New light on an old syndrome: Role of Api g 7 in mugwort pollen–related celery allergy - 18/06/24
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Graphical abstract |
Abstract |
Background |
Celery root is known to cause severe allergic reactions in patients sensitized to mugwort pollen.
Objective |
We studied clinically well-characterized patients with celery allergy by IgE testing with a comprehensive panel of celery allergens to disentangle the molecular basis of what is known as the celery–mugwort syndrome.
Methods |
Patients with suspected food allergy to celery underwent a standardized interview. Main inclusion criteria were a positive food challenge with celery or an unambiguous case history of severe anaphylaxis. IgE to celery allergens (rApi g 1.01, rApi g 1.02, rApi g 2, rApi g 4, nApi g 5, rApi g 6, rApi g 7) and to mugwort allergens (rArt v 1, rArt v 3, rArt v 4) were determined. IgE levels ≥0.35 kUA/L were regarded positive.
Results |
Seventy-nine patients with allergy to celery were included. Thirty patients had mild oral or rhinoconjunctival symptoms, and 49 had systemic reactions. Sixty-eight percent had IgE to celery extract, 80% to birch pollen, and 77% to mugwort pollen. A combination of Api g 1.01, 1.02, 4, 5, and 7 increased the diagnostic sensitivity for celery allergy to 92%. The lipid transfer proteins Api g 2 and Api g 6 were not relevant in our celery-allergic population. IgE to Api g 7, detected in 52% of patients, correlated closely (r = 0.86) to Art v 1 from mugwort pollen. Eleven of 12 patients with monosensitization to Api g 7 were IgE negative to celery extract. The odds ratio for developing a severe anaphylactic reaction rather than only mild oral symptoms was about 6 times greater (odds ratio, 5.87; 95% confidence interval, 1.08-32.0; P = .0410) for Api g 7–sensitized versus –nonsensitized subjects.
Conclusion |
There is an urgent need for routine diagnostic tests to assess sensitization to Api g 7, not only to increase test sensitivity but also to identify patients at risk of a severe allergic reaction to celery.
Le texte complet de cet article est disponible en PDF.Key words : Component-resolved diagnosis, food challenge, threshold dose, mugwort pollen, birch pollen, cross-reactivity, pollen food syndrome, defensin-like protein 1, celery root, celeriac
Abbreviations used : Api g, Art v, Bet v, CCD, CI, CRD, ED10, LOAEL, LTP, nsLTP, OR, Pru p
Plan
The last 2 authors contributed equally to this article, and both should be considered senior author. |
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