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Les "fruits rouges"
mardi 10 août 2010, par
La dénomination "fruits rouges" recouvre un ensemble de fruits qui ont en commun, hormis la couleur, une origine souvent arbustive (« fruits des bois ») et un usage volontiers en mélange.
Les plus classiques sont : cerise, fraise, framboise, cassis, groseille, mûre et myrtille.
D’un point de vue allergologique, les fruits rouges ne sont pas homogènes car ils appartiennent à des familles botaniques variées : selon telle ou telle famille botanique ou type de fruit, telle famille d’allergènes peut donc être plus ou moins présente.
Certains de ces fruits sont largement consommés et bien connus sur le plan allergologique (ex. cerise, fraise), tandis que d’autres n’ont fait l’objet que de rares descriptions cliniques.
L’article présent regroupe ces observations et tente d’apporter une aide dans les dénominations anglo-saxonnes qui peuvent porter à confusion du fait de la multitude des fruits dénommés « berries ».
Le tableau ci-après donne un aperçu des "berry" et des "currant", y compris pour des aliments autres que des fruits rouges.
Sont envisagés ailleurs :
- La cerise, la fraise, la mûre sauvage (Rubus spp.) et la framboise qui sont abordées avec les Rosacées)
- et la mûre noire ou blanche du mûrier (Morus spp., Moracées) qui est traitée avec l’article sur figue, ficus et Moracées.
La myrtille a été la cause de quelques cas de réactions allergiques 
pouvant aller jusqu’à l’anaphylaxie .
Ce fruit présente une allergénicité très en faveur de LTP : réactivité conservée après cuisson , réactions croisées d’une bande 9-10 kDa avec les LTP de Rosacées , détection par un anticorps anti-Mal d 3 et, bien sûr, observation de réactions cliniques sévères.
Autres fruits rouges
Les données sont très parcellaires pour cassis, groseille ou airelle / canneberge , certaines observations étant compatibles avec une réactivité de type LTP et d’autres non .
[1] - Wolbert MP, Baldwin J. Angioedema Due to Blueberry Hypersensitivity. J Allergy Clin Immunol 2007;119(1 suppl):S196
RATIONALE: To investigate a case of angioedema likely due to blueberry allergy, and to review the literature on this subject.
METHODS: A 46 year old man developed repeated episodes of throat and facial itching and swelling, and difficulty swallowing over a 4 month period within 2 hours after the consumption of blueberries. His symptoms required emergency medical treatment on one occasion with methylprednisolone, diphenhydramine, and ranitidine. He self-treated with diphenhydramine other occasions. The patient was thoroughly evaluated by SPT and IgE RAST testing. A comprehensive PUBMED literature search on blueberry and Ericaceae hypersensitivity revealed an extreme lack of data on this topic.
RESULTS: IgE RAST testing to blueberry and a very broad array of other foods revealed Class 2 positive to blueberry only, but negative to all other foods tested. SPT, however, was negative to all foods tested, including blueberries and cranberries using commercial and/or fresh food prick-prick testing.
CONCLUSIONS: Blueberries are members of the Ericaceae family. Other members include cranberry, azalea, heather, holly, heath, huckleberry, and wintergreen. It is felt to be a family with extremely low allergenic potential. An extensive literature search resulted in zero publications about hypersensitivity to members of the Ericaceae family. Interestingly, our patient seemed to react to blueberry by clinical history. IgE RAST testing and resolution of symptoms with food avoidance support this conclusion; however, SPT with fresh blueberry was negative. This case report supports the claim that blueberries have an extremely low, but likely real, allergic potential.
↩[2] - Gebhardt C, Vieths S, Gubesch M, Averbeck M, Simon JC, Treudler R. 10 kDa lipid transfer protein: the main allergenic structure in a German patient with anaphylaxis to blueberry. Allergy 2009;64:498-499 ↩
[3] - Egger C, Oberhuber C, Reider N, Marsh J, Focke M. Anaphylaxis to blueberry (Vaccinium myrtillus) - identification of a new lipid transfer protein. EAACI 25th Congress, Vienna, 10-14 June, 2006, Poster n°1671
A 29-year old female presented with a first-time anaphylactic reaction with pruritus, generalized urticaria, angioedema of the face and tongue, dyspnoe and dizziness. After appropriate anti-anaphylactic treatment and observation for another two days she was discharged from the hospital. Emergency medication including an epinephrine autoinjector was prescribed.
