Allergol Immunopathol (Madr). 2003 May-Jun;31(3):151-61.

DOI:
Abstract

Legumes are dicotyledonous plants belonging to the Fabales order. The main distinctive characteristic of which is their fruit (legumen, seeds contained in pods). This botanical order is formed by three families: Mimosaceae, Caesalpiniaceae and Papilionaceae or Fabacea. The Papilionaceae family includes the most important allergenic species: Lens culinaris (lentil), Cicer arietinum (chick-pea), Pisum sátivum (pea), Arachis hipogea (peanut), Phaseolus vulgaris (bean) y Glycine max (soy). Legumes are an important ingredient in the Mediterranean diet. Among Spanish children, sensitivity to legumes is the fifth most prevalent food allergy. Lentil and chick-pea are the most frequent cause of allergic reactions to legumes in Spanish children. Legumes could be involved in severe allergic symptoms. The different legumes have structurally homologous proteins, but they are not all equally allergenic, thus making it difficult to distinguish in vitro and in vivo cross-reactivity. We have demonstrated by skin tests and CAP that most of the patients are sensitised to more than one species. We have demonstrated a great degree of cross-reactivity among lentil, chick-pea, pea and peanut by ELISA inhibition (> 50 % max. inhibition). Unlike the Anglo-Saxons population, this phenomenon implies clinical sensitisation for many Spanish children. The majority of our patients have had symptoms with more than one legume (median 3 legumes). Thirty-nine patients were challenged (open or simple blind) with two or more legumes and 32 (82 %) reacted to two or more legumes: 43,5 % to 3, 25,6 % to 2, 13 % to 4 legumes. Seventy three per cent of the patients challenged with lentil and pea had positive challenge to both, 69,4 % to lentil and chick-pea, 60 % to chick-pea and 64,3 % to lentil, chick-pea and pea simultaneously. Peanut allergy peanut can be associated to allergy to lentil, chick-pea and pea but less frequently. Contrarily, white bean and overall green bean and soy are well tolerated by children allergic to other legumes. In our study, 82 % of the children allergic to legumes had a sensitisation to pollen. Pea and bean are the legumes with more in vitro cross-reactivity with Lolium perenne, Olea europea and Betula alba. This cross-reactivity could be because of common antigenic determinants or due to the coexistence of pollen and legume allergy. Panallergens implication seems to be less probable. It is important to emphasize that in spite of an evident clinical and immunological cross-reactivity, the diagnosis of legume allergy should not be based only on specific IgE tests. The decision to eliminate one legume from the diet should be based on a positive oral food challenge.

摘要

豆类是属于豆目(Fabales order)的双子叶植物。其主要显著特征是它们的果实(荚果,豆荚中包含的种子)。这个植物目由三个科组成:含羞草科(Mimosaceae)、苏木科(Caesalpiniaceae)和蝶形花科(Papilionaceae)或豆科(Fabacea)。蝶形花科包含最重要的致敏物种:兵豆(Lens culinaris)、鹰嘴豆(Cicer arietinum)、豌豆(Pisum sátivum)、花生(Arachis hypogea)、菜豆(Phaseolus vulgaris)和大豆(Glycine max)。豆类是地中海饮食中的重要成分。在西班牙儿童中,对豆类的敏感性是第五大最常见的食物过敏。兵豆和鹰嘴豆是西班牙儿童对豆类过敏反应最常见的原因。豆类可能会引发严重的过敏症状。不同的豆类具有结构同源的蛋白质,但它们并非都具有同等的致敏性,因此难以区分体外和体内的交叉反应性。我们通过皮肤试验和CAP检测证明,大多数患者对不止一种物种敏感。我们通过ELISA抑制试验(最大抑制率>50%)证明了兵豆、鹰嘴豆、豌豆和花生之间存在高度的交叉反应性。与盎格鲁 - 撒克逊人群不同,这种现象对许多西班牙儿童意味着临床致敏。我们的大多数患者对不止一种豆类有症状(中位数为3种豆类)。39名患者接受了两种或更多种豆类的激发试验(开放或简单盲法),32名(82%)对两种或更多种豆类有反应:对3种豆类有反应的占43.5%,对2种豆类有反应的占25.6%,对4种豆类有反应的占13%。接受兵豆和豌豆激发试验的患者中,73%对两者均呈阳性激发反应,对兵豆和鹰嘴豆呈阳性激发反应的占69.4%,对鹰嘴豆呈阳性激发反应的占60%,对兵豆、鹰嘴豆和豌豆同时呈阳性激发反应的占64.3%。花生过敏可能与对兵豆、鹰嘴豆和豌豆的过敏相关,但频率较低。相反,对其他豆类过敏的儿童对白芸豆以及总体上的绿豆和大豆耐受性良好。在我们的研究中,82%对豆类过敏的儿童对花粉敏感。豌豆和菜豆是与黑麦草(Lolium perenne)、油橄榄(Olea europea)和白桦(Betula alba)在体外交叉反应性较高的豆类。这种交叉反应性可能是由于共同的抗原决定簇,或者是由于花粉和豆类过敏的共存。泛过敏原的影响似乎可能性较小。需要强调的是,尽管存在明显的临床和免疫交叉反应性,但豆类过敏的诊断不应仅基于特异性IgE检测。从饮食中排除一种豆类的决定应基于口服食物激发试验呈阳性。

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