Mami Miyakawa

High prevalence of sensitization to gibberellin‐regulated protein (peamaclein) in fruit allergies with negative immunoglobulin E reactivity to Bet v 1 homologs and profilin: Clinical pattern, causative fruits and cofactor effect of gibberellin‐regulated protein allergy

Gibberellin‐regulated protein (GRP) is a new allergen in peach allergy, with an amino acid sequence very well conserved through several botanical species. We investigated the allergenicity of GRP in fruit allergies other than peaches and identified the clinical characteristics of fruit allergy patients with GRP sensitization. One hundred consecutive Japanese patients with fruit allergies were enrolled in the present study. To identify the features of GRP sensitization, we selected patients with negative ImmunoCAP results for Bet v 1 homologs and profilin, which are marker allergens for pollen‐food allergy syndrome (PFAS), or lipid transfer protein. These patients underwent specific immunoglobulin E measurements by enzyme‐linked immunosorbent assay (ELISA) and skin prick tests (SPT) using purified nPru p 7. Twenty of 100 consecutive patients with fruit allergies had negative ImmunoCAP results for Bet v 1 homologs and profilin. Thirteen (65.0%) of the 20 patients had positive ELISA and/or SPT results using nPru p 7, whereas one of the 20 patients had positive ImmunoCAP results for Pru p 3. In 13 nPru p 7‐sensitized patients, the causative foods were peaches (92.3%), apricots (61.5%), oranges (46.2%) and apples (30.8%). Ten patients (76.9%) had multiple causative fruits. Frequent symptoms included facial edema (92.3%) and laryngeal tightness (66.7%). In eight patients (61.5%), exercise or aspirin intake enhanced the allergic reaction onset as cofactors. The prevalence of GRP sensitization was high in Japanese fruit allergy patients except for PFAS patients. In conclusion, GRP‐sensitized patients may have allergies to multiple fruits and may show peculiar characteristics such as facial swelling and cofactor dependence.

Eyelid edema as a predictive factor for sensitization to Pru p 7 in peach allergy.

The clinical and laboratory factors related to Pru p 7 sensitization in peach allergy, compared with those associated with sensitization to Pru p 1, which is related to pollen‐food allergy syndrome (PFAS), have still not been clarified. The aim of the present study was to identify the clinical and laboratory features associated with sensitization to Pru p 7. Fifty patients (male : female, 14:36; mean age, 31.8 years) with peach allergy were enrolled in this study. Specific immunoglobulin E (sIgE) against the purified nPru p 7 was measured by enzyme‐linked immunoassay, whereas using ImmunoCAP, sIgE levels against peach, rPru p 1, rPru p 3 and rPru p 4 were measured. Correlations between the clinical characteristics of peach allergy and sensitization to the allergens were statistically analyzed. In 50 patients with peach allergy, 13 and 33 patients were sensitized with nPru p 7 and rPru p 1, respectively. Laryngeal tightness, conjunctival injection, facial edema, eyelid edema and urticaria were significantly associated with Pru p 7 sensitization. In contrast, oropharyngeal symptoms were strongly related to Pru p 1 sensitization but were significantly less common in the Pru p 7‐positive group. Co‐sensitization to the representative pollens related to PFAS, such as alder pollens, was significantly related to Pru p 1 sensitization, but not Pru p 7 sensitization. Along with the absence of co‐sensitization to pollens related to PFAS, facial edema and especially eyelid edema after the ingestion of peaches could be a predictive factor for sensitization to Pru p 7.

Anaphylaxis due to carmine-containing foods induced by epicutaneous sensitization to red eye-liner

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Gibberellin-regulated protein in Japanese apricot is an allergen cross-reactive to Pru p 7

Gibberellin‐regulated protein (GRP, also known as peamaclein) was recently identified as a new marker allergen related to systemic reactions in peach allergy; however, its role in other fruit allergies is unknown.

Contact urticaria syndrome caused by sulfamethoxazole sodium contained in eye drops

A 31-year-old woman was referred to our hospital because she had suffered from two intolerance reactions immediately after applying eye drops. Just after applying the over-the-counter eye drops (Shinganryo®; Hisamitsu Pharmaceutical, Tokyo, Japan) for allergic conjunctivitis for the fourth time, she developed conjunctival congestion, lacrimation, eye pruritus, sneezing, and nasal discharge. Four months later, she applied the same eye drops. Immediately, she developed the same symptoms as before, and also throat swelling, wheezing, dyspnoea, generalized urticaria, and abdominal pain. To investigate the causative allergen of the anaphylactic reactions, prick tests were performed with the eye drops and their ingredients (Table 1) on the volar forearm according to standard procedures (1). The skin was pricked through the allergen drop with the tip of a prick lancetter (EWO CARE, Gislaved, Sweden), and the responses were read 15 min following application. The response elicited by prick tests was considered to be

Identification of gibberellin-regulated protein as a new allergen in orange allergy

To date, three orange allergens have been reported. However, it is still unclear whether gibberellin‐regulated proteins (GRPs), identified as new allergens in other fruit allergies, are also involved in orange allergy.