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Severe Allergy to Sharon Fruit Caused by Birch PollenBolhaar S.T.H.P.a · van Ree R.b · Ma Y.c · Bruijnzeel-Koomen C.A.F.M.a · Vieths S.d · Hoffmann-Sommergruber K.c · Knulst A.C.a · Zuidmeer L.b
aDepartment of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, bDepartment of Immunopathology, Sanquin, Amsterdam, The Netherlands; cDepartment of Pathophysiology, Medical University Vienna, Vienna, Austria; dDivision of Allergology, Paul Ehrlich Institute, Langen, Germany
Background: Allergy to sharon fruit (persimmon) has been only rarely reported. Cross-reactivity with pollen (profilin and Bet v 6) appeared to be involved, but Bet v 1 has not been implicated previously. Objective: It is our aim to identify whether Bet v 1 sensitization is linked to sharon fruit allergy. Methods: Two patients with a reaction upon first exposure to sharon fruit were included in the study, as well as 7 patients with birch-pollen-related apple allergy. Sensitivity was assessed by skin prick testing (SPT), a radio-allergosorbent test (RAST) and immunoblotting. RAST analysis was performed for Bet v 1, Bet v 2 and Bet v 6. Cross-reactivity was evaluated by RAST and immunoblot inhibitions. Biological activity of IgE was measured by basophil histamine release. Sharon fruit allergy was evaluated by double-blind placebo-controlled food challenge (DBPCFC) or open challenge (OC). Results: Both sharon-fruit-allergic patients demonstrated positive reactions in the RAST (8.6 and 6.2 IU/ml, respectively) and SPT (wheal area 37 and 36 mm2). Sharon fruit allergy was confirmed by DBPCFC in 1 patient. The second patient refused a challenge because of the severe initial reaction. Sera from both patients were reactive to Bet v 1 and Bet v 6, which was cross-reactive with sharon fruit by inhibition assays. The patient with the severest reactions was reactive to profilin on immunoblotting. However, profilin did not induce significant histamine release, nor did Bet v 6. Bet v 1 induce approximately 60% histamine release. An OC with sharon fruit in 7 patients allergic to birch pollen and apple, who had not eaten sharon fruit previously, was positive in 6/7 cases. Conclusions: Birch-pollen-related allergy to sharon fruit is mediated by the known cross-reactive pollen allergens including Bet v 1 and may become more of a problem should sharon fruit consumption increase.
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