Asero Riccardo, Mistrello Gianni, Roncarolo Daniela, Amato Stefano, Zanoni Dario, Barocci Fiorella, Caldironi Gianni
Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy.
J Allergy Clin Immunol. 2003 Aug;112(2):427-32. doi: 10.1067/mai.2003.1611.
A proper classification of patients allergic to plant-derived foods is of pivotal importance because the clinical features of allergic reactions to fruits and vegetables depend on the nature and characteristics of proteins responsible for sensitization. However, in normal clinical settings this is presently impossible.
We sought to detect clinical markers of sensitization to profilin.
Seventy-one patients allergic to fruits and vegetables but not sensitized to lipid transfer protein or natural rubber latex were studied. Food allergy was ascertained on the basis of clinical history and positive skin prick test responses with fresh foods, commercial extracts, or both. Allergies to foods that had caused less than 2 adverse reactions were confirmed by means of open oral challenge. IgE reactivity to rBet v 1/rBet v 2 and to natural Phleum species profilin were detected. Moreover, IgE to the 30- to 40-kd and 60- to 90-kd birch pollen-enriched fractions, which also can be involved in cross-reactivity phenomena, were measured in sera from 52 patients by means of ELISA.
On the basis of in vitro tests, 24, 18, and 25 patients turned out to be sensitized to Bet v 1, Bet v 2, or both, respectively. Four patients had negative test results for both allergens. Hypersensitivity to Bet v 2 was strongly associated with clinical allergy to citrus fruits (39% in patients monosensitized to Bet v 2 vs 4% in patients monosensitized to Bet v 1, P <.025), melon or watermelon (67% vs 0%, P <.001), banana (66% vs 8%, P <.001), and tomato (33% vs 0%, P <.05), whereas Bet v 1 sensitivity was associated with clinical allergy to apple (100% vs 39%, P <.001) and hazelnut (56% vs 0%, P <.001). The sensitivity of a history of allergy to gourd fruits, citrus fruits, tomato, banana, or a combination thereof as a means to detect profilin-hypersensitive patients was 85% (41/48). The specificity of an allergy to any of these fruits exceeded 85%, with positive predictive values ranging between 68% and 91%.
In clinical settings in which laboratory investigations are not easily accessible, allergy to melon, watermelon, citrus fruits, tomato, and banana can be used as a marker of profilin hypersensitivity once a sensitization to natural rubber latex and lipid transfer protein is ruled out.
对植物源性食物过敏的患者进行恰当分类至关重要，因为对水果和蔬菜过敏反应的临床特征取决于引发致敏的蛋白质的性质和特点。然而，在常规临床环境中，目前这是不可能做到的。
我们试图检测对原肌球蛋白致敏的临床标志物。
对71名对水果和蔬菜过敏但对脂质转移蛋白或天然橡胶乳胶不过敏的患者进行了研究。根据临床病史以及对新鲜食物、商业提取物或两者进行的皮肤点刺试验阳性反应来确定食物过敏。对引起少于2次不良反应的食物过敏通过开放性口服激发试验进行确认。检测了对重组Bet v 1/重组Bet v 2以及天然梯牧草属原肌球蛋白的IgE反应性。此外，通过酶联免疫吸附测定法（ELISA）检测了52名患者血清中对30至40kd和60至90kd富含桦树花粉的组分的IgE，这些组分也可能参与交叉反应现象。
根据体外试验，分别有24名、18名和25名患者对Bet v 1、Bet v 2或两者致敏。4名患者对这两种变应原的检测结果均为阴性。对Bet v 2的超敏反应与对柑橘类水果的临床过敏密切相关（对Bet v 2单致敏的患者中为39%，而对Bet v 1单致敏的患者中为4%，P<.025），对甜瓜或西瓜的临床过敏（67%对0%，P<.001），对香蕉的临床过敏（66%对8%，P<.001）以及对番茄的临床过敏（33%对0%，P<.05），而对Bet v 1的敏感性与对苹果的临床过敏（100%对39%，P<.001）和榛子的临床过敏（56%对0%，P<.001）相关。将对葫芦科水果、柑橘类水果、番茄、香蕉或其组合的过敏史作为检测原肌球蛋白超敏患者的手段，其敏感性为85%（41/48）。对这些水果中任何一种过敏的特异性超过85%，阳性预测值在68%至91%之间。
在难以进行实验室检查的临床环境中，一旦排除对天然橡胶乳胶和脂质转移蛋白的致敏，对甜瓜、西瓜、柑橘类水果、番茄和香蕉的过敏可作为原肌球蛋白超敏的标志物。
