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Systemic allergic reactions induced by labile plant‐food allergens: Seeking potential cofactors. A multicenter study
Author(s) -
Asero Riccardo,
Ariano Renato,
Aruanno Arianna,
Barzaghi Claudio,
Borrelli Paolo,
Busa Moira,
Celi Giorgio,
Cinquini Massimo,
Cortellini Gabriele,
D’Auria Francesca,
De Carli Marco,
Di Paolo Camilla,
Garzi Giulia,
Lodi Rizzini Fabio,
Magnani Monica,
Manzotti Giuseppina,
Marra Alessandro,
Miceli Sopo Stefano,
Murzilli Francesco,
Nucera Eleonora,
Pinter Elena,
Pravettoni Valerio,
Rivolta Federica,
Rizzi Angela,
Saporiti Nicoletta,
Scala Enrico,
Villalta Danilo,
Yacoub MonaRita,
Zisa Giuliana
Publication year - 2021
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.14634
Subject(s) - oral allergy syndrome , ingestion , allergen , medicine , allergy , food allergy , immunoglobulin e , sensitization , systemic reaction , anaphylaxis , immunology , antibody
Background Heat‐and‐pepsin‐sensitive plant food allergens (PR‐10 and profilin) sometimes cause systemic reaction. Objective To detect the risk factors for systemic reactions induced by labile food allergens. Methods A retrospective multicenter study was performed on patients with a documented history of systemic allergic reaction to labile plant food allergens and on age‐matched controls with a history of oral allergy syndrome (OAS) induced by the same foods. Offending foods, their amount, and state (solid or liquid), and potential cofactors (nonsteroidal anti‐inflammatory drugs, protonic pump inhibitors, exercise, alcohol, and fasting) were considered. Results We studied 89 patients and 81 controls. Sensitization to PR‐10 or profilin, IgE to Bet v 1 and/or Bet v 2, and foods causing OAS were similar in the two groups. Twenty patients experienced >1 systemic allergic reaction. Tree nuts, Rosaceae, Apiaceae, and soymilk were the main offending foods. Seventeen (19%) patients were taking a PPI when the systemic reaction occurred (vs 5% in controls; P < .025). The ingestion of the offending food in liquid form (soymilk) was frequent among patients (15%) but unusual among controls (2%; P < .025). Soy milk‐induced systemic reactions were independent of PPI treatment. Fasting and excess of allergen, but not NSAID and exercise, were other relevant cofactors for systemic reactions. Systemic reactions occurred without any identifiable cofactor in 39 (44%) cases. Conclusion PR‐10‐ and profilin‐induced systemic reactions are facilitated by PPI, ingestion of large amounts of unprocessed foods, and fasting. Soybean beverages represent a risk for PR‐10 hypersensitive patients and should be avoided.