History revealed the intake of "Schwarzbeernocken", a tyrolean speciality and sort of pancake containing blueberries, one hour prior to the onset of symptoms. Previous allergies were not known. Positive prick-to-prick-test and specific IgE to blueberry as determined by UniCAP confirmed allergy to blueberries. In addition, sensitisation to mugwort was noted. Tryptase, which was elevated at admission, later returned to normal levels.
For allergen-specific evaluation, blueberries were extracted according to the low-temperature acetone-powder method described by Vieths et al.
Extracts were separated by reducing SDS-PAGE and blotted to nitrocellulose for IgE immunoblot experiments. For IgE inhibition experiments, serum was pre-adsorbed with purified natural lipid transfer protein (LTP) from peach, Pru p 3. A single positive band of approximately 9 kD, which could be inhibited with Pru p 3, was detected.
LTPs are widely distributed in the plant kingdom. Because of their high resistance to heat and digestion LTPs are important food allergens. Sensitisation to LPTs not only in Southern Europe, where it was first recognized to cause severe food allergy, is increasingly reported and should be considered when severe reactions to plant foods occur. To our knowledge, this is the first report of food allergy to blueberries and the first description of a lipid transfer protein in blueberry.
↩[4] - Déruaz C, Fellrath JM, Ballmer-Weber B. A delicious but dangerous raspberry (Rubus ideaus) jelly jam from a 68 year non atopic grand mam having presented a lipid transfer protein (Rub i 3) mediated anaphylactic reaction. Rev Fr Allergol 2009;49:302-303
Background.ˆ Up to 50% of birch pollen allergic patients react mildly (by the so-called oral allergic syndrome) when eating fruits of the rosaceae familiy (mainly apples, pears, peaches, rarely also berries), nuts and vegetables in relation with Bet v 1 homologous or profilin allergens. More severe anaphylactic reactions are reported after consumption of peach for example, related to a heat stable protein called lipid transfer protein (LTP: Pru p 3) an ubiquitous plant food lipid binding protein and potential panallergen.
We report an anaphylactic reaction ˆ to our knowledge the first reported ˆ in a 68-year-old lady after ingestion of cooked raspberry jelly jam.
History.ˆ Five minutes after eating raspberry jelly jam this 68 old patient ˆ treated for a metabolic syndrome ˆ presented palmoplantar pruritus, generalized urticaria and an enormous lip angioedema treated by i.v.
corticosteroid and i.v. antihistamine. Ten years ago she presented a similar but weaker reaction after raw blueberry consumption. She tolerates well peaches and apples.
Allergic workup.ˆ Revealed strong positive skin reactions to defrozen raspberry (wild and common) and blueberry extract, and cooked raspberry jelly jam whereas all other skin test (common aeroallergen and food allergens) resulted negative. Total IgE amounted 6,82 kU/l. Specific IgE (CAP: Phadia1) : positive in class 2 for recombinant peach LTP (rPru p3 = f420) 1,64 kU/l, for raspberry (f343) 0,84 kU/l and in class 1 for blueberry (f288) at 0,37 kU/l. Bet v1 (t215) was negative.
Conclusion.ˆ This unique anaphylactic reaction underlines the extreme high degree of heat stability of the raspberry LTP allergen (Rub i 3). The strong positive skin test with heated raspberry jelly jam established the diagnosis, supported by a recombinant serological peach LTP ˆ probably highly homologous to raspberry LTP. Future work in the clinical and molecular field of Bet v 1 homologous (Rub i1) and LTP (Rub i 3) proteins in raspberry and other berries is warranted.
↩[5] - Gebhardt C, Vieths S, Gubesch M, Averbeck M, Simon JC, Treudler R. 10 kDa lipid transfer protein: the main allergenic structure in a German patient with anaphylaxis to blueberry. Allergy 2009;64:498-499 ↩
[6] - Egger C, Oberhuber C, Reider N, Marsh J, Focke M. Anaphylaxis to blueberry (Vaccinium myrtillus) - identification of a new lipid transfer protein. EAACI 25th Congress, Vienna, 10-14 June, 2006, Poster n°1671
A 29-year old female presented with a first-time anaphylactic reaction with pruritus, generalized urticaria, angioedema of the face and tongue, dyspnoe and dizziness. After appropriate anti-anaphylactic treatment and observation for another two days she was discharged from the hospital. Emergency medication including an epinephrine autoinjector was prescribed.
History revealed the intake of "Schwarzbeernocken", a tyrolean speciality and sort of pancake containing blueberries, one hour prior to the onset of symptoms. Previous allergies were not known. Positive prick-to-prick-test and specific IgE to blueberry as determined by UniCAP confirmed allergy to blueberries. In addition, sensitisation to mugwort was noted. Tryptase, which was elevated at admission, later returned to normal levels.
For allergen-specific evaluation, blueberries were extracted according to the low-temperature acetone-powder method described by Vieths et al.
Extracts were separated by reducing SDS-PAGE and blotted to nitrocellulose for IgE immunoblot experiments. For IgE inhibition experiments, serum was pre-adsorbed with purified natural lipid transfer protein (LTP) from peach, Pru p 3. A single positive band of approximately 9 kD, which could be inhibited with Pru p 3, was detected.
LTPs are widely distributed in the plant kingdom. Because of their high resistance to heat and digestion LTPs are important food allergens. Sensitisation to LPTs not only in Southern Europe, where it was first recognized to cause severe food allergy, is increasingly reported and should be considered when severe reactions to plant foods occur. To our knowledge, this is the first report of food allergy to blueberries and the first description of a lipid transfer protein in blueberry.
↩[7] - Marzban G, Mansfeld A, Hemmer W, Stoyanova E, Katinger H, da Camara Machado ML. Fruit cross-reactive allergens: a theme of uprising interest for consumers' health. Biofactors 2005;23:235-241
Regular consumption of fruits has a positive influence on human health by disease prevention. However parallel to dietetic benefits, IgE-mediated fruit allergies have been shown to be an increasing health risk for children and adults in the Northern hemisphere. The spectrum of food allergies ranges from chronic symptoms to more acute problems and even anaphylaxis. Fruit proteins with high primary sequence similarity display also homologous tertiary structures, resulting in similar epitopes to IgEs and consequently in cross-reactivity. In this review we present the major allergens of stone and pome fruits and discuss the presence of homologous proteins in small fruits. Interestingly these proteins, which might pose an allergenic potential for pre-sensitised individuals are expressed also in strawberry, raspberry and blueberry, otherwise rich in beneficial biofactors.
↩[8] - Pérez-Ezquerra PR, Vazquez de la Torre GM, de Fernández MB, Flores VT, Alvarez-Santullano AV, de Ocáriz ML. Currant allergy and the Rosaceae-grass pollen allergy syndrome: a case report. Ann Allergy Asthma Immunol 2007;98:480-482
BACKGROUND: Despite the increasing use of currants in culinary recipes, currant allergy has rarely been reported.
OBJECTIVES: To study a case of currant allergy and to explore cross-reactivity between grass pollen and Rosaceae family fruit allergens.
METHODS: Skin prick tests to pollen and skin prick-to-prick tests with currants and peach were performed. Specific IgE levels were determined using the CAP method. We prepared a protein extract of 0.1 mg/mL in phosphate-buffered saline using red currant in the presence of protease inhibitors. Immunoblot inhibition studies were performed to explore cross-reactivity between grass pollen and currant allergens.
RESULTS: Skin prick test results were positive to Dactylis, arizonic, and olive pollens. Results of skin prick-to-prick tests with fresh red and black currants were negative and positive, respectively, to peach. The specific IgE level was 5.7 KU/L to red currant and 2.92 KU/L to peach (CAP). Western blot analysis with red currant extract revealed specific IgE protein bands of 37 and 26 kDa. Preincubation of sera with extracts from red currant and peach inhibited both IgE bands, and preincubation with Dactylis pollen inhibited the 37-kDa band only.
CONCLUSIONS: We report a case of allergy to grass pollen with an oral allergy syndrome involving several fruits from 2 different families of the Rosidae subclass confirmed by in vitro tests. Inhibition studies demonstrated cross-reactivity between different fruits (currant and raspberry) from the Rosidae subclass and were incomplete with grass pollen allergens.
↩[9] - Déruaz C, Fellrath JM, Ballmer-Weber B. A delicious but dangerous raspberry (Rubus ideaus) jelly jam from a 68 year non atopic grand mam having presented a lipid transfer protein (Rub i 3) mediated anaphylactic reaction. Rev Fr Allergol 2009;49:302-303
Background.ˆ Up to 50% of birch pollen allergic patients react mildly (by the so-called oral allergic syndrome) when eating fruits of the rosaceae familiy (mainly apples, pears, peaches, rarely also berries), nuts and vegetables in relation with Bet v 1 homologous or profilin allergens. More severe anaphylactic reactions are reported after consumption of peach for example, related to a heat stable protein called lipid transfer protein (LTP: Pru p 3) an ubiquitous plant food lipid binding protein and potential panallergen.
We report an anaphylactic reaction ˆ to our knowledge the first reported ˆ in a 68-year-old lady after ingestion of cooked raspberry jelly jam.
History.ˆ Five minutes after eating raspberry jelly jam this 68 old patient ˆ treated for a metabolic syndrome ˆ presented palmoplantar pruritus, generalized urticaria and an enormous lip angioedema treated by i.v.
corticosteroid and i.v. antihistamine. Ten years ago she presented a similar but weaker reaction after raw blueberry consumption. She tolerates well peaches and apples.
Allergic workup.ˆ Revealed strong positive skin reactions to defrozen raspberry (wild and common) and blueberry extract, and cooked raspberry jelly jam whereas all other skin test (common aeroallergen and food allergens) resulted negative. Total IgE amounted 6,82 kU/l. Specific IgE (CAP: Phadia1) : positive in class 2 for recombinant peach LTP (rPru p3 = f420) 1,64 kU/l, for raspberry (f343) 0,84 kU/l and in class 1 for blueberry (f288) at 0,37 kU/l. Bet v1 (t215) was negative.
Conclusion.ˆ This unique anaphylactic reaction underlines the extreme high degree of heat stability of the raspberry LTP allergen (Rub i 3). The strong positive skin test with heated raspberry jelly jam established the diagnosis, supported by a recombinant serological peach LTP ˆ probably highly homologous to raspberry LTP. Future work in the clinical and molecular field of Bet v 1 homologous (Rub i1) and LTP (Rub i 3) proteins in raspberry and other berries is warranted.
↩[10] - Matheu V, Baeza ML, Zubeldia JM, Barrios Y. Allergy to lingonberry: A case report. Clin Mol Allergy 2004;2:2 ↩
[11] - Marzban G, Mansfeld A, Hemmer W, Stoyanova E, Katinger H, da Camara Machado ML. Fruit cross-reactive allergens: a theme of uprising interest for consumers' health. Biofactors 2005;23:235-241
Regular consumption of fruits has a positive influence on human health by disease prevention. However parallel to dietetic benefits, IgE-mediated fruit allergies have been shown to be an increasing health risk for children and adults in the Northern hemisphere. The spectrum of food allergies ranges from chronic symptoms to more acute problems and even anaphylaxis. Fruit proteins with high primary sequence similarity display also homologous tertiary structures, resulting in similar epitopes to IgEs and consequently in cross-reactivity. In this review we present the major allergens of stone and pome fruits and discuss the presence of homologous proteins in small fruits. Interestingly these proteins, which might pose an allergenic potential for pre-sensitised individuals are expressed also in strawberry, raspberry and blueberry, otherwise rich in beneficial biofactors.
↩[12] - Pérez-Ezquerra PR, Vazquez de la Torre GM, de Fernández MB, Flores VT, Alvarez-Santullano AV, de Ocáriz ML. Currant allergy and the Rosaceae-grass pollen allergy syndrome: a case report. Ann Allergy Asthma Immunol 2007;98:480-482
Imprimer la bibliographieBACKGROUND: Despite the increasing use of currants in culinary recipes, currant allergy has rarely been reported.
OBJECTIVES: To study a case of currant allergy and to explore cross-reactivity between grass pollen and Rosaceae family fruit allergens.
METHODS: Skin prick tests to pollen and skin prick-to-prick tests with currants and peach were performed. Specific IgE levels were determined using the CAP method. We prepared a protein extract of 0.1 mg/mL in phosphate-buffered saline using red currant in the presence of protease inhibitors. Immunoblot inhibition studies were performed to explore cross-reactivity between grass pollen and currant allergens.
RESULTS: Skin prick test results were positive to Dactylis, arizonic, and olive pollens. Results of skin prick-to-prick tests with fresh red and black currants were negative and positive, respectively, to peach. The specific IgE level was 5.7 KU/L to red currant and 2.92 KU/L to peach (CAP). Western blot analysis with red currant extract revealed specific IgE protein bands of 37 and 26 kDa. Preincubation of sera with extracts from red currant and peach inhibited both IgE bands, and preincubation with Dactylis pollen inhibited the 37-kDa band only.
CONCLUSIONS: We report a case of allergy to grass pollen with an oral allergy syndrome involving several fruits from 2 different families of the Rosidae subclass confirmed by in vitro tests. Inhibition studies demonstrated cross-reactivity between different fruits (currant and raspberry) from the Rosidae subclass and were incomplete with grass pollen allergens.
